Page Title

Text Box: Provide details of the banking and financial arrangements (loans) operated by the Company and any subsidiaries, including any repayable grants. (Use reverse or continue on a separate sheet if necessary)

My reason for seking capital is: (tick as appropriate)

a. growth opportunity

b. retirement

c. death of a key person

d. contractual difficulty

e. major business setback

f. business is under funded

g. management buy out/in

h. cash flow (seasonality/credit control)

i. some other reason (describe)

Text Box: Authorised Share Capital Issued Share Capital Shareholder details (names and number of shares held). (Use reverse or continue on a separate sheet if necessary) d. Are there any agreements in place relating to the ownership or control of the Company? (If so, enclose copy or give details)