To Invoice Discounting Operations HSBC Invoice Finance (UK) Ltd Cannon House 23-29 Chatsworth Road Worthing BN11 1NA

BN11 1 uwave NA

From

Client name*

Client number*

Please complete all the mandatory boxes on the form (marked with*) and attach all the required documentation in order for us to process the claim effectively. Please sign and return to ifc.mail@hsbc.com.

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Customer registered name*

Customer account number*

Trading name* (if different)

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Customer VAT number ___

Customer contact name* Customer tel. number*

Customer mobile number ___

Balance outstanding* ___

Customer trading terms*

Customer reg. number (if Limited company)*

Customer email address*

Customer address*

Please take responsibility for collection of this debt. We understand that our agency arrangement to collect the debt has ended and further collection activity may involve legal proceedings. We confirm that, for the purpose of any such proceedings, the information and the documentation supplied is true and accurate. We also confirm that we have given notice to the above customer that all unpaid debts owing by it have been assigned to you.