OxfordCapital
Declaration with regard to directors and partners
Company Name (subsequently referred as the 'Company')
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Please answer all questions and if a question is answerable in the negative, please answer "No". Do not leave any section blank.
In this form, the term "company" includes any company or corporation wherever
incorporated and "director" includes a person in accordance with whose directions
or instructions the company's directors are or were accustomed to act.
Present surname and any former surname(s)
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Present forename(s) and any former forename(s)
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Professional qualifications, if any
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2. Are you or your spouse a director of any
other companies?
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2. Are you or your spouse a director of any
other companies?
3. Please state the names, nature of (and,
where appropriate, termination) of all
shareholdings (other than listed
companies of whose shares you hold or
have held less than 1%) or partnerships
or proprietorships of companies which you
or spouse hold or have held.
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4. Is any company of which you or your
spouse is or has been a director,
shareholder, partner or proprietor
presently a party (or likely to become a
party) to any litigation or court
proceedings which may or will have a
significant effect on the financial position
of that firm?
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4. Is any company of which you or your
spouse is or has been a director,
shareholder, partner or proprietor
presently a party (or likely to become a
party) to any litigation or court
proceedings which may or will have a
significant effect on the financial position
of that firm?
5. Have you or your spouse at any time been
adjudged bankrupt or had a bankruptcy
petition filed, or served or presented
either in the United Kingdom or
elsewhere?
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5. Have you or your spouse at any time been
adjudged bankrupt or had a bankruptcy
petition filed, or served or presented
either in the United Kingdom or
elsewhere?
6. Have you or your spouse at any time been
a party to a deed of arrangement or made
any other form of composition with your
creditors?
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6. Have you or your spouse at any time been
a party to a deed of arrangement or made
any other form of composition with your
creditors?
7. Have you or your spouse at any time been
a party or presently are a party, to any
litigation or court proceedings?
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7. Have you or your spouse at any time been
a party or presently are a party, to any
litigation or court proceedings?
8. Have you or your spouse at any time been
a party or presently are a party, to any
litigation or court proceedings?
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8. Have you or your spouse at any time been
a party or presently are a party, to any
litigation or court proceedings?
9. Are there any unsatisfied judgments
outstanding against you or your spouse?
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9. Are there any unsatisfied judgments
outstanding against you or your spouse?
10. Have you or your spouse ever been the
subject of a claim for unpaid taxes?
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10. Have you or your spouse ever been the
subject of a claim for unpaid taxes?
11. Have you ever been “blacklisted” by any
stockbroker, the Financial Services
Authority or by the London Stock
Exchange or any other investment
exchanges?
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11. Have you ever been “blacklisted” by any
stockbroker, the Financial Services
Authority or by the London Stock
Exchange or any other investment
exchanges?
12. Has any company been put into
liquidation (otherwise than by a members'
voluntary winding up when the company
was solvent) or had a receiver appointed
during the period when you or your
spouse were (or within the preceding six
months had been) one of its directors?
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12. Has any company been put into
liquidation (otherwise than by a members'
voluntary winding up when the company
was solvent) or had a receiver appointed
during the period when you or your
spouse were (or within the preceding six
months had been) one of its directors?
13. Have you or your spouse at any time been
convicted in the United Kingdom or
elsewhere of any offence involving fraud
or dishonesty or an offence under
legislation (whether or not of the United
Kingdom) relating to companies (including
insider dealing), building societies
industrial and provident societies, credit
unions, friendly societies, insurance,
banking or other financial services,
insolvency, consumer credit or consumer
protection?
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13. Have you or your spouse at any time been
convicted in the United Kingdom or
elsewhere of any offence involving fraud
or dishonesty or an offence under
legislation (whether or not of the United
Kingdom) relating to companies (including
insider dealing), building societies
industrial and provident societies, credit
unions, friendly societies, insurance,
banking or other financial services,
insolvency, consumer credit or consumer
protection?
14. Have you or your spouse ever been
concerned with the management or
conduct of affairs of any company which
to your knowledge is being or has at any
time, while you have been concerned with
the company, been inspected by any
inspector with statutory authority?
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14. Have you or your spouse ever been
concerned with the management or
conduct of affairs of any company which
to your knowledge is being or has at any
time, while you have been concerned with
the company, been inspected by any
inspector with statutory authority?
15. Have you or your spouse ever been
disqualified by a court from being a
director of any corporation?
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15. Have you or your spouse ever been
disqualified by a court from being a
director of any corporation?
16. Are you or your spouse or have you or
your spouse ever been the subject of an
investigation or litigation in the United
Kingdom or elsewhere or are there
circumstances of which you are aware as
a result of which you may become the
subject of any investigation or litigation?
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16. Are you or your spouse or have you or
your spouse ever been the subject of an
investigation or litigation in the United
Kingdom or elsewhere or are there
circumstances of which you are aware as
a result of which you may become the
subject of any investigation or litigation?
17. Have you or your spouse, in connection
with the formation or management of any
body corporate, partnership or
unincorporated institution been adjudged
by a court in the United Kingdom or
elsewhere civilly liable for any fraud,
misfeasance or other misconduct by you
towards such a body or company or
towards any members thereof?
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17. Have you or your spouse, in connection
with the formation or management of any
body corporate, partnership or
unincorporated institution been adjudged
by a court in the United Kingdom or
elsewhere civilly liable for any fraud,
misfeasance or other misconduct by you
towards such a body or company or
towards any members thereof?
18. Have you, in the United Kingdom or
elsewhere, been refused to be admitted to
membership of any professional body or
been censured or disciplined by any such
body to which you belong or belonged or
have you held a practising certificate
subject to conditions?
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18. Have you, in the United Kingdom or
elsewhere, been refused to be admitted to
membership of any professional body or
been censured or disciplined by any such
body to which you belong or belonged or
have you held a practising certificate
subject to conditions?
19. Please confirm that you are not currently,
and that you have never been, a director,
shareholder, partner or proprietor or
otherwise associated with any company
which carries on or has carried on
business similar to or in competition with
the Company?
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19. Please confirm that you are not currently,
and that you have never been, a director,
shareholder, partner or proprietor or
otherwise associated with any company
which carries on or has carried on
business similar to or in competition with
the Company?
20. Please supply a list of the names of
your employers during the last
fifteen years and the dates during
which you worked for them, together
with a short description of your job
and your job title, and reason for leaving each place of employment
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Have you ever been dismissed from
any office or employment?
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Have you ever been dismissed from
any office or employment?
Please give details of any restrictive
convenants or other obligations by
which you are still bound by reason
of any previous employment
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21. Do you suffer or have you ever suffered
from any serious disease or illness or
disability or has any application for life or
health assurance made by you been
turned down or accepted on special
terms?
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22. Please attach details of all payments
(whether of dividend, salary or any form
of charge or repayment) received by you,
any member of your family or any other
person, partnership or company
associated with you, from the Company or
any of its group in the last 12 months and
those likely to be received as aforesaid by
you and such persons in the next 12
months and details of all loans from and
to the Company and its group to and from
you or such persons
23. Please give details of all borrowing and
any other undischarged debts
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24. Are you satisfied that you and your
spouse have the financial resources to
meet your existing and anticipated
financial liabilities?
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25. Are there any other facts or
circumstances relating to you or your
spouse and your respective business
careers which could be relevant to a
prospective venture capital funder in the
Company or be material for consideration
in the context of the Company’s business
plan?
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25. Are there any other facts or
circumstances relating to you or your
spouse and your respective business
careers which could be relevant to a
prospective venture capital funder in the
Company or be material for consideration
in the context of the Company’s business
plan?
26. Are there any other facts or
circumstances that could in any way
impair your suitability to be a director of a
private company?
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26. Are there any other facts or
circumstances that could in any way
impair your suitability to be a director of a
private company?
27. Please supply to us a copy of your
passport and one utility bill (less than 3
months old)
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28. Please nominate one Director to supply a
certified copy of the Company’s certificate
of incorporation, together with evidence
of the registered address of the Company
and a list of its shareholders and
directors
I, of a director of declare that the answers to all of the above questions (including any documents produced as part of an answer) are true
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