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NO :

SURNAME: []MR. [] MRS. [] MISS :

CHRISTIAN NAME : (OTHER NAME(S))

ADDRESS :

TELEPHONE NO : E-MAIL:

NATIONALITY : IDENTIFICATION NO.:

DATE OF BIRTH : AGE:  SEX: MALE    FEMALE

INTENDED LOCATION TO SELL GOODS/SERVICES :

DESCRIPTION OF GOODS/SERVICES TO BE SOLD OR OFFERED :

STATE WHETHER GOODS AND /OR SERVICES ARE MADE LOCALLY OR IMPORTED :

STATE NAMES AND ADDRESSES OF TWO (2) REFEREES :

1. NAME : 2. NAME :

ADDRESS : ADDRESS :

Signature of Applicants : Date :

YOU ARE REQUIRED TO PROVIDE ALONG WITH THIS APPLICATION THE FOLLOWING:

• A POLICE CERTIFICATE OF CHARACTER

• Two (2) RECENT TESTIMONIALS

• TWO (2) PASSPORT SIZE PHOTOS

When completed this form must be returned to:

The General Manager. Natianal Conservatian Commission, Codrinaton. House. St. Michael