Government of Dominica Work In Nature Initiative

Work in Nature(WIN)
Registration Form

Section 1

Name of Property:

Address:

Village

Phone Number:

Fax Number:

Email Address:

Website:

Mailing address,(if different from above)

Address:

Name of Owner:

Address:

Village

Phone Number:

Fax Number:

Email:

Nationality

Name of Manager:

Address of Manager:

Village

Nationality

Phone Number:

Fax Number:

Email Address:

Section 2

Property Classification

Section 3

Number of Rooms:

Number of Employees:

Section 4

Please Indicate whether your property possess the following:

Public Liability Insurance Enviromental Health Certificate of Approval Fire Certificate

Disaster Management Plan Business Registration

Amenities Listing

I hereby certify that the above information is true and correct.

Full Name