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ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff00040000002701ffff030000000000}}}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 
\par \ltrrow}\trowd \irow0\irowband-1\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf17 \clbrdrl
\brdrs\brdrw20\brdrcf17 \clbrdrb\brdrs\brdrw20\brdrcf17 \clbrdrr\brdrs\brdrw20\brdrcf17 \clcbpat18\cltxlrtb\clftsWidth3\clwWidth9242\clcbpatraw18 \cellx9134\pard\plain \ltrpar
\ql \li0\ri0\sb120\sa120\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstrow\tscfirstcol\yts15 \rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 
\b\f31506\fs22\cf20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\fs32\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid6685646 C}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\f1\fs32\lang2057\langfe2057\langfenp2057\insrsid9261783 are 17³Ô¹ÏÍø Wales \endash  Bank}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\fs32\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid6685646  reference}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\f1\fs32\lang2057\langfe2057\langfenp2057\insrsid9261783 
\par }\pard \ltrpar\ql \li0\ri0\sb120\sa120\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid13457853\tscfirstrow\tscfirstcol\yts15 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\f1\fs32\lang2057\langfe2057\langfenp2057\insrsid9261783 Organisation Applicant}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\fs32\lang2057\langfe2057\langfenp2057\insrsid13457853  }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f1\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13457853 (to be used by all provider types, }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f1\lang2057\langfe2057\langfenp2057\insrsid13457853 except }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\f1\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13457853 individuals)\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 
\ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 \trowd \irow0\irowband-1\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb
\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf17 \clbrdrl
\brdrs\brdrw20\brdrcf17 \clbrdrb\brdrs\brdrw20\brdrcf17 \clbrdrr\brdrs\brdrw20\brdrcf17 \clcbpat18\cltxlrtb\clftsWidth3\clwWidth9242\clcbpatraw18 \cellx9134\row \ltrrow}\trowd \irow1\irowband0\ltrrow\ts15\trgaph108\trleft-108\trbrdrt
\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth3227\clcbpatraw21 \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat21\cltxlrtb\clftsWidth3\clwWidth6015\clcbpatraw21 \cellx9134\pard\plain \ltrpar\ql \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzodd\yts15 \rtlch\fcs1 
\ab\af31507\afs22\alang1025 \ltrch\fcs0 \b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab0\af0\afs20 \ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13457853 Name of Bank}{\rtlch\fcs1 
\ab0\af0\afs20 \ltrch\fcs0 \f1\fs28\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13457853 \cell }\pard\plain \ltrpar
\ql \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscbandhorzodd\yts15 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 
{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\fs28\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid6685646 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 \trowd \irow1\irowband0\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl
\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth3227\clcbpatraw21 \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat21\cltxlrtb\clftsWidth3\clwWidth6015\clcbpatraw21 \cellx9134\row \ltrrow}\trowd \irow2\irowband1\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr
\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3227\clshdrawnil \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6015\clshdrawnil \cellx9134\pard\plain \ltrpar\ql \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzeven\yts15 
\rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 \b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab0\af0\afs20 \ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13457853 Address\cell 
}\pard\plain \ltrpar\ql \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscbandhorzeven\yts15 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\fs28\lang2057\langfe2057\langfenp2057\insrsid9261783 
\par 
\par }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\fs28\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid6685646 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 \trowd \irow2\irowband1\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl
\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3227\clshdrawnil \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6015\clshdrawnil 
\cellx9134\row \ltrrow}\trowd \irow3\irowband2\lastrow \ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth3227\clcbpatraw21 \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat21\cltxlrtb\clftsWidth3\clwWidth6015\clcbpatraw21 \cellx9134\pard\plain \ltrpar\ql \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzodd\yts15 \rtlch\fcs1 
\ab\af31507\afs22\alang1025 \ltrch\fcs0 \b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab0\af0\afs20 \ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13457853 Post code\cell }\pard\plain \ltrpar
\ql \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscbandhorzodd\yts15 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 
{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\fs28\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid6685646 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 \trowd \irow3\irowband2\lastrow \ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl
\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth3227\clcbpatraw21 \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat21\cltxlrtb\clftsWidth3\clwWidth6015\clcbpatraw21 \cellx9134\row }\pard \ltrpar\ql \li0\ri0\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid9261783 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\b\f1\fs28\lang2057\langfe2057\langfenp2057\insrsid9261783 
\par \ltrrow}\trowd \irow0\irowband-1\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf17 \clbrdrl
\brdrs\brdrw20\brdrcf17 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20\brdrcf17 \clcbpat18\cltxlrtb\clftsWidth3\clwWidth9242\clcbpatraw18 \cellx9134\pard\plain \ltrpar
\ql \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstrow\tscfirstcol\yts15 \rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 
\b\f31506\fs22\cf20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\fs32\lang2057\langfe2057\langfenp2057\insrsid9261783 Applicant}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\f1\fs32\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid6685646  details\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 
\ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 \trowd \irow0\irowband-1\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb
\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf17 \clbrdrl
\brdrs\brdrw20\brdrcf17 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20\brdrcf17 \clcbpat18\cltxlrtb\clftsWidth3\clwWidth9242\clcbpatraw18 \cellx9134\row \ltrrow}\trowd \irow1\irowband0\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 
\trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth3227\clcbpatraw21 \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat21\cltxlrtb\clftsWidth3\clwWidth6015\clcbpatraw21 \cellx9134\pard\plain \ltrpar\ql \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzodd\yts15 \rtlch\fcs1 
\ab\af31507\afs22\alang1025 \ltrch\fcs0 \b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13457853 Organisation  Name\cell 
}\pard\plain \ltrpar\qc \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscbandhorzodd\yts15 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b\f1\fs28\lang2057\langfe2057\langfenp2057\insrsid9261783 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 
\trowd \irow1\irowband0\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth3227\clcbpatraw21 \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat21\cltxlrtb\clftsWidth3\clwWidth6015\clcbpatraw21 \cellx9134\row \ltrrow}\trowd \irow2\irowband1\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr
\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3227\clshdrawnil \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6015\clshdrawnil \cellx9134\pard\plain \ltrpar\ql \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzeven\yts15 
\rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 \b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13457853 Address\cell 
}\pard\plain \ltrpar\qc \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscbandhorzeven\yts15 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b\f1\fs28\lang2057\langfe2057\langfenp2057\insrsid9261783 
\par 
\par \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 \trowd \irow2\irowband1\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh
\brdrs\brdrw20\brdrcf17 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3227\clshdrawnil \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth6015\clshdrawnil \cellx9134\row \ltrrow}\trowd \irow3\irowband2\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 
\trbrdrh\brdrs\brdrw20\brdrcf17 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth3227\clcbpatraw21 \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat21\cltxlrtb\clftsWidth3\clwWidth6015\clcbpatraw21 \cellx9134\pard\plain \ltrpar\ql \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzodd\yts15 \rtlch\fcs1 
\ab\af31507\afs22\alang1025 \ltrch\fcs0 \b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13457853 Postcode\cell }\pard\plain \ltrpar
\qc \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscbandhorzodd\yts15 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 
{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b\f1\fs28\lang2057\langfe2057\langfenp2057\insrsid9261783 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 \trowd \irow3\irowband2\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl
\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth3227\clcbpatraw21 \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat21\cltxlrtb\clftsWidth3\clwWidth6015\clcbpatraw21 \cellx9134\row \ltrrow}\trowd \irow4\irowband3\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr
\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3227\clshdrawnil \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6015\clshdrawnil \cellx9134\pard\plain \ltrpar\ql \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzeven\yts15 
\rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 \b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13457853 Type of service 
\par }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b0\f1\fs20\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid9261783 (for example care home service, domiciliary support service) }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 \cell }\pard\plain \ltrpar\qc \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscbandhorzeven\yts15 \rtlch\fcs1 
\af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b\f1\fs28\lang2057\langfe2057\langfenp2057\insrsid9261783 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 
\trowd \irow4\irowband3\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3227\clshdrawnil \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6015\clshdrawnil 
\cellx9134\row \ltrrow}\trowd \irow5\irowband4\ltrrow\ts15\trgaph108\trrh2537\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth9242\clcbpatraw21 \cellx9134\pard\plain \ltrpar
\ql \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzodd\yts15 \rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 
\b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 
\par The above organisation is applying to register}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13640444  to provide a regulated service under the Regulation and }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\b0\f1\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13640444 Inspection}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13640444  of Social Care (Wales) Act 2016.}{\rtlch\fcs1 \af0\afs20 
\ltrch\fcs0 \b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 
\par }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13640444 
\par }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 As part of the registration process the regulator, }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13640444 17³Ô¹ÏÍø}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 
, requires a bank reference in relation to the financial standing of the organisation.
\par 
\par I authorise you to provide 17³Ô¹ÏÍø with an opinion as to our financial standing.
\par }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13640444  \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783\charrsid13640444 \trowd \irow5\irowband4\ltrrow\ts15\trgaph108\trrh2537\trleft-108\trbrdrt
\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth9242\clcbpatraw21 \cellx9134\row \ltrrow}\trowd \irow6\irowband5\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb
\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3227\clshdrawnil \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6015\clshdrawnil 
\cellx9134\pard\plain \ltrpar\ql \li0\ri0\sb120\sa120\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzeven\yts15 \rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 
\b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 Signature}{\rtlch\fcs1 \ab0\af0\afs20 \ltrch\fcs0 
\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 \cell }\pard\plain \ltrpar\ql \li0\ri0\sb120\sa120\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscbandhorzeven\yts15 \rtlch\fcs1 
\af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783\charrsid13640444 
\trowd \irow6\irowband5\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3227\clshdrawnil \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6015\clshdrawnil 
\cellx9134\row \ltrrow}\trowd \irow7\irowband6\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth3227\clcbpatraw21 \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat21\cltxlrtb\clftsWidth3\clwWidth6015\clcbpatraw21 \cellx9134\pard\plain \ltrpar\ql \li0\ri0\sb120\sa120\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzodd\yts15 
\rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 \b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 Print name}{\rtlch\fcs1 \ab0\af0\afs20 
\ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 \cell }\pard\plain \ltrpar\ql \li0\ri0\sb120\sa120\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscbandhorzodd\yts15 
\rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 \cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 
\insrsid9261783\charrsid13640444 \trowd \irow7\irowband6\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth3227\clcbpatraw21 \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat21\cltxlrtb\clftsWidth3\clwWidth6015\clcbpatraw21 \cellx9134\row \ltrrow}\trowd \irow8\irowband7\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr
\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3227\clshdrawnil \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6015\clshdrawnil \cellx9134\pard\plain \ltrpar
\ql \li0\ri0\sb120\sa120\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzeven\yts15 \rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 
\b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 Date}{\rtlch\fcs1 \ab0\af0\afs20 \ltrch\fcs0 
\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 \cell }\pard\plain \ltrpar\ql \li0\ri0\sb120\sa120\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscbandhorzeven\yts15 \rtlch\fcs1 
\af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783\charrsid13640444 
\trowd \irow8\irowband7\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3227\clshdrawnil \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6015\clshdrawnil 
\cellx9134\row \ltrrow}\trowd \irow9\irowband8\lastrow \ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth3227\clcbpatraw21 \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat21\cltxlrtb\clftsWidth3\clwWidth6015\clcbpatraw21 \cellx9134\pard\plain \ltrpar\ql \li0\ri0\sb120\sa120\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzodd\yts15 
\rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 \b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b0\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 Position in organisation \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sb120\sa120\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\pararsid9261783\tscbandhorzodd\yts15 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783\charrsid13640444 
\trowd \irow9\irowband8\lastrow \ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf17 \trbrdrl\brdrs\brdrw20\brdrcf17 \trbrdrb\brdrs\brdrw20\brdrcf17 \trbrdrr\brdrs\brdrw20\brdrcf17 \trbrdrh\brdrs\brdrw20\brdrcf17 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid13457853\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth3227\clcbpatraw21 \cellx3119\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\clcbpat21\cltxlrtb\clftsWidth3\clwWidth6015\clcbpatraw21 \cellx9134\row }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid9261783 {\rtlch\fcs1 \af1 \ltrch\fcs0 
\b\f1\insrsid13457853\charrsid13457853 Important:}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid13457853\charrsid13457853 
 We process any personal and/or sensitive information we hold about you fairly and lawfully, and we only ask for such information where it is necessary for us to carry out our role. For more information about how we process your personal
 data, and your rights in relation to this, please see our Privacy Notice at }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid1182992  HYPERLINK "https://careinspectorate.wales/how-we-use-your-information" }}{\fldrslt {\rtlch\fcs1 
\af1 \ltrch\fcs0 \cs22\f1\ul\cf22\insrsid13457853\charrsid13457853 https://careinspectorate.wales/how-we-use-your-information}}}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid9261783\sftnbj {
\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid13457853\charrsid13457853 , or contact us for a paper copy.}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13457853 \page 
\par }\pard \ltrpar\qc \li0\ri0\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0\itap0\pararsid9261783 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \b\f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid13640444 
\par \ltrrow}\trowd \irow0\irowband-1\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat18\cltxlrtb\clftsWidth3\clwWidth9242\clcbpatraw18 \cellx9134\pard\plain \ltrpar
\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9261783\tscfirstrow\tscfirstcol\yts15 \rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 
\b\f31506\fs22\cf20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af1\afs28 \ltrch\fcs0 \f1\fs28\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid16535421 To be completed by bank\cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 
\insrsid9261783 \trowd \irow0\irowband-1\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat18\cltxlrtb\clftsWidth3\clwWidth9242\clcbpatraw18 \cellx9134\row \ltrrow}\trowd \irow1\irowband0\ltrrow\ts15\trgaph108\trrh902\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth9242\clcbpatraw21 \cellx9134\pard\plain \ltrpar
\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzodd\yts15 \rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 
\b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid16535421 Please use the space below to detail the bank}{\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 \rquote }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid16535421 s opinion on the financial standing for the }{\rtlch\fcs1 
\af1\afs24 \ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 individual/}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid16535421 organisation detail}{\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783 ed}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\lang2057\langfe2057\langfenp2057\insrsid9261783\charrsid16535421  above\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 
\trowd \irow1\irowband0\ltrrow\ts15\trgaph108\trrh902\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth9242\clcbpatraw21 \cellx9134\row \ltrrow}\trowd \irow2\irowband1\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 
\trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9242\clshdrawnil \cellx9134\pard\plain \ltrpar
\ql \li0\ri0\sb120\sa1440\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzeven\yts15 \rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 
\b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\lang2057\langfe2057\langfenp2057\insrsid9261783 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 
\trowd \irow2\irowband1\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9242\clshdrawnil \cellx9134\row \ltrrow}\trowd \irow3\irowband2\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr
\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth9242\clcbpatraw21 \cellx9134\pard\plain \ltrpar
\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzodd\yts15 \rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 
\b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\lang2057\langfe2057\langfenp2057\insrsid9261783 Signature\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 
\trowd \irow3\irowband2\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth9242\clcbpatraw21 \cellx9134\row \ltrrow}\trowd \irow4\irowband3\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 
\trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9242\clshdrawnil \cellx9134\pard\plain \ltrpar
\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9261783\tscfirstcol\tscbandhorzeven\yts15 \rtlch\fcs1 \ab\af31507\afs22\alang1025 \ltrch\fcs0 
\b\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\lang2057\langfe2057\langfenp2057\insrsid9261783 Print name\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid9261783 
\trowd \irow4\irowband3\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth9242\clshdrawnil \cellx9134\row \ltrrow}\trowd \irow5\irowband4\ltrrow\ts15\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr
\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tscbandsh1\tscbandsv1\tblrsid9261783\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat21\cltxlrtb\clftsWidth3\clwWidth9242\clcbpatraw21 \cellx9134\pard\plain \ltrpar
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