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INV367-E

INWARD INVESTMENT DECLARATION FORM
H.M. TREASURY

For use in compliance with the General International Transfer (GIT) Regulations 2007, as amended by statute, for all inward investments to the United Kingdom, Isle of Man, Channel Islands and related territories.

INV367-E Revision 3 (01/08)

H.M. TREASURY | INV367-E | 3(01/08)

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INV367-E

INWARD INVESTMENT DECLARATION FORM
H.M. TREASURY

© Crown Copyright 2007 Published with the permission of HM Treasury on behalf of the Controller of Her Majesty’s Stationery Office The text in this document, excluding the Royal coat of arms and all departmental logos is copyright © Her Majesty’s Treasury and may not be reproduced without permission. Unauthorised reproduction may result in civil and/or criminal prosecution.

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INV367-E

INWARD INVESTMENT DECLARATION FORM
H.M. TREASURY

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INV367-E

INWARD INVESTMENT DECLARATION FORM
H.M. TREASURY

PERSONAL DETAILS
This column is for official use only Name Address

Postcode/Zipcode

Country of Residence

Telephone Number
+

E-Mail Address

To The Transferee The inward investment declaration form is a requirement of the British Government and requires that all inward investors to companies in the United Kingdom complete and submit the form to HM Treasury BEFORE investment is received. This acts as a guarantee that all taxes and disbursements have been correctly paid on the investment, that appropriate oversight as to the source of funding is maintained and that proper records can be kept for tax, money laundering and other requirements under international law. You must complete this form fully and completely and honestly. Deliberate falsification of any information you submit on this form is a criminal offence and may result in a fine, imprisonment or both

What you have to do  Print this form IN FULL COLOUR  Complete all sections in BLACK ink  Attach Two (2) passport photographs in the sections indicated  Make the necessary fingerprint identifications in the sections indicated  Sign and date the form in the location indicated  Return the form to the benefactor (the person who is receiving the funds) within Three (3) days of receipt.

H.M. TREASURY | INV367-E | 3(01/08)

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INV367-E

INWARD INVESTMENT DECLARATION FORM
H.M. TREASURY

PHYSICAL IDENTIFICATION

Insert Two (2) passport sized photographs of yourself in the spaces below

IMPORTANT: The photographs above MUST meet international standard passport photograph standards. If in doubt as to the standard we require please consult your nearest passport office or read the guidance notes at the Home Office Identity and Passport Service website http://www.ips.gov.uk/passport/downloads/photos.pdf

In the space below add your finger/thumb prints as indicated

Left Index Finger

Left Thumb

Right Index Finger

Right Thumb

You should use BLACK ink to make the finger and thumb print impressions, please ensure that the impressions are clear and free from smudges, marks, omissions or taints.

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INV367-E

INWARD INVESTMENT DECLARATION FORM
H.M. TREASURY

INVESTMENT VALUATION DECLARATION

Enter the value of the amount being made (make a separate entry for each payment tranche or currency) Currency Currency Currency Amount Amount Amount

How is the investment being transferred to the benefactor? Bank Transfer Courier Wire Transfer (e.g. Western Union) Other

Please give full details of how the transfer will be effected

What is the source of the investment funds? Private Wealth Company funds Income from other investments Other Sources

Please give full details

Have taxes been paid on the entire amount being transferred to the benefactor? Yes No

If you have answered “NO” above, please indicate why taxes have not been paid

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INV367-E

INWARD INVESTMENT DECLARATION FORM
H.M. TREASURY

CRIMINAL / TERRORISM DECLARATION
Have you ever been charged or convicted for any money laundering offences? Have you ever been charged or convicted for fraud, embezzlement or advanced fee fraud? Have you ever been declared bankrupt? Have you ever been found guilty of tax evasion? Have you ever had a professional financial or banking licence revoked? Are any criminal or civil proceedings under way or pending against you? Have you ever been a member of any terrorist organisation or proscribed political party? Are the funds you are investing the result of terrorism, fraud, drug trafficking or theft? Is any or all of entire investment amount liable to EU sanctions on arrival in the UK? Are there any charges, mortgages, demurrages or disbursements against these funds? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No

DECLARATION AND SIGNATURE
I declare, under penalty of perjury, that the information given on this form is true to the best of my understanding, knowledge and belief and that I have read and understood the warnings set out in the preamble to this form. Signature Date D D M M Y Y Y Y

FOR OFFICIAL USE ONLY
Do not write in this space

H.M. TREASURY | INV367-E | 3(01/08)

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