Application for Permanent Resident’s Certificate

1 This form is for a Permanent Resident s Certificate Application under Section 31A, 31ZA, 31ZB or 31B of the bermuda Immigration and Protection Act 1956. The qualifications for Application under each Section of the Act are listed below. Please read them carefully and check the box for the Section of the Act under which you are applying. Refer to the checklist at the back of this form which details additional documents required to process this S SURNAMEALL OTHER NAMESAPPLYING UNDER SECTION 31 ZAYOU MUST FULFIL ALL THE REQUIREMENTS BELOW IN ORDER TO APPLY UNDER THIS SECTION:a) You were ordinarily resident in bermuda for a period of at least 20 years; and b) You were ordinarily resident in bermuda during the two years immediately preceding this Application .

2 1 Application for Permanent Resident s Certificate GOVERNMENT OF BERMUDAD epartment of ImmigrationForm PRCYOU MUST FULFIL ALL THE REQUIREMENTS BELOW IN ORDER TO APPLY UNDER THIS SECTION:a) You have been exempted from Part V of the bermuda Immigration and Protection Act 1956, under section 5 of the Economic Development Act 1968 for at least 10 years; b) You have been ordinarily resident in bermuda for a period of at least 10 years; andc) You have been ordinarily resident in bermuda during the two years immediately preceding this Application .

3 I WISH TO APPLY UNDER SECTION 31AI WISH TO APPLY UNDER SECTION 31 ZAAPPLYING UNDER SECTION 31 AYou may add to your response on a separate sheet is another sheet attached?2 APPLYING UNDER SECTION 31 BYou are EITHER: The son or daughter of a person who possesses a Permanent Resident s Certificate and you are above the upper limit of compulsory school age OR: The spouse of a person who possesses a Permanent Resident s Certificate AND in all cases a) You are at least 18 years of age b) You have been ordinarily resident in bermuda for a period of 10 years immediately preceding this Application I WISH TO APPLY UNDER SECTION 31 BAPPLYING UNDER SECTION 31 ZBYOU MUST FULFIL ALL THE REQUIREMENTS BELOW IN ORDER TO APPLY UNDER THIS SECTION:a) You were ordinarily resident in bermuda for a period of at least 15 years.

4 B) You were ordinarily resident in bermuda during the two years immediately preceding this Application ; and c) You are the non-Bermudian parent of a son or daughter who possesses Bermudians WISH TO APPLY UNDER SECTION 31 ZBFOR OFFICIAL USE ONLYDEPT OF IMMIGRATIONREFERENCE NUMBER1 SECTIONP ersonal DetailsSurname/Family nameFirst name Middle name(s) Family name at birthAge Sex Date of BirthDD / MM / YRStreet address in BermudaPostal address (if different from above)Telephone numbers (Home)(Work)NOTE: Please inform the Department of Immigration in writing of any change of address or phone number which occurs while this Application is being nationality at birthYour present nationalityAre there any restrictionson your right to return toyour country of origin?

5 If YES, please state whatthese restrictions areNOYESN ationality DetailsMarital StatusAre youSingleDivorcedWidowedMarried you ever been convicted in a court of lawon any criminal or civil proceedings?NO YESIf YES, please state: WhenWhereNature of offenceSentenceYou may add to your response on a separate sheet is another sheet attached?YESNOC ountry of birthEmploymentJob TitleEmployer, with address and phone numberConvictions (Cellular) (E-mail)32 SECTIONR esidence3 SECTIOND etails of Spouse or Former SpouseIf not applicable, please write NONE through this sectionDD / MM / YRDD / MM / YRDD / MM / YRDD / MM / YRYESYESYESYESNONONONODate of BirthSurname Maiden name (if applicable)All other namesDate of arrival in BermudaHave you been resided in bermuda for a period of 10, 15 or 20 years?

6 NOYESNOYESIn this period, have you lived abroad for more than two months?If YES, please give details of each residence abroad:Country ofresidenceReason for residence, for example periods ofemployment or educationEmployer orschoolPeriod of residence(Month/Year to Month/YearPlease provide supporting documentation from place of employment or educational establishmentAge Sex Nationality at birthPresent nationality (if different)Date and place of marriageDate marriage ended(if applicable)Reason (death,divorce, etc.)Is your spouse currentlyresiding in bermuda ?)

7 Does your spouse possessBermudian status?Does your spouse possess a Permanent Resident s Certificate ?Is your spouse employedin bermuda ? Certificate NumberCertificate NumberIf YES, please give occupation and employerHas your spouse or dependent children ever been convicted in a court of lawon any criminal or civil proceedings?If YES, provide details on a separate sheet and attach it to this form is a sheet attached?NOTE: A Police Certificate will be accepted as a satisfactory response to this requirement4 YESNOYESNO4 SECTIOND etails of Applicant s ParentsCOMPLETE THIS SECTION IF YOU ARE APPLYING AS THE SON OR DAUGHTER OF PARENT(S) IN POSSESSION OF A Permanent RESIDENT S Certificate NOYESNOYESDoes she possess Bermudian status?

8 Or a Permanent Resident s Certificate ? Certificate # Certificate #MOTHER S SurnameAll other names Maiden nameNationality at birthPresent nationality(if different)DD / MM / YRDD / MM / YRDate and place of parents marriageDate marriage ended(if applicable)Reason (death,divorce, etc.)5DD / MM / YRDD / MM / YRDoes he possess Bermudian status?Or a Permanent Resident s Certificate ? Certificate # Certificate #FATHER S SurnameAll other names Nationality at birthAgeAgeYESNOYESNOIs he employed in bermuda ?YESNOIs she employed in bermuda ?YESNOC ountry of birthCountry of birthPresent nationality(if different)65 SECTIOND etails of Applicant s ChildrenCOMPLETE THIS SECTION IF YOU ARE APPLYING AS THE NATURAL PARENT OF PERSON(S) POSSESSING BERMUDIAN STATUSSPONSOR 1 Full nameCHILD 1 Surname CHILD 2 Surname All other names All other names Nationality at birthNationality at birthPresent nationality(if different)Present nationality(if different)Country of birthCountry of birthDoes child possess Bermudian status?

9 Does child possess Bermudian status? Certificate # Certificate #YESNOYESNOCHILD 3 Surname All other names Nationality at birthPresent nationality(if different)Country of birthDoes child possess Bermudian status? Certificate #YESNODD / MM / YRDD / MM / YRDate and place of parents marriageDate marriage ended(if applicable)Reason (death,divorce, etc.)DD / MM / YRDD / MM / YRDD / MM / YRAgeAgeAge76 SECTIONR eferencesYou require two sponsors in support of your Application . They must both be Commonwealth citizens who possess Bermudian status and have known you for at least seven years.

10 Letters of support from both these sponsors must be attached to this 1 Full nameTelephone numbers (Home) (Work)Street address in BermudaPostal address (if different from above)SignatureI, the undersigned, hereby state:I am a Commonwealth citizen I possess Bermudian status I have known the applicant well for years and have extensive knowledge of his/her character and integrityI am not the counsel or agent of the applicant, nor am I related to the applicantYESNOYESNO (Cellular) (E-mail)Date of BirthDD / MM / YR86 SECTIONR eferencesSPONSOR 2 Full nameTelephone numbers (Home) (Work)Street address in BermudaPostal address (if different from above)SignatureI, the undersigned, hereby state.