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BE Mogul
2018 Application Form
Email address *
1. Applicant Information
Title *
Required
First name *
Last name *
Citizenship *
Country of Origin *
Age *
Address *
Postcode *
Do you have a good quality head-and-shoulder photograph, in .jpg format to attach with your application? *
Required
2. Business Information
Please complete this information as you wish them to appear on any literature or publicity
Company name *
Address: *
Post code *
Type of Company *
Required
UTR No./Company No. (If Known)
Nature of Business *
Sector *
Business Start Date *
No. of Employees *
Annual Turnover (Sales) (2017) *
Expected Turnover (Sales) (2021) *
Website: *
Email: *
Telephone number
Brief description of Business: *
Academic Background: *
Please list any awards, accreditation, accolades or recognised achievements, giving a brief quote/testimony from client or any authorities:
How did you get started in this business? *
What has been the highlight of your career? *
What is the best advice you have received? *
What has been the greatest challenge you have faced in business and how have you overcome it? *
What are the most crucial things you have done to grow your business? *
Have you ever been made bankrupt, or been the subject of Debt Settlement, Arrangement or Personal Insolvency Arrangement under the Personal Insolvency Act 2012, made any arrangements with creditors or had any court judgements for debt made against you. *
Required
If they answered Yes, please provide details below:
If they answered No, are you in the process of applying for bankruptcy for 2018? *
Required
If they answered Yes, please provide details below:
Have they ever been convicted of a crime? *
Required
If you answered Yes, please provide details below
Have you ever been convicted of a crime? *
Required
If you answered Yes, explain number of conviction(s), nature of offence(s) leading to conviction(s), how recently such offence(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.
Have you at any time been disqualified from being a Company Director under the Company Director Disqualification Act (1986) *
Required
If you answered Yes, please provide details below
3. Declaration
I certify that the information provided and the statements made by myself are, to the best of my knowledge, true and accurate. I confirm that I have read full Terms and Conditions and agree to abide by them.
Name (Please Print): *
Position: *
Date *
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Please refer to the T&Cs below
A copy of your responses will be emailed to the address you provided.
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