CERTIFICATES REPRESENTING EQUITY SECURITIES IN PUBLIC HANDS STATEMENT INFORMATION

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CERTIFICATES REPRESENTING EQUITY SECURITIES IN PUBLIC HANDS STATEMENT

Information provided on this form must be typed or printed electronically.

(Note: Italicised terms have the same meaning as given in the Listing Rules.)

To: The FCA

Date: _________________20__

Name of applicant:
Description of security:
Total number of securities to be admitted:
Name of advisor* (if applicable):

Summary of holdings:
	Percentage of issued certificates representing equity securities
Certificates representing equity securities in public hands (EEA States):
Certificates representing equity securities in public hands (non-EEA States)**
Certificates representing equity securities not in public hands:***
Total	100%
Where less than 25% of the certificates representing equity securities are in public hands, has prior approval been obtained from the FCA?	Yes / No

* - If this confirmation is being submitted by an advisor to the issuer, then a letter of appointment is required with this schedule (unless this has been previously provided to the FCA)

** - see LR18.2.9

*** - see LR18.2.8(4)

SIGNED BY _____________________________________________

Duly authorised officer for and on behalf of:

_______________________________________________

Name of advisor or name of applicant

If you knowingly or recklessly give false or misleading information you may be liable to prosecution.

APPLICATION FOR AN UNABRIDGED DEATH CERTIFICATE UNABRIDGED DEATH CERTIFICATES
APPLICATION FOR MULTIPLE LOAD LINE CERTIFICATES DATE TO
CERTIFICATES REPRESENTING EQUITY SECURITIES IN PUBLIC HANDS STATEMENT INFORMATION

Tags: certificates representing, the certificates, equity, representing, hands, statement, information, certificates, securities, public

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