Economic Development Bank - Affidavit of Eligibility Form                                                                          Rev. 9/2015 
 
 
               AFFIDAVIT OF ELIGIBILITY 
 
 
United States Virgin Islands                                   ) 
District of ________________________________________) ss: 
 
 I, __________________________________________________, being first duly sworn depose and say:  
                                    (Name)                                              
 
1. I make this affidavit for the purpose in inducing the Government Development Bank/Small Business 
Development Agency to grant a loan and/or other assistance to __________________________________________ herein  
                                                                                                                                                              (Name of Concern)  
 
known as the “applicant.”  
 
2. I own at least 50% legal or equitable interest in applicant. 
 
3. I do not hold such interest in trust for any other person. 
  
4. I am or will be active in the management or operation of the applicant’s business on a full-time basis and 
such business is or will be my principal means of support. 
 
5. I am otherwise eligible as follows: 
  
[   ] I was born in the Virgin Islands. 
 
[   ] My Father (   ) and/or Mother (   ) was / were born in the Virgin Islands and I have been a bona fide 
continuous resident of the U.S. Virgin Islands for five (5) years or more. 
 
[   ] I have been a bona fide continuous resident of the U.S. Virgin Islands for ten (10) years or more. 
 
6. I understand that a false statement on this affidavit is punishable by a fine of $5000.00 and imprisonment 
for five (5) years or such other penalty as may be provided by law. 
                                                                                    
Further affiant sayeth not. 
                    __________________________________________________________ 
                                                   (Signature of Affiant) 
 
Subscribed and sworn before me, a Notary Public,   
in and for the United States Virgin Islands on this 
_______ day of _________________________________, 20_____. 
 
_________________________________________________________  
                               (Notary Republic) 
 
      (SEAL) 
 
My Commission Expires:  _____________________________ 
 
 
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