Bolero Association Ltd and
Bolero International Ltd

Enrolment Application

Please follow the instructions in this form and the Enrolment Guide to assist you in completing this form.

Part 1: User Information

Please fill out the form below with information about your company. Note: The information that you provide must be accurate.

Information to be certified:

The company signing in Box A below hereby requests Bolero International Limited to issue a certificate based on the following information:

Name of your company

Registration number of your company
(If registration numbers are issued in your jurisdiction)

In which country, state, or province is your company incorporated?

Company telephone number (Please include the international dialling code)

Company Fax number

Registered address of your company




Please enter the name and company title of the person(s) authorised to sign Box A on behalf of your company. (That person(s) is termed the Primary Representative(s).)

Name:

Title:

E-mail address:

Please complete this information if your company requires two persons to act as Primary Representatives.

Name:

Title:

E-mail address:

Which interface software will you be using to access the Bolero System?

Contact Name details:
If the form is completed on behalf of the Primary Representative, this information lets us know who to contact if we have questions. We do not disclose this information except within the Bolero Association and Bolero International.

Name:

Department:

E-mail address:

Telephone number (Please include the international dialling code)

Part 2: Signing

Having completed part 1 above, please do the following:

  1. Print a copy of this form.
  2. Please attach the signed Request for a USER Certificate to this form
  3. Have the authorised person(s) sign Box A below.
  4. Please ensure you follow instructions for the Enrolment Process you have chosen.

Box A
Declaration and Assent to Incorporated Contracts

The undersigned company:

  1. Confirms that the information contained in this document is true and correct;
  2. Enters into the BAL Service Contract which is incorporated into this document;
  3. Shall comply with the terms of the Bolero Rulebook which is incorporated into this document;
  4. Confirms its agreement that any questions arising in relation to the document shall be determined in accordance with English law and jurisdiction;
Company Name:
Signature:Signature:(if required):
Print name:Print name:
Title:Title:
Date:Date:

Please send these documents by mail (or courier service) to:

Bolero Association Limited
Stirling Building,
Hersham Place Technology Park,
Molesey Road,
Walton-on-Thames,
Surrey,KT12 4RZ
United Kingdom

If you have any enrolment related questions please feel free to contact:

Bolero support: +44 (0)20 7759 7030
support@bolero.net