06/17 Version 2.0
Company name in full
In accordance with
Section 853A of the
Companies Act 2006.
What this form is for
You may use this form to conﬁrm
that the company has ﬁled up to
date. You must ﬁle a conﬁrmation
statement at least once every year.
What this form is NOT for
You cannot use this form to tell us
of changes to the company ofﬁcers,
people with signiﬁcant control
(PSC), registered ofﬁce address,
or single alternative inspection
address (SAIL) information.
For further information, please
refer to our guidance at
If you need to make any
• registered ofﬁce address
• single alternative inspection
address (SAIL) and company
• ofﬁcer appointments
• information about people with
You must do this separately
before or at the same time as this
Filling in this form
Please complete in typescript or in
bold black capitals.
Check when your conﬁrmation
statement is due
To check your conﬁrmation
You can make a statement at
any time during the conﬁrmation
period. This will change your next
Please give the conﬁrmation statement date. You must deliver this form within
14 days of this date. Please check your company records for the date of your
y y y y
A fee may be payable with this form
Please see ‘How to pay’ on the last page.
Go online to ﬁle this information
I conﬁrm that all information required to be delivered by the company pursuant
to section 853A(1)(a) of the Companies Act 2006 in relation to the conﬁrmation
period ending on the conﬁrmation date above either has been delivered or is
being delivered with this statement.
If the form is being ﬁled on behalf
of a Societas Europaea (SE) please
delete ‘director’ and insert details
of which organ of the SE the person
signing has membership.
Under either section 270 or 274 of
the Companies Act 2006.
This form may be signed by:
Director , Secretary, Person authorised , Charity commission receiver and
manager, CIC manager, Judicial factor.
Before you start
You can check your company details for free on our online service:
Change to your company information
If you need to make any changes to:
• Part 1 Principal business activities or standard industrial classiﬁcation (SIC)
• Part 2 Statement of capital
• Part 3 Trading status of shares and exemption from keeping a register of
people with signiﬁcant control (PSC)
• Part 4 Shareholder information
Use the additional parts of this form to do this.