QU OF NT AT A FE RU

BERMUDA

LEGAL EXECUTIVES (REGISTRATION) REGULATIONS 2013

BR 76 / 2013

PART IAPPLICATION

TO: The Registrar-General I hereby make application for the entry of the following additional qualifications granted since the entry of my name in the Register of Legal Executives maintained by the Registrar- General under section 6 of the Legal Executives (Registration) Act 2011, and I do hereby declare that to the best of my information and belief the particulars hereunder are true: Dated this day of 20.. Signature of Applicant

PART IIPARTICULARS TO BE FURNISHED BY APPLICANT

1. Full name

2. Details of any professional degrees, diplomas or other qualifications awarded since

registration (with dates of grant).

Made this 19th day of August 2013

Attorney General and Minister of Legal Affairs