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    Introducer Appointed Representative Questionnaire

    STATEMENT OF HONESTY, INTEGRITY AND REPUTATION

    Please answer the following questions by ticking the appropriate box. Where a "Yes" box is ticked, please provide full details.

    1. Are you, or have you ever been, the subject of, or are you aware of any intention to begin against you, either in the UK or elsewhere:

    Q1a. any civil proceedings, or litigation, including judgement debts or arbitration? YesNo

    Q1b. any bankruptcy proceedings, or proceedings for the sequestration of your estate, including entering into a deed of arrangement, an individual voluntary arrangement (or in Scotland a trust deed) in favour of your creditors, or other composition, or arrangement with creditors? YesNo

    Q2a. any such debts still outstanding, whether in full or in part? YesNo

    Q2b. failed to satisfy any such debts within one year of the making of the order?YesNo

    If answer yes please give details:

    Q3a. been refused entry to any profession or vocation, or been dismissed or requested to resign from any office or employment or from any fiduciary office or position of trust, whether or not renumerated? YesNo

    Q3b. been refused, or restricted in, the right to carry on any trade,business or profession for which specific licence, authorisation, registration, membership or other permission is required? YesNo

    Q3c. been disqualified by a court from acting as a director of a company or from acting in a management capacity or from conducting the affairs of any company, partnership or unincorporated association? YesNo

    Q4a. been refused, had revoked, restricted or terminated any licence, authorisation, registration, notification, membership or other permission granted by any such body? YesNo

    Q4b. been criticised, censured, disciplined, suspended, expelled, fined, or been the subject of any other disciplinary or intervention action of any such body? YesNo

    Q4c. resigned, or been asked to resign, from any such body or, after making a notification or application for any licence, authorisastion, registration, membership or other permission granted by any such body, decided not to proceed with it? YesNo

    Q4d. been the subject of any civil action that has resulted in a finding against you or it by a court? YesNo

    Q4e. knowingly been the subject of an investigation into allegations of misconduct or malpractice in connection with any business activity? YesNo

    Q5a. been put into liquidation, had a petition presented, or a meeting summoned to consider a resolution, to wind up the company, or been wound up, had apetition for bankruptcy presented, or been declared bankrupt? YesNo

    Q5b. ceased trading in circumstances in which one or more creditors did not receive full payment, had a receiver or administrator appointed, or entered into (or made any proposal to enter into) any arrangement with creditors, or made a trust deed for creditors, or been dissolved? YesNo

    Q6a. been adjudged by a court liable for any fraud, misfeasance, wrongful trading or other misconduct towards a Regulatory Authority or towards any members or creditors of a Regulatory Authority? YesNo

    Q6b. been investigated by an inspector appointed under companies or any other legislation, or required to produce books and papers to the Secretary of State? YesNo

    Contact details

    E-mail address:
    mail@safeandsecure.co.uk

    Contact us!

    01332 200 888