(D) PAYMENT AUTHORITY [ ] Please tick box to confirm that the majority of the officers of the company have completed, signed and dated the Payment Authority attached to this application form. [ ] Please tick box to confirm you have submitted 1 proof of name and 1 proof of address document for each person signing the Payment Authority. ALL COPIES OF IDENTITY EVIDENCE MUST BE CERTIFIED BY A PRACTISING SOLICITOR OR THE POST OFFICE IDENTITY CHECKING SERVICE. (E) CHECKLIST Please complete the following checklist before you sign and date Section F (Declaration) of this form. [ ] I have provided all the relevant information. [ ] The majority of the officers of the company have completed, signed and the Payment Authority (if applicable). [ ] I have provided a copy of the order restoring the company or confirmation from Companies House for administrative restoration as applicable. [ ] If a Payment Authority is being submitted, I confirm that I have enclosed 2 forms of identity for all those signing it and any copies have been certified. (F) DECLARATION I confirm that all the information I have given in this application form and the Payment Authority (if applicable) is correct to the best of my knowledge. Signature: Full name: Date:
(D) PAYMENT AUTHORITY [ ] Please tick box to confirm that the majority of the officers of the company have completed, signed and dated the Payment Authority attached to this application form. [ ] Please tick box to confirm you have submitted 1 proof of name and 1 proof of address document for each person signing the Payment Authority. ALL COPIES OF IDENTITY EVIDENCE MUST BE CERTIFIED BY A PRACTISING SOLICITOR OR THE POST OFFICE IDENTITY CHECKING SERVICE. (E) CHECKLIST Please complete the following checklist before you sign and date Section F (Declaration) of this form. [ ] I have provided all the relevant information. [ ] The majority of the officers of the company have completed, signed and the Payment Authority (if applicable). [ ] I have provided a copy of the order restoring the company or confirmation from Companies House for administrative restoration as applicable. [ ] If a Payment Authority is being submitted, I confirm that I have enclosed 2 forms of identity for all those signing it and any copies have been certified. (F) DECLARATION I confirm that all the information I have given in this application form and the Payment Authority (if applicable) is correct to the best of my knowledge. Signature: Full name: Date:
RA15_repaying_funds_to_restored_companies.docx