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On behalf of: applicant

By: [insert name]

No: [insert statement number]

Exhibits: [insert details]

Date: [insert date]

Filed: [insert date]

Court Reference No: [INSERT COURT REF. NUMBER]

[IN THE HIGH COURT OF JUSTICE]

[BUSINESS AND PROPERTY COURTS] [OF ENGLAND AND WALES] OR IN [insert location] OR

THE COUNTY COURT AT [insert location]

[BUSINESS AND PROPERTY COURTS LIST

In the matter of [insert Company name]

And

In the matter of the companies act 2006

Statement of [insert full name]

I, [insert full name], [insert role/job title] of [insert company name] of [insert address] will say as follows:

1. 1. 1

      Introduction

      I am the [insert role/job title] of [insert company name] (the Company), having been appointed on [insert date]. I have been the officer of the Company most closely connected with the proposal that is the subject of this witness statement. The facts and matters to which I refer in this witness statement are either within my own knowledge and are true, or derived from the sources to which I refer below, in which case they are true to the best of my information and belief.

   1. 2

      I