Additional form for information about a Nominated individual

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					Additional section for information about a nominated individual


 Please use this form to submit details for an additional nominated individual.

 You must use a separate form for each nominated individual.

 Please give each nominated individual a number so that we know you have sent us
 information about all of the nominated individuals required in your application.

 If you don’t submit a form for each nominated individual we will have to return your
 application.


 The information below is for nominated                                      nominated
                                                      of a total of:
 individual number:                                                          individuals


 Details of a nominated individual for regulated activity(ies)

 *Regulated activity(ies)
 (From the list of regulated
 activities checked or ticked at
 section 1.7 of the main
 application form)

 *Title

 *First name

 Middle name (if applicable)

 *Last name

 Previous name (if applicable)

 *Business address line 1

 *Business address line 2

 *Town/city

 *County

 *Postcode

 *Email

 *Main business telephone

 Fax



20120529 800023 v2 00 Additional NI form

				
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