Board nomination form

Structure Wellness Limited
FCA registration no. 9648
8 Stevenson Square, Manchester, M1 1FB

For election to the Board of Structure Wellness Limited at the general meeting on

1. Nominee

Full name

Member no.

Email or phone

Address

I confirm that:

I am a member of the society aged 16 or over

I am not disqualified by law from acting as a director

I am not an undischarged bankrupt

I am not disqualified from acting as a charity trustee

No Connected Person (family, household or business associate) of mine serves on the Board

List any directorships, senior roles or business interests that could create a conflict of interest (Rule 85).

I consent to stand for election and, if elected, agree to sign and follow the Board's code of conduct (Rule 64).

Signature

Date

Proposer (member) name

Signature

Seconder (member) name

Signature

Date received

Membership checked by

Structure Wellness Limited · Community Benefit Society · FCA no. 9648