On behalf of: Applicant By: [insert name] No: 1 Exhibits: [insert details] Date: [insert date] Filed: [insert date] Court Reference No:[ INSERT COURT REF. NUMBER] [ IN THE HIGH COURT OF JUSTICE BUSINESS AND PROPERTY COURTS[ OF ENGLAND AND WALES][ IN [INSERT LOCATION]] [ INSOLVENCY AND COMPANIES LIST (ChD)] OR [ IN THE HIGH COURT OF JUSTICE [CHANCERY DIVISION ] In the matter of [Insert company name] And In the matter of the companies act 2006 Statement of [Insert full name] I, [Insert full name], [insert role/job title] of [insert company name] of [insert address] Do state as follows: 1 Introduction I am the [insert role or job title] of [insert company name] (the Company), having been appointed on [insert date]. I have been the officer of the Company most closely connected with the proposal that is the subject of this witness statement. The facts and matters to which I refer in this witness statement are either within my own knowledge and are true, or derived from the sources to which I refer below, in which case they are true to the best of my information