Date:

(1)  Instruction given by:                            

                              Name:               
                Email Address:               
Firm or Company Name:               
Correspondance Address:
                                                        

Telephone Number:                       
Fax Number:                                  

(2)    Proposed Name of Company:           1.
        In order of preference:                      2.
                                                                    3.

(3)     Amount of Members Guarantee:       
         (Usually £1 per Member)                         

(4)    Registered Office Address:   (Must be situate in Country of Registration)
                                                        

(5)    Does the Proposed Company intend to seek Charitable Status:   

(6)    Outline of Main Objects and Scope of Proposed Company:
        If the Proposers already have a Constitution please let us have a copy.
       

(7)    Other Information: