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44-46 South Quay, Port of Spain, Tel: 623-(HOME) 4663 ext. 3100

RESIDENTIAL LOTS APPLICATION FORM Section A: MAIN APPLICANT'S PERSONAL INFORMATION Surname

First Name

ID Card No.

Drivers Permit No.

Date of Birth (DD/MM/YYYY) __ __ / __ __ / __ __ __ __ Marital Status:

Single □

Other Names

Passport No.

Gender (MALE/FEMALE)

Married □

Divorced □

Birth Certificate Pin No.

TT Citizen (YES/NO)

TT Resident (YES/NO)

Common Law □

Widowed □

Separated □

Country of Birth

Residential Address:

Mailing Address (if different from residential):

Telephone - Home

Work

Cell

Total Monthly Income

Email

Income Source:

Are you in the Protective Services? Yes □

No □

Sector of Occupation: State □ Do you own or are you a part owner of any property? If Yes, Please specify Location/ Duration:

Pension □

Self□

Employed □

State Assisted□

Other□

Place of occupation: Private □ YES □

Other : NO □

Are you Squatting? YES □ NO □ If Yes, Please Specify Location/ Duration: State Lands □ Select which area the Land is being requested and state name of area: North East □ North West □ South West □ East West Corridor □

Private Lands □

Unknown / Uncertain □

Central □

South East □

SECTION B: CO-APPLICANT'S PERSONAL INFORMATION Surname

First Name

ID Card No.

Other Names

Driver's Permit No.

Date of Birth (DD/MM/YYYY) __ __ / __ __ / __ __ __ __ Marital Status: Single □ Residential Address:

Passport No.

Gender (MALE/FEMALE)

Married □

Divorced □

Birth Certificate Pin No.

TT Citizen (YES/NO)

Separated □

Common Law □

TT Resident (YES/NO)

Country of Birth

Widowed □

Mailing Address (if different from residential):

Telephone - Home

Work

Cell

Total Monthly Income

Income Source:

Are you in the Protective Services? Yes □ Sector of Occupation:

Email

State □

No □

Pension □

Self□

Employed □

State Assisted□

Other□

Place of occupation: Private □

Other :

SECTION C: APPLICANTS' & DEPENDANTS' INFORMATION Please specify total number of occupants per household if successful: The following are considered dependants - A child/children under 18 years, Parents 65 years and over, Physically and/or Mentally Challenged Dependants NAME Date of Birth Relation to Applicant State Disability (DD/MM/YYYY) SURNAME FIRST NAME Applicant __ __ / __ __ / __ __ __ __

Co- Applicant (s) __ __ / __ __ / __ __ __ __ __ __ / __ __ / __ __ __ __ __ __ / __ __ / __ __ __ __ __ __ / __ __ / __ __ __ __ __ __ / __ __ / __ __ __ __

I/ We…………………………………………………………………………………. certify that the information given in this form is true to the best of my/our knowledge and belief. If there is anything given in the information above which is not true or incorrect, knowingly or unknowingly then the Land Settlement Agency reserves the right to refuse this application.

Applicant's Signature:

Date:

Co-Applicant's Signature:

Date:

All information provided are subject to verification. Applicants are reminded that all criteria must be met for further consideration.


GUIDELINES Who are eligible to apply?   

Any citizen or legal resident of Trinidad and Tobago, Any person 18 years and over; and Not be the owner/part owner of or have a share or interest in any real property (house or land) in Trinidad and Tobago at the time of submitting an application and at the time of allocation of the lot, if successful.

Use this map as a guide when selecting area land is being requested for. THE APPLICATION PROCESS WALK-IN APPLICATIONS: The application form will be verified and entered into our database and a letter bearing your unique reference number confirming acceptance of your application will be issued to you. NOTE: Incomplete forms will not be entered. ONLINE APPLICATIONS: Complete the application form on the Ministry’s website (http://www.mhe.gov.tt/). Once you have successfully completed and submitted the form, a unique reference number will be generated for you. You will then be prompted to print: -your completed application form that you submitted -a letter bearing your unique reference number confirming acceptance of your application In both cases, the unique reference number will allow you to check on your application and to update any changes in your status. OFFICES OF THE LSA

Orange Grove Road South, Orange Grove Estate, Tacarigua 623-4663 ext. 3100 or 640-6816

The HDC Building, Corner Flamingo Road and the Old Southern Main Road, Couva 623-4663 ext. 3353/3354

Agostini Building Corner South Quay and Duncan Street, Port-of-Spain 623-4663 ext. 3120

#1 Factory Road, Ste. Madeleine 623-4663 ext. 3351/3352 or 299-4096


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