PAYMENT AUTHORITY

REPAYING FUNDS TO RESTORED COMPANIES (BVC 15)

(Majority of the company officers must complete this form)

Please use this key to complete all sections of the payment authority

(1) full name(s) of company officer(s)

(2) full residential address(es) of company officer(s)
(3) company name
(4) company number
(5) registered office address of the company
(6) date of dissolution
(7) date of restoration

PERSONAL DETAILS

I/WE

(1) Full Name(s) Kiran Sabharwal And Varsha Sabharwal of

(2) Residential Address(es) 118 Hinton Avenue, Hounslow, Middlesex, TW46AP

DO SOLEMNLY AND SINCERELY STATE the following:-

A. (3) Goldpine Estates Limited is registered at Companies House under company number (4)
03611720 and with the registered office address of (5) Hinton Avenue, Hounslow, Middlesex, TW46AP

B. (3) Goldpine Estates Limited was dissolved on (6)_22/01/2019 and subsequently restored to the
Register on (7)_06/03/2019

C. We form the majority of the officers of (3 Goldpine Estates Limited and we have full authority to
make this request.

D. We confirm that the company does not have an open account in its own name with a bank or other
similar financial institution at the date of the request.

E. We are requesting that the Treasury Solicitor pays the funds due to the dissolved company to a third
party for the following reason (s): (please state briefly below why you are requesting a third party
payment)__Goldpine Estates does not currently have an acive bank account and payment is required
to be made to third parties for legal works under normal business procedure. Our solicitor will be
making these payments on our behalf until the bank accounts are restored.

NB. please attach separate sheets if necessary

F .We would like the cheque to be made payable to March and Bloom Law Limited
and sent to the following address: 35 Maclise Road, London W140PR

G. We acknowledge and accept that any payment made in this way is for the restored company’s convenience
and at its sole risk.

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H. We have provided identity in accordance with the requirements set out below under “Proof of
Identity.”

Full Name(s) and position(s) within the company:_Kiran Sabharwal

Signed:_

Date:10/03/2019

Proof of Identity

1. We will need to see satisfactory proof of identity for each of the applicants. Please see the
checklist entitled “Acceptable Proof of Identity” which you can download from our website.

2. Please send identity documents certified as true copies by a practising solicitor or by the Post
Office ID Checking Service. Where the applicant is resident outside of England and Wales, the
documents can be certified by a Notary Public and Apostilles registered in their country of
residence.

3. The person certifying the documents must sign and date them, and must print their full name,
business name and business address. They must also provide us with details of a publicly
accessible website which we can check to confirm their status.