Have you ever, in the last 10 years, been a director or senior manager of a company, or other incorporated or unincorporated entity, which has been placed into liquidation, Yes administration or No receivership, entered into any compromise agreement, moratorium or other restructuring to avoid liquidation, administration or receivership ?* Details Are you subject to pending proceedings which, if any adverse Yes finding is reached, will result in one or more of No the matters set out in the paragraphs above applying to you ?* Details Please enclose copy of Passport Passport Evidence* Copy of Passport Evidence enclosed. Evidence. Please enclose copy of evidence Evidence of Copy of evidence of appointment enclosed. of appointment. Appointment* I consent to act as secretary of the above named company. I declare that the information in this application is true and complete as at the date of this form. Please complete this section if secretary is an Individual. Use Individual (2) continuation sheet if necessary. Title* Forenames* Surname* Name by which the individual Former Names was formerly known for business purposes. Country of Residence* Nationality*
Have you ever, in the last 10 years, been a director or senior manager of a company, or other incorporated or unincorporated entity, which has been placed into liquidation, administration or receivership, entered into any compromise agreement, moratorium or other restructuring to avoid liquidation, administration or receivership ?* Yes No Details Are you subject to pending proceedings which, if any adverse finding is reached, will result in one or more of the matters set out in the paragraphs above applying to you ?* Yes No Details Passport Evidence* Copy of Passport Evidence enclosed. Please enclose copy of Passport Evidence. Evidence of Appointment* Copy of evidence of appointment enclosed. Please enclose copy of evidence of appointment. I consent to act as secretary of the above named company. I declare that the information in this application is true and complete as at the date of this form. Individual (2) Please complete this section if secretary is an Individual. Use continuation sheet if necessary. Title* Forenames* Surname* Former Names Name by which the individual was formerly known for business purposes. Country of Residence* Nationality*
INC-02-RSC-SFO-Incorporate-A-Restricted-Scope-Company-SFO_2015-11-20_V20.docx