Settlement deed application form

When completing this application, please provide all the required information. If we do not have the required information we will not be able to progress the application. For further clarification or assistance on how each area should be completed, please refer to the settlement deed help guide. This will help ensure that your application can be considered as quickly as possible. When sending supporting documentation, please provide originals or copies certified by a solicitor or other appropriately qualified person. Contact details
First person 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 Title First name Middle name Surname Telephone number (day) Telephone number (evening) Email address (if applicable) Address of the building which would benefit from the settlement deed Second (if joint applicant)

Go to Section 1

Section 1 Interest in building

What interest do you have in the building to which the application relates? (Please select only one option) 1.1 1.2 1.3 1.4 A private individual A company A partnership Other organisation or unincorporated body Go to Section 2 Go to Section 3 Go to Section 4 Go to Section 5

Section 2 A private individual

2.1 Postal address (if different from the building address set out above)

Go to Section 6

Section 3 A company
3.1 3.2 3.3 Company name Company number Registered address

3.4

How the company will sign the settlement deed Go to Section 6

Section 4 A partnership
4.1 4.2 Name of the partnership List of partners

4.3

Principal address

4.4

How the partnership will sign the settlement deed Go to Section 6

Section 5 Other organisation or unincorporated body

5.1 5.2 How the organisation should be designated Principal address

5.3

How the organisation will sign the settlement deed Go to Section 6

Section 6 Address for service of notifications

6.1 Postal address

Continued overleaf

How your personal information will be used

Thames Water Utilities Limited and its agents will use your personal information solely for the purpose of processing your application for a settlement deed. The personal information you have provided in your responses to this questionnaire will be used only for the purpose of the Thames Tideway Tunnel project and in accordance with the Data Protection Act 1998. We will not disclose your information to other organisations except to prevent fraud or if required to do so by law. While we are considering the application we will make a copy of your documents and supporting evidence and return your documents to you.

Declaration
I / we understand that you will use the information I have provided on this form to determine my application for a settlement deed. I declare that the information I have given on this form is correct and complete. I understand that if I knowingly give information that is incorrect in order to secure financial gain, I may have court action taken against me. Signature of the applicant(s): Date: Send completed application forms, along with supporting evidence to: Settlement Deed Administrator Thames Tideway Tunnel The Point 37 North Wharf Road London W2 1AF

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