<FormSubmission xmlns="http://xmlgw.companieshouse.gov.uk/Header" xmlns:bs="http://xmlgw.companieshouse.gov.uk" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://xmlgw.companieshouse.gov.uk/Header http://xmlgw.companieshouse.gov.uk/v1-0/schema/forms/FormSubmission-v2-11.xsd">
  <FormHeader>
    <CompanyNumber>11111111</CompanyNumber>
    <CompanyName>EXAMPLE COMPANY</CompanyName>
    <CompanyAuthenticationCode>222222</CompanyAuthenticationCode>
    <PackageReference>9999</PackageReference>
    <FormIdentifier>ConfirmationStatement</FormIdentifier>
    <SubmissionNumber>000-033764</SubmissionNumber>
  </FormHeader>
  <DateSigned>2022-01-26</DateSigned>
  <Form>
    <ConfirmationStatement xmlns="http://xmlgw.companieshouse.gov.uk" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://xmlgw.companieshouse.gov.uk http://xmlgw.companieshouse.gov.uk/v1-0/schema/forms/ConfirmationStatement-v1-2.xsd">
      <ReviewDate>2016-09-18</ReviewDate>
      <SICCodes>
        <SICCode>15200</SICCode>
        <SICCode>41100</SICCode>
      </SICCodes>
      <StatementOfCapital>
        <Capital>
          <TotalAmountUnpaid>0</TotalAmountUnpaid>
          <TotalNumberOfIssuedShares>100</TotalNumberOfIssuedShares>
          <ShareCurrency>GBP</ShareCurrency>
          <TotalAggregateNominalValue>100</TotalAggregateNominalValue>
          <Shares>
            <ShareClass>ORDINARY</ShareClass>
            <PrescribedParticulars>ORDINARY SHARES WITH EACH SHARE BEING ENTITLED TO ONE VOTE IN ANY CIRCUMSTANCES AND PARI PASSU TO DIVIDEND PAYMENTS, EACH SHA
RE IS ENTITLED TO PARTICIPATE IN A DISTRIBUTION ARISING FROM A WINDING UP OF THE COMPANY</PrescribedParticulars>
            <NumShares>100</NumShares>
            <AggregateNominalValue>100</AggregateNominalValue>
          </Shares>
        </Capital>
      </StatementOfCapital>
      <Shareholdings>
        <ShareClass>ORDINARY</ShareClass>
        <NumberHeld>10</NumberHeld>
        <Shareholders>
          <Name>
            <Surname>CONGRESSPERSONLIQUOR</Surname>
            <Forename>JACKET</Forename>
          </Name>
        </Shareholders>
      </Shareholdings>
      <Shareholdings>
        <ShareClass>ORDINARY</ShareClass>
        <NumberHeld>80</NumberHeld>
        <Transfers>
          <DateOfTransfer>2016-01-01</DateOfTransfer>
          <NumberSharesTransferred>10</NumberSharesTransferred>
        </Transfers>
        <Shareholders>
          <Name>
            <Surname>CONGRESSPERSONLIQUOR</Surname>
            <Forename>FAXRIVULET</Forename>
          </Name>
        </Shareholders>
      </Shareholdings>
      <Shareholdings>
        <ShareClass>ORDINARY</ShareClass>
        <NumberHeld>10</NumberHeld>
        <Shareholders>
          <Name>
            <Surname>CONGRESSPERSONLIQUOR</Surname>
            <Forename>LEWIS</Forename>
          </Name>
        </Shareholders>
      </Shareholdings>
      <StateConfirmation>true</StateConfirmation>
    </ConfirmationStatement>
  </Form>
</FormSubmission>