Request for deposit

							Request for deposit                                                                                                                               CFO 103
(Trustee Act 1925 with affidavit or witness statement)                                                                                                 (12.11)


Name of beneficiary or company to which the shares relate                              Name of court


Name of trustee or acquiring company



Details of funds to be deposited. If                        Amount                                                  Notes
securities are to be deposited list overleaf                                                                        A sealed copy of the affidavit or
                                                                                                                    witness statement filed in accordance
                                                                                                                    with rule 37.4 of the Civil Procedure
                                                                                                                    Rules 1998 must accompany this
                                                                                                                    request.

                                                                                                                    If the amount to be deposited is under
                                                                                                                    £500 in value, the Chief Chancery
                                                                                                                    Master must approve the deposit by
                                                                                                                    endorsing this form.

                                                                                                                    Authentication stamp




Cash (including interest)                                                                         (net/gross)




   Signed                                                                      Date

Give the name, address and reference of the person who will make the deposit          Give the name, address and reference of the person filing this form

Name                                                                                  Name

Address                                                                               Address



                Postcode                                                                              Postcode

Ref.                                                                                  Ref.

How to contact the Court Funds Office

Customer Helpline                                                        Address                               How to pay
0845 223 8500                                                            Court Funds Office Court Funds Office Cheques must be made payable
                                                                         Glasgow            DX 501757          to: Accountant General of the
Email                                                                                                                      Senior Courts
enquiries@cfo.gsi.gov.uk                                                 G58 1AB               Cowglen
Securities
Nominal (if appropriate)       Description of security




Court Funds Office (CFO 103)