Application For A Vital Record - Registry Of Civil Status, Saint Lucia Page 2
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1
2Explanation Notes
You must be at least 18 years of age to apply. Personal information collected on this form will be used to provide
certified copies of civil registry records, to verify the information provided, and for security purposes. It is an offence
to willfully make a false statement on this form. Questions may be directed to: The Registrar, Registry of Civil Status,
Castries, St. Lucia.
1. Applicant Information
This is information about yourself (the person completing the application form), and must be the same person who is
submitting the form to the Registry of Civil Status.
First Name, Last Name
‐
Enter your full first and last names
Mailing address
‐
Enter the mailing address, or the nearest local post office to where you live.
Telephone
‐
Full telephone number (include area code if phone is listed outside of St. Lucia)
Email Address
‐
Optional.
NIS #, Other form of ID
‐
Enter your NIS number. If you do not have an NIS card, then enter another form
of ID such as Passport and the passport number, or Driver’s License and Driver’s
License number. Your photo id must be shown when submitting this application.
Relationship to the bride
‐
If you are not the bride or the groom, then select ‘Other’ and enter the
or groom
relationship for example ‘Mother of bride’ or ‘Minister of religion’
2. Wedding Information
Date of wedding
‐
Enter the date of the wedding in the format indicated
Parish of wedding
‐
Indicate parish where the wedding was held for example Castries, Gros Islet, etc
Denomination/Church/
‐
Indicate the Church where the wedding took place; if not at a church, then
indicate the location for example ‘Pigeon Island Park’ or the full name of the
Other
hotel
3. Bride’s Information
First name
‐
Enter the full first name of the bride
Maiden name
‐
The last name which appears on the birth certificate of the bride
Middle name
‐
At least one middle name of the bride
Date of birth
‐
Full date of birth in the format indicated
4. Groom’s Information
First name, Last name,
‐
Enter the complete name of the groom as would appear on his birth certificate
Middle name
Date of birth
‐
Full date of birth in the format indicated
5. Certificate Information
Enter the number of copies required. Note that the maximum number of certificates issued at any one time is TWO (2)
•
Certificate costs are as listed. However an additional amount will be charged if a detailed search for the record is
required or if application is made for an emergency certificate.
Signature, Date: By signing the form you authorize the Registry of Civil Status to issue the requested information, and
consent to the Government of St. Lucia verifying the collected information from any other sources that may be
necessary. You also indicate that you are aware that it is an offence to willfully make a false statement on this form.
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