Transfer of Application/Registration - NICEIC

NICEICWarwick House, Houghton Hall Park,Houghton Regis, Dunstable, Beds, LU5 5ZXTel: 0870 013 0382 Fax: 01582 556024Registration Number:1 BusinessTransfer of Application/RegistrationTrading name of business registered with NICEIC:Current trading name of business (if different from above):Address:Ref:Post Town:Postcode:Mobile No:County:Telephone No:Fax No:2 Financial statusHas the business been, or about to be, the subject of Receivership, Liquidation, Bankruptcy or anyother provisions of the Insolvency Act 1986 in the past 12 months or arrangement that may breachNICEIC Domestic Installer Scheme rules Relating to Registration Rule 3.1. h. (iii)NoYes3 Type of change required (tick box(es) as applicable)Change in Trading TitleChange in Legal Constitution (e.g. from sole trader to 'limited' status)Partnership Split (agreement of former partner(s) required page 2)Sole trader to Partnership (agreement of all partners required - page 2(Change of Ownership (agreement of former owner(s) required page 2)Company Split (full details to be provided)Amalgamation of CompaniesYesYesYesYesYesYesYes4 Reason(s) for change (please give a brief explanation)5 Details of Qualified SupervisorName of present Qualified Supervisor:Name of previous Qualified Supervisor, if applicable:If the 'present Qualified Supervisor' above is not confirmed in post with us, we will arrange to send you the appropriateApplication Forms for completion and return to the NICEIC Domestic Installer Scheme.

6 Former Partner(s)/Proprietor(s)/Director(s)' AgreementPlease arrange for all former/new Partner(s)/Proprietor(s)/Director(s) of the business to give their consent to the Transfer bycompleting the section below; further contacts to sign consent on continuation page.Name:Signature:Position:Name:Signature:Position:If your transfer involves a partnership split would any of your ex partner(s) wish to apply for NICEICDomestic Installer Scheme registration?YesIf 'yes', please provide names(s) and address(es) and we will arrange to send the appropriate Application Forms:7 Payment DetailsPlease tick asappropriateI/We hereby confirm the current bank information held by NICEIC is no longer valid and enclose our completed DirectDebit MandateI/We hereby confirm the current bank information held by NICEIC remains unchanged and confirm my/our authority tocontinue the use of the existing Direct Debit MandateI/We do not currently pay via Direct Debit. However, we now enclose a completed Direct Debit Mandate & request allfuture payments are cleared via this routeI/We enclose our cheque in settlement of the administration fee in respect of our Request for Transfer of Registrationand request all future invoices are paid via cheque only8 UndertakingI/We declare that the information given on this form is correct. I/We undertake, as a condition of transfer of registration, to complywith the NICEIC Rules for Registration of Domestic Installers as prescribed and published by NICEIC from time to time, and I/Weaccept full responsibility for the work carried out by the business under its former registration:Signature of Proprietor/Principal/Director of the business:Name in BLOCK CAPITALS:Position:Date:For Office UseOffice commentsHead Office recommendation Approve: TrustMark status x/f'dReject:TrustMark status removedHead Office signature:Date: