List Of Requirements For Dominica Citizenship Application


Forms & Questionnaires:
Forms to fill:
Disclosure Form; required for applicants aged 16 years and older.
Application Form 12 [two (2) sets with original signatures]; required for all applicants. Both
parents or legal guardian of applicant under 18 years of age must sign the Application Form 12
on behalf of the minor. All Form 12s must be notarized to be complete. The section of Form 12
labeled “REFERENCE” can be left undone.
Medical Questionnaire; is to be completed in English by a Registered Medical Practitioner.
Original results of routine tests to be attached (HIV, Blood & Urine and Immunization Schedule
against Diphtheria, Tetanus, Hepatitis, Influenza, and Pneumococcus). Applicants between the
ages of 0 – 5 years will not be required to take an HIV test.
Personal Documents:
Four (4) passport size photos for all applicants, at least one should be certified;
Certified copy of the Passport main page (+ Residence visa copy);
Certified copy of National ID/Social Security card for all applicants;
Certified copy of Birth Certificate for all applicants;
Certified copy of Driver’s License (for both main applicant and spouse);
Certified copy of Military Service Card;
Certified copy of Marriage Certificate/Divorce Certificate;
Original Police Clearance Certificate (or similar document) is required for all applicants 16
years and over. Police records are required from country of birth, citizenship and residence
(where the applicant has lived for 6 months or more for the past 10 years); and must be from a
County/State and at Federal Level. All police records must be accompanied by a FINGERPRINTS
VERIFICATION CARD. For children 12-15 years old, there must be a sworn affidavit by the
parent that the child does not have a criminal record.
Detailed Resume/Business Background Report is required of all applicants who are working
adults, occupation must be clearly indicated.


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