Please state your business or other address if you
wish mail to be sent there
Please address all correspondence to
Business Address
Home Address
Other matters. Please answer the following question by ticking appropriately.
Bankruptcy and Corporate Failure
Have you, or has any corporation of which you have been a Director or Officer within
the last ten years ever gone into creditors liquidation, or been obliged to compound with
creditors?
Yes No
If yes please give details below.
Tax Investigation or Litigation
Are you currently being investigated by or involved in litigation with HM Inland
Revenue or HM Customs and Excise or other tax authorities in any Jurisdiction?
Yes No
If yes please give details below.