I confirm that, subject to any matters of which I have given particulars below, I have not been:

1. convicted by a court of any criminal offence, or accepted a caution; (see note below)
2. disqualified as a company director, or been a director of a company subject to winding-up or put into administration in circumstances of insolvency
3. declared bankrupt or entered into an Individual Voluntary Arrangement
4. subject to any disciplinary proceedings or investigations by a regulator; or
5. involved in any conduct which calls into question my honesty, integrity or respect for the law.

This confirmation is given to the best of my knowledge and belief and I understand that the Company will be relying on it when considering my application, and on it continuing to be correct for so long as I am a member. I will therefore inform the Company promptly if there is any relevant change in my circumstances. Note. For the avoidance of doubt, this does not include (a) any fixed penalties for speeding, if these have been settled entirely by a paper process and did not involve a court appearance, or (b) any convictions which are “spent” under the Rehabilitation of Offenders Act 1974.

Circumstances

Penalty imposed (if any)