BUY SHARES | Ship Portloe

Portloe Community Benefit Society Ltd

I wish to invest in Portloe Community Benefit Society Limited (the Society) on the Terms and Conditions of the Investment Share Prospectus at the price of £1 per Share and thereby becoming a member of the Society.

Please enter the total amount you wish to invest in the Society at the price of £1 per Share. The minimum purchase is £100 i.e. 100 shares and the maximum purchase is £50,000 i.e. 50,000 shares.

For institutions or corporations purchasing shares, please enter their name

For institutions or corporations purchasing shares, please enter the name of the person who shall be holding the members' vote on their behalf.

Member Title

Member name

Member last name

Address Line 1

Address Line 2

Town

County

PostCode

Date of Birth

Day

Month

Year

Email Address

UK Phone Number

Declaration : By submitting this form, I confirm and understand that:

I have read the Investment Share Prospectus and the Plunkett Model Rules of the Society

I am over 16

I support the aims of the Society and agree to abide by its rules

I hereby authorise you to make such enquiries as are deemed necessary to confirm the eligibility of this application. The Applicant shall provide all additional information and documentation requested by the Society in connection with this Application, including in connection with money laundering, taxation or other regulations

By supplying my contact details, I agree to be contacted by the Society with news and updates

My personal details will be used and stored according to the Data Protection Act

Additionally (please check as appropriate)

I would be interested in becoming a member of the Board

I have paid by bank electronic transfer/BACS to The Co-operative Bank (Account Name: Portloe Community Benefit Society Limited, Sort Code: 08-92-99, Account Number: 67424302)

In the event of my death, I nominate the following person to receive my shares: (name, address and any other contact details you may have)