Name & Address where cash held Owner and % Ownership Balance Balance Currency € Sub Total Client Money Accounts (24) Name & Address where cash held Owner and % Ownership Balance Balance Currency € Sub Total Investments (25) NAME OF Entity % of Date of Fund manager/Stock Broker Asset Description Investment/Cost to Current Value Valuation Valuation Date Annual Income Annual Holding Surplus Income € € € Entity Ownership Investment date Costs € € (If applicable) Sub Total Pensions (26) NAME OF Entity % of Date Fund Pension Broker Pension Description including how Pension is to Amount paid into Fund to date Current Value Valuation Basis Valuation Date Annual Income Annual Holding Surplus Income € € € € ENTITY Ownership Established be paid out Costs € (If applicable) Sub Trusts (including discretionary trusts) (27) NAME OF Entity % of Date Trust Trust Name Trust Location / Jurisdiction beneficiaries Amount paid / Curernt Value Valuation Basis Valuation Date € ENTITY Ownership Established Transferred into Trust to date € Sub Total Chattels (28) Description of Chattel and Address where Chattel Held Owner and % Ownership Current Value Valuation Basis Valuation Date Original Cost € € Sub Total Other (29) Asset Description Owner and % Ownership Current Value Valuation Basis Valuation Date €
Name & Address where cash held Owner and % Ownership Balance € Balance Currency Sub Total Client Money Accounts (24) Name & Address where cash held Owner and % Ownership Balance € Balance Currency Sub Total Investments (25) NAME OF Entity Entity % of Ownership Date of Investment Fund manager/Stock Broker Asset Description Investment/Cost to date € Current Value € Valuation Valuation Date Annual Income € Annual Holding Costs € (If applicable) Surplus Income € Sub Total Pensions (26) NAME OF ENTITY Entity % of Ownership Date Fund Established Pension Broker Pension Description including how Pension is to be paid out Amount paid into Fund to date € Current Value € Valuation Basis Valuation Date Annual Income € Annual Holding Costs € (If applicable) Surplus Income € Sub Trusts (including discretionary trusts) (27) NAME OF ENTITY Entity % of Ownership Date Trust Established Trust Name Trust Location / Jurisdiction beneficiaries Amount paid / Transferred into Trust to date € Curernt Value € Valuation Basis Valuation Date Sub Total Chattels (28) Description of Chattel and Address where Chattel Held Owner and % Ownership Current Value € Valuation Basis Valuation Date Original Cost € Sub Total Other (29) Asset Description Owner and % Ownership Current Value € Valuation Basis Valuation Date
Statement_of_Affairs_Template__ROI__v2_1_.docx