Right to Acquire Scheme:

Insolvency Declaration

This declaration must be completed by each applicant entering their name onto the Right to Acquire application form (RTA1).

Please tick the box that applies:

1. Do you have a bankruptcy petition pending against you? YES NO 2. Are you an undischarged bankrupt? YES NO Have you made a composition or arrangement with your creditors (if any) and not yet fulfilled YES NO the terms of the composition or arrangement?

Name:

Address:

Signature:

Date:

IMPORTANT NOTE:

You must inform us if the answer to any of these questions changes before you complete the purchase.