Patient Finance

Please read the following questions and answer the questions at the end.

Are you, or have you ever been, the subject of, or are you aware of any intention to begin against you, either in the UK or elsewhere:

• Any civil proceedings, or litigation, including judgement debts or arbitration?
• Any bankruptcy proceedings or proceedings for the sequestration of your estate, including entering into a deed of arrangement, an individual voluntary arrangement (or in Scotland a trust deed) in favour of your creditors, or other composition, or arrangement with creditors?

If you have been the subject of any judgment debts under a court order, have you:

• Any such debts outstanding, whether in full or in part?
• Failed to satisfy any such debts within one year of the making of the order?

Have you ever, either in the UK or elsewhere:

• Been refused entry to any profession or vocation, or been dismissed or requested to resign from any office or employment, or from any fiduciary office or position of trust, whether or not remunerated?
• Been refused, or restricted in, the right to carry on any trade, business or profession for which specific licence, authorisation, registration, membership or other permission is required?
• Been disqualified by a court from acting as a director of a company or from acting in a management capacity or from conducting the affairs of any company, partnership or unincorporated association?

Have you, or has any company, partnership, or unincorporated association of which you are or have been a controller, director, partner, manager or company secretary, whilst you were associated with that entity and for a period of three years after you ceased to be associated with it, in respect of activities falling within the jurisdiction of a Regulatory Authority or any other professional body, ever:

• Been refused, had revoked, restricted or terminated any licence, authorisation, registration, notification, membership or other permission granted by any such body
• Been criticised, censured, disciplined, suspended, expelled, fined, or been the subject of any other disciplinary or intervention action by any such body?
• Resigned, or been asked to resign, from any such body or, after making a notification or application for any licence, authorisation, registration, membership or other permission granted by any such body, decided not to proceed with it?
• Been the subject of any civil action which has resulted in a finding against you or it by a court?
• Knowingly been the subject of an investigation into allegations of misconduct or malpractice in connection with any business activity?

Has any company, partnership, or unincorporated association of which you are or have been a controller, director, partner, manager or company secretary, in the UK or elsewhere, at any time during your involvement:

• Been put into liquidation, had a petition presented, or a meeting summoned to consider a resolution, to wind up the company, or been wound up, had a petition for bankruptcy presented, or been declared bankrupt?
• Ceased trading in circumstances in which one or more creditors did not receive full payment, had a receiver or administrator appointed, or entered into (or made any proposal to enter into) any arrangement with creditors, or made a trust deed for creditors, or been dissolved?

Have you ever, or has any company, partnership, or unincorporated association of which you are or have been a controller, director, partner, manager or company secretary, in the UK or elsewhere, at any time during your involvement:

• Been adjudged by a court liable for any fraud, misfeasance, wrongful trading or other misconduct towards a Regulatory Authority or towards any members or creditors of a Regulatory Authority?
• Been investigated by an inspector appointed under companies or any other legislation, or required to produce books and papers to the Secretary of State?