V1

APPLICATION NUMBER#

CAYMAN ISLANDS IMMIGRATION LAW

APPLICATION FORM FOR A CAYMAN ISLANDS VISA - GENERAL VISITOR

Please ensure that you have read the accompanying information leaflet before completing this application form.
The completed application form and supporting documents should be sent, together with the prescribed fee, to The Cayman Islands
Visa Office in your respective country.
APPLICATION FORM CONTAINS 5 PAGES

PART1 - What Type of Visa Are You Applying For?

Single Entry Visitor Multiple Entry Visitor

PART2 - About You

2.1. Full name, as it appears in your passport. Please underline your family name.

2.2 Date of Birth 2.3 Place of Birth 2.4 Nationality

2.5 Sex: Male Female 2.6 Marital status Single Married Divorced Widowed Separated

2.7 What is your fathers full name?

2.8 What is your mothers full name?

Number Issue date Expiry date Place of issue Is this your first passport?

2.9 Current Passport (this passport): Yes No

2.10 Previous passport:

YOUR CONTACT DETAILS

2.11 Your permanent home address

2.12 Your correspondence address if different from 2.11

2.13 Home or mobile telephone number 2.14 Any home fax number

2.15 Your personal email address

PART3 - Your Family

3.1 If you are married or living with your partner, what is your husband, wife or partners name?

3.2 What is your husband, wife or partners date of birth (dd/mm/yy)? 3.3 Where is your husband, wife or partner now?

3.4 What is your husband, wife or partners nationality?

3.5 Is your husband, wife or partner travelling with you? Yes, on my passport Yes, on his/her own passport No

IMM/STV (2012/05) V1
PAGE 1
 APPLICATION FORM FOR A CAYMAN ISLANDS VISA - GENERAL VISITOR

Please ensure that you have read the accompanying information leaflet before completing this application form.
The completed application form and supporting documents should be sent, together with the prescribed fee,
to The Cayman Islands Visa Office in your respective country.

3.6 Do you have any children? Yes No If you have answered yes to question 3.6, please give their details below

Full name Date of Birth D/M/Y Nationality Are they travelling with you?
Yes, on my passport Yes, on their passport No

PART4 - Previous applications and travel

4.1 Have you travelled outside your home country? Yes No If yes, where?

4.2 Have you previously visited the Cayman Islands? Yes No

4.3 Have you ever been refused entry or a visa for the Cayman Islands, or been refused entry to the UK or any UK Overseas Territories or had your leave to enter or remain cancelled?

Yes No

4.4 Have you ever been refused a visa for another country? Yes No

If you have answered yes to questions 4.3 or 4.4 please complete questions 4.5 4.7 as applicable. Otherwise please go to question 4.8

4.5 Where did you make your previous application?

4.6 When did you make your previous application? (dd/mm/yy)

4.7 What happened? Please give the details of any forms that were given to you

4.8 Have you ever been refused entry to, deported from, or required to leave the Cayman Islands, the UK, any UK Overseas Territory or another country? Yes No

4.9 Do you have any criminal convictions in any country? Yes No

If you have answered yes to question 4.9 please answer questions 4.10 to 4.12. If you have answered no please go to question 4.13

4.10 What was your conviction for?

4.11 When and where were you convicted?

4.12 What was your sentence?

4.13 Have you ever been concerned in the commission, preparation, organisation or support of acts of terrorism, or have you ever been a member of an organisation which has been
involved in or advocated terrorism in furtherance of its aims?
Yes No
4.14 Have you ever been concerned in the commission, preparation or organisation or genocide or crimes, including crimes against humanity and war crimes, committed in the course
of armed conflict?
Yes No
If you have answered yes to any of the questions, please give details below.

IMM/STV (2012/05) V1 PAGE 2

 APPLICATION FORM FOR A CAYMAN ISLANDS VISA - GENERAL VISITOR

Please ensure that you have read the accompanying information leaflet before completing this application form.
The completed application form and supporting documents should be sent, together with the prescribed fee,
to The Cayman Islands Visa Office in your respective country.

4.15 Are you, your husband, wife or partner or any dependants included in this application, suffering from any contagious diseases of more than a short term nature or mental
disorder? If so, please give details below:

PART5 - About your stay in the Cayman Islands

5.1 How long do you intend to stay in the Cayman Islands? 5.2 On what date do you intend to arrive?

5.3 Purpose of travel?

5.4 What is your intended date of departure?

5.5 Please give the full address & telephone number of all the places where you will be staying during your visit, & the name & relationship of the person(s) you will be staying with

Full name Relationship (if any) Address Contact telephone number

PART6 - Your Finances and Employment Details

6.1 What is your present job? 6.2 When did you start this job (dd/mm/yy)

6.3 What is your work address? 6.4 Your employers telephone number

6.5 Your employers fax number 6.6 Your employers email address

6.7 What is your monthly income from employment? 6.8 Do you receive income from any other sources, including friends or family? Yes No

6.9 Do you own any assets, for example property? Yes No If you have answered yes to questions 6.8 -6.9 please give details below

6.10 How much money is available to you for your stay in the Cayman Islands?

6.11 Who is paying for your trip?

IMM/STV (2012/05) V1 PAGE 3

 APPLICATION FORM FOR A CAYMAN ISLANDS VISA - GENERAL VISITOR

Please ensure that you have read the accompanying information leaflet before completing this application form.
The completed application form and supporting documents should be sent, together with the prescribed fee,
to The Cayman Islands Visa Office in your respective country.

PART7 - Other Information

Is there any other information you wish to give about your application?

PART8 - Declaration
To be completed by all applicants
The Cayman Islands Department of Immigration is processing the personal data on this form and related data for the purposes of promoting and protecting the interests of the Cayman Islands and its
citizens abroad. The data may be disclosed to other Cayman Islands Government Departments and public authorities.

Declaration
You must now read the declaration below and sign it. This must be signed by the applicant personally and not by a representative or other person acting on his/her behalf. An application for a person under
the age of 18 may be completed by the parent or legal guardian.

I hereby apply for a visa for the Cayman Islands. The information I have given is complete and is true to the best of my knowledge. I also declare that the photograph(s) submitted with this form is/are a
true likeness of myself. I confirm that if, before this application is decided, there is a material change in my circumstances or new information relevant to this application becomes available, I will inform
the Cayman Islands Visa Office at which I have applied.

I am aware that it is an offence under the Immigration Law to make to a person acting in execution of the Law a statement or representation which the maker knows to be false or does not believe to be
true, and to obtain or seek to obtain leave to enter in the Cayman Islands by means which include deception.

I declare that the information given on this form is correct to the best of my knowledge and belief.

Applicants signature Date

FOR OFFICIAL USE ONLY

Approved Effective from Valid to

Refused
Deferred Details of any conditions to be applied

Signature of Visa issuing officer

DATE Official Stamp

IMM/STV (2012/05) V1 PAGE 4
 VISITOR VISA - CHECKLIST
This list is a summary of general requirements for ALL applicants. The Visa Office reserves the right to request additional information or documentation as it sees fit.

APPLICANT REQUIREMENTS:

Two Application forms duly completed, signed and dated by applicant. - original signatures required. Please do not leave any question blank. If a
question does not apply to you, insert "not applicable" or "n/a" in the space provided.

Correct fee, in the form of a bank draft, payable to the Cayman Islands Government

2 full face passport sized photographs

Bank Reference

Evidence of your current employment or studies

A valid Passport with at least 6 months validity remaining and enough space to insert a visa

Original signed and sealed, Police Clearance certificate - less than 6 months old, from last place of residence

Children under the age of 18 will be required to produce a birth certificate

It helps the Caymanian authorities to assess your application if you can show evidence of or personal circumstances, which may include bank
statements, evidence of assets or other sources of income.

Evidence of your marital status

Pay slips

Tax returns (Business or Personal)

Evidence of property or land

Evidence of any additional sources of income

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IMM/CKL (2012/05) CKLV1