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Applicant

[NAME OF WITNESS]

First Witness Statement

Date: []

Exhibit [XX1]

Court Reference No: [INSERT COURT REF. NUMBER]

[IN THE HIGH COURT OF JUSTICE]

BUSINESS AND PROPERTY COURTS [OF ENGLAND AND WALES] [IN [INSERT LOCATION]]

[COMPANY & INSOLVENCY LIST (ChD)]

OR

[IN THE COUNTY COURT AT [INSERT LOCATION]]

[BUSINESS AND PROPERTY COURTS LIST]

OR

[IN THE HIGH COURT OF JUSTICE]

[CHANCERY DIVISION]

OR

IN THE MATTER OF [INVESTMENT BANK NAME]

AND

IN THE MATTER OF THE INVESTMENT BANK SPECIAL ADMINISTRATION REGULATIONS 2011

AND

IN THE MATTER OF THE INSOLVENCY ACT 1986

_________________________________________

WITNESS STATEMENT OF [WITNESS NAME]

___________________________________________

I, [witness name], director [and chairperson] of [investment bank name] of [investment bank address] WILL SAY AS FOLLOWS:

1. 1. 1

      I am [a director and] [the chairperson] of [investment bank address] with company number [company number] (the Company). The Company is a wholly-owned subsidiary of [insert details], a company incorporated in [location]. It is in the business of [insert summary of the investment bank's business]. The Company is regulated by the Financial Conduct Authority (FCA) [Prudential Regulatory Authority (PRA)