FCIM220060 - Where CDF offer is made 30 June 2014 onwards: appendices: appendix 6 - CDF report adoption certificate

Sample form - do not use

TO: HM REVENUE & CUSTOMS

On 鈥︹�︹�︹�︹�︹�︹�︹�� I accepted HM Revenue and Customs offer to enter into the Contractual Disclosure Facility and submitted my Outline Disclosure on *鈥︹�︹�︹�︹�︹�︹�︹��/the same day (* delete as appropriate).

I confirm that I have seen Code of Practice 9, which incorporates the HMRC Investigation of Fraud Statement and that I have read and understood this.

I have also read and examined the Report dated 鈥︹�︹�︹�︹�︹�︹�� prepared on my instructions by 鈥︹�︹�︹�︹�︹�︹�︹�︹�� 鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�nd adopt it as my full disclosure in accordance with the HMRC Investigation of Fraud Statement and practice outlined in Code of Practice 9.

I certify that, to the best of my knowledge and belief:

a. the statements, figures and schedules in the Report are true and correct

b. the Report incorporates a complete statement of my assets and liabilities as at鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹��

c. the Report incorporates a complete schedule of bank accounts operated by me from鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�o鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹��

d. the Report incorporates a complete schedule of credit and debit cards operated by me from鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�o鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹��..

e. the Report includes all facts which have any reference to all taxes and duties to which I am or have been liable and which I have caused to be evaded, both for my own benefit or that of others including any corporate entities

f. the Report, together with returns already made to HMRC, contains a full disclosure of all taxed and duties due to HMRC for the period from鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�o鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�� for the following persons and entities 鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹��

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FALSE STATEMENTS MAY RESULT IN A CRIMINAL INVESTIGATION WITH A VIEW TO PROSECUTION