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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

2. If you have been the subject of any judgement debts under a court order, have you:

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

3. Have you ever, either in the UK or elsewhere:

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

4. Have you or has any partnership or unincorportated association of which you have been a controller, director or partner:

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

5. Has any company, partnership, or unincorporated association of which you are or have been a controller, director, partner, mamanger or company secretary, in the UK or elsewhere, at any time during your involvement:

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

6. Have you ever, or has any company, partnership, or unincorporated association of which you are or have been a controller, director, partner, manager or company secretary, in the UK or elsewhere, at any time during your involvement:

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