Application for Consent Orders Kit - Community Law

APPLICANTRESPONDENT1135Interest in any Name of businessName of businessbusiness (giveyour bestestimate of thegross marketvalue) Your % share Your % shareValue of your share $ Value of your share $36Investmentsincludingshares inpubliccompaniesName and type of investmentNumber shares held/Your % shareName and type of investmentNumber shares held/Your % shareValue $ Value $Name and type of investmentName and type of investmentNumber shares held/Your % shareNumber shares held/Your % shareValue $ Value $37Life insurancepolicesCompanyCompanyPolicy No.Policy No.Surrender value of your share $ Surrender value of your share $38Interest in anyother property,including inany leasedpropertyGive detailsGive detailsValue of your share $ Value of your share $Give detailsGive detailsValue of your share $ Value of your share $39TOTAL VALUEOF PROPERTYOWNED BYYOU$ $Write this amount at Item 48A on page 13 Write this amount at Item 48C on page 13