SIGNED for and on behalf of
♦
By:

)
)
)

………………………………………………..
Authorised signatory

Name:

Position:

THE COMMON SEAL of
[LOCAL AUTHORITY]
was hereunto
Affixed in the presence of :

)
)
)
)

_____________________________
Authorised Signatory

SIGNED as a DEED by
[PFI CONTRACTOR]
acting by a director
in the presence of:

)
)
)
)

_____________________________

WITNESS

SIGNATURE: ____________________________

NAME:

ADDRESS:

OCCUPATION