Please ensure this form is placed at the top of your application, if
posted to Companies House, and the Company Name is consistent
throughout all documents
CIC 36
Declarations on Formation of a
Community Interest Company1
Please Company Name in
complete full
in
typescript
, or in
bold black
capitals. Community Interest Company
SECTION A: COMMUNITY INTEREST STATEMENT – beneficiaries
1. We/I, the undersigned, declare that the company will carry on
its activities for the benefit of the community, or a section of the
community2. [Insert a short description of the community, or
section of the community, which it is intended that the company
will benefit below ]3
The company’s activities will provide benefit to ...
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COMPANY NAME
SECTION B: Community Interest Statement – Activities & Related Benefit
Please indicate how it is proposed that the company’s activities will benefit the
community, or a section of the community. Please provide as much detail as
possible as to what the company is being set up to do. It would be useful if you
were to explain how you think your company will be different from a commercial
company providing similar services or products for individual or personal gain.
Activities How will the activity benefit the community?
(Tell us here what the (The community will benefit by…)
company is being set up to
do)
If the company makes any surplus, it will be used for … (If donating or fundraising for
charities, please include the wording ‘with the consent of the CIC Regulator’)
(Please continue separate sheet if necessary.)
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COMPANY NAME
SECTION C:
1. We/I, the undersigned, declare that the company in respect of which this
application is made will not be:
(a) a political party;
(b) a political campaigning organisation; or
(c) a subsidiary of a political party or of a political campaigning
organisation.4
SECTION D:
If this section is not completed your application will be rejected.
TYPED NAMES ARE NOT ACCEPTABLE AND WILL BE REJECTED
Each
person who Signed Date
is a director
of the Signed Date
company
must sign
Signed Date
the
declarations.
Signed Date
[Signed, Signed Date
scanned or
DocuSign Signed Date
signatures
are allowed.] Signed Date
Signed Date
Signed Date
Signed Date
You do not have to give any
contact information in the box
opposite but if you do, it will
help the Registrar of Companies to
contact you if there is a query
on the form. The contact Email: Tel
information that you give will be
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visible to searchers of the public DX Number DX Exchange
record.
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CHECKLIST
ALL Applications
Have the first directors signed the CIC36? (typed names instead of
signatures are not accepted)
Is the company name consistent throughout?
Hardcopy Applications only
This form must be posted with the following documents:
(a) Memorandum of Association
(b)Articles of Association, which comply with CIC legislative requirements
(c) Form IN01- indicating that the proposed company is adopting bespoke
articles.
(d)Any completed continuation sheets
(e) A cheque or postal order for £86 made payable to Companies House
When you have completed and signed this form, please ensure it is placed at the
top of your application and send it to the Registrar of Companies at:
For companies registered in England, Scotland, Wales and Northern Ireland:
New Companies Section, Companies House, Crown Way, Cardiff, CF14 3UZ
DX 33050 Cardiff
NOTES
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1 This form will be placed on the public record. Any information relevant to the application that
you do not wish to appear on the public record, should be described in a separate letter addressed
to the CIC Regulator and delivered to the Registrar of Companies with the other documents.
2 The community interest test is referred to in section 35 of the Companies (Audit, Investigations
and Community Enterprise) Act 2004 and is expanded upon in regulations 3, 4 & 5 of the
Regulations.
3 E.g. “the residents of Oldtown” or “those suffering from XYZ disease”.
4 A company is not eligible to be formed as a community interest company if it will be an
“excluded company”. If you are not sure whether the company which you wish to form falls
into any of these categories, you should refer to the definitions of the terms “political party”,
“political campaigning organisation” and “subsidiary” (and of the related terms “election”,
“governmental authority”, “public authority” and “referendum”) in Regulation 2 of the
Regulations before completing this form.
