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Ltd Company Application Form
Please complete the following questions accurately

Title*

Your First Name*

Surname*

Address*

City*

Post Code*

Country*

Mobile*

Phone

Email*

NI Number*

Marital Status*

Date Of Birth*

Job Title*

No. Of Years Experience*

Qualifications*

Are you currently resident in the UK?*
---YesNo

Section Two - Personal Bank Details
Please enter your personal bank details (not any business accounts).

Bank Name:*

Bank Address*

Account Name:*

Sort Code:*

Account Number:*

Section Three - Company Details
Please provide details of your existing business.

Company Name:*

Registered Office:*

Business Type:*
---Limited CompanyLLPSole TraderPartnershipOther

If Other Business Type Is Selected, Please provide details:

Country of Incorporation:*
---England & WalesScotlandNorthern IrelandOther

If Other Country Of Incorporation Is Selected, Please provide details:

Registered No:*

Company Year End:*

Section Four - Declaration
I declare that the information provided is complete and accurate to the best of my knowledge. I authorise Umbrella-Paye to store these details in compliance with their published Privacy Policy. I confirm exclusive jurisdiction of the courts of England and Wales over any disputes arising from this application.

I also agree to provide such proofs of identity and address as are required in compliance with relevant Anti-Money Laundering regulations.

By printing my name below and returning this document I hereby accept the above terms.

AGREED BY:

Name:

Date: