The Insolvency Service 
Investigations and Enforcement Services Breach Questionnaire
Use this form if you wish to report:
  • a disqualified director who is breaching a disqualification order
  •  
  • an individual breaching bankruptcy or debt relief restrictions
  •  
  • a company / business re-using a prohibited name
Before you complete this form please read the following to find out what we do and other useful information:

For breaches of restrictions or a disqualification order

For companies / businesses re-using a company name

Please provide as much of the information asked for as you can, as this will give us the best start to considering your complaint and where we might go for further details. We appreciate that you may not be able to provide everything requested, but any information you give will greatly help any enquiries that may be undertaken into your allegations.

Fields with an asterisk (*) must be completed to submit the form.

Details

Name of bankrupt / disqualified director / person complained of *
Name & address of company they are involved with (if applicable)
Company name
Company registered number
You can find the company's number using the Companies House Register.
Website
Address
 
 
 
 
Postcode
 
Is the above named company still trading?

Are you are giving the following information on behalf of a partnership or company?

If YES, please complete the following information
Business name
 
 
Type of Business (e.g. company/partnership)
Your position in the business (e.g. director/partner/manager)
Business address (if different from above)
Address
 
 
 
 
Postcode
 

Are you, the partnership or your company owed any money by the company in which the (bankrupt / disqualified) director is involved?


If YES, how much?
Were any representations made by the bankrupt / disqualified director in order to obtain credit, either by writing or verbally?
 
If either you, your partnership or your company are not a creditor, how has information that an undischarged bankrupt/disqualified individual is involved in the management of
a limited company been brought to your attention?
 
 
What are your reasons for believing that the individual has taken part in the company's management or otherwise directed its affairs?
 

Are you in possession of any letters or other documents signed by or on behalf of the bankrupt/disqualified individual in connection with the company's affairs?


Are you aware of any other persons who can support what you have to say? If yes please supply their details
First name
Last name
Address
 
 
 
 
Postcode
 



About you


You are able to submit your complaint anonymously, however if you do so, we will not be able to contact you if further information is needed.

If you provide your email address, a copy of your complaint will be forwarded to you on submission.


Please provide your full name and address, telephone number and email
First name *
Last name *  
Address *
 
 
 
 
 
Postcode *
 
Email *
 
 
Telephone *
 
In the event that the matter leads to legal proceedings for prosecution, would you be prepared to act as a witness, possibly including appearance in court to give evidence? *

If you would like to attach any electronic documents in support of this form please use the Choose File buttons below.

Each file must be one of the following doc, docx, xls, xlsx, txt, pdf, png, jpg, jpeg, odt and the size of each file must not exceed 3MB in size.

File 1
 
File 2
 
 
File 3
 
 
File 4
 
 
File 5
 

Please use this space to supply any further information



   

Your data will be handled in accordance with our Personal Information Charter