LDF and Swiss-UK Tax Agreement 
Section B 
Name: 1, (BLOCK CAPITALS) 
(for and on behalf of the Relevant Person) 
Principal permanent residential address of the signatory: 
s w«(BLOCK CAPITALS) 
Date of birth of signatory:........................... 
Status. sss eee (Parent, Guardian, Power of Attorney) 
Signature... ee 
DEE 
Please also attach: 
(1) proof of your identity and (2) proof of your principal permanent residential address in the form of 
a copy of (1) your passport and (2) a recent credit card or utility bill, valid driving licence, etc (PO 
Box or 'care of' addresses are not permitted) 
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