Developer Data Capture Form

Surveyor’s Technical Description
Certified copy of the certificate of the legal right to land ownership or occupancy OR Certified copy of a long-term lease agreement clearly stating the duration of the lease OR Document establishing that the Applicant is in the process of obtaining occupancy rights to the subject land area
Business Plan

Step 1 of 9 - GENERAL BUSINESS INFORMATION

SECTION 2 - SHAREHOLDING/PARTNERSHIP/DIRECTOR INFORMATION
12. Equity/Share Capital participation including Foreign Investment (in US$)*
a. Authorised b. Subscribed c. Paid up capital
13. Details of each Director/Partner/Sponsor*
Name Building No. and Street Address Zip/Postal Code Country Nationality
14. Principal Shareholders/Directors shareholding*
Shareholder Name No. of Shares
15. List of company directorship/trustees/fiduciary positions held by directors with any firms/corporations/associates/partnerships/business entity in the last 10 years:*
Name Company Relationship
16. Corporation/business and companies in which directors have held/holds ownership interest*
Name Company Relationship
17. Are any of the company directors/shareholders currently involved in any bankruptcy proceedings or are undischarged bankrupts?*
- Yes
- No
If yes, please state name of director(s)/shareholder(s)

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SECTION 5 - EMPLOYEE SAFETY AND SECURITY
33. What are the security measures that the firm currently uses (to include physical security plan, access controls for employees and visitors, ID system for staff, Payment Card Data Security Standard (PCIDSS) compliance, where applicable, employee screening process). Please include a detailed security plan with your application.*
34. Define your occupational safety and health management systems, policy and procedures:*

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SECTION 6 - EMPLOYMENT INFORMATION
35. Indicate direct and indirect employment likely to be generated during the first three (3) years of the project*
Direct Indirect Male (direct) Female (direct) Local Foreign

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SECTION 7 - DISASTER MANAGEMENT AND EMERGENCY PLAN
36. Does the company have a disaster management and emergency plan in place?*
- Yes
- No
37. Define your disaster mitigation plan, emergency response mechanisms and incident management procedures.*

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SECTION 8 - INVESTMENT AND FINANCIAL INFORMATION
38. Proposed Financial/Investment Details
i. Value of Land (US$)*
ii. On-Site Infrastructure such as boundary walls, roads, drainage, water supply, electricity etc. (US$)*
iii. Building/Factory Development Cost (US$)*
iv. Port (US$)*
v. Airport (US$)*
vi. Other*
vii. Total Investment*
39. Total Local Direct Investment (LDI)*
40. Total Foreign Direct Investment (FDI)*
41. If any, source of FDI (Sponsors company and country details should be provided)
Company Name
Resident Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
42. Source of Funds*

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SECTION 9 - DEVELOPER’S UNDERTAKING
1. I/We hereby confirm that the Board of Directors has authorized the filing of this application in accordance with the terms thereof;

2. I/We have read the Special Economic Zone Act 2016, (No 7 of 2016) and SEZ Regulations, 2016 and the Rules as adopted by the JSEZA and commit to abide by the provisions thereof as well as amendments thereto;

3. I/We declare that to the best of our knowledge, that the project is economically, technically and financially sound and have provided the Authority with the project business proposal;

4. I/We declare that the company is capable of operating, on a sound and efficient basis, and agree to conduct further negotiations towards contributing to the objectives of the Jamaica Special Economic Zone Authority;

5. I/We declare that if the company is engaged, or intends to be engaged in, any other Jamaican Business entity and/or any additional activities outside of this project and/or operates any subsidiary company/s that it will operate with an “arms length consideration” as per the Income Tax (Amendment) (No. 2) Act, 2015 (No 30 of 2015);

6. I/We declare that the company shall submit quarterly reports and other information, pertaining to its activities in the Special Economic Zone as the Authority and/or Jamaica Customs Agency may require;

7. I/We declare that the company will start and operate the project covered by this application within such reasonable time as may be fixed by the Authority;

8. I/We declare that the company will pay over to the Authority all fees due it as prescribed by the Fee Schedule;

9. I/We declare that the company will be subject to taxes and benefits pursuant to the First Schedule of the Special Economic Zone Act, 2016 (No. 7 of 2016);

10. I/We hereby undertake to abide by the provisions of the Special Economic Zones Act, 2016 and Regulations/Rules and Orders made thereunder;

11. I/We hereby declare that to the best of my/our knowledge the applicant and their shareholders/directors are not engaged in money laundering or other financial crimes, the financing of terrorism, or the manufacture or proliferation of weapons of mass destruction;

12. I/We will abide by any other condition, which may be stipulated by the Government of Jamaica;

13. I/We acknowledge that this application and its approval is subject to due diligence and regulatory approvals;

14. I/We declare that neither the company nor any of its directors/shareholders have been debarred from being granted a Letter of Approval, Letter of Authorisation, Developer’s Agreement and Operating Certificate as prescribed by the Special Economic Zone Act, 2016 (No. 7 of 2016)

15. I/We fully understand that any Letter of Approval and subsequent SEZ Developer’s Agreement (Master Concession or License Agreement) granted to the company on the basis of the statement furnished is liable to cancellation or any other action that may be taken having regard to the circumstances of the case if it is found that any of the statements or facts therein is incorrect or false. An affidavit duly sworn in support of the above information is enclosed;

16. I/We declare that the authorised representatives, management, directors and shareholders/stockholder have received legal advice and that I/We fully understand the terms of the application and the company’s duties and responsibilities on the signing of the form/s and on being granted any agreements thereafter.

17. I/We hereby declare that the above statements are true and correct to the best of my/our knowledge and belief and I/We sincerely declare and affirm that this application and that any exhibits and/or annexures submitted with this application and their contents is true.
Applicant’s signature and certification
Name of Applicant*
Title of Applicant*
Telephone No.*
E-mail Address*
Signature*
Date*
MM slash DD slash YYYY
Name of Notary Public/Justice of the Peace*
First Last
Signature
Date*
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

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Developer Data Capture Form

Guidelines on completing the form

Checklist

Step 1 of 9 - GENERAL BUSINESS INFORMATION

SECTION 1 - GENERAL BUSINESS INFORMATION

SECTION 2 - SHAREHOLDING/PARTNERSHIP/DIRECTOR INFORMATION

SECTION 3 - EXISTING AND PROPOSED PROJECT BRIEF

SECTION 4 - PROPOSED DEVELOPMENT PLAN

SECTION 5 - EMPLOYEE SAFETY AND SECURITY

SECTION 6 - EMPLOYMENT INFORMATION

SECTION 7 - DISASTER MANAGEMENT AND EMERGENCY PLAN

SECTION 8 - INVESTMENT AND FINANCIAL INFORMATION

SECTION 9 - DEVELOPER’S UNDERTAKING

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Name	Building No. and Street Address	Zip/Postal Code	Country	Nationality

Shareholder Name	No. of Shares

Name	Company	Relationship

Name	Company	Relationship