Application to invest in MaidEnergy Ltd

Organisation Application Details
Organisation Name
Organisation Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Type of Organisation
Reg No (or N/A)
Name and position of person authorised to sign this form
Please provide evidence of your agreement to invest e.g. business meeting minutes, signed letter of authorisation on headed paper

Cancel of
Email of authorised signatory
example@example.com

Special Conditions
Please specify if you would like to hold shares for a fixed period (eg five/ten years)
The Board will make every effort to honour these requests, subject to funds being available; it is not guaranteed.
Are you purchasing shares as a gift for someone else? *

Yes No
Gift Purchase

If you wish to purchase shares as a gift for someone else, please give their details below. Anyone 16 or over will also need to agree to join MaidEnergy.
Beneficiary Name

First Name Last Name
Beneficiary Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Beneficiary Email
example@example.com
Beneficiary Phone Number
Please enter a valid phone number.
Beneficiary Date of Birth (if under 16)

Day Month Year
Date
Number of Shares

Account for Interest and Repayments

We will make payments by bank transfer, so please provide your bank details for this.
Account Name *
Account Number *
Sort Code *
Contact Preferences
MaidEnergy prefers to use email to send statutory notices (eg AGM). Please tick to consent to this. *

Confirm
Please tick if you would also like MaidEnergy to send you other updates, for example newsletters.

Yes, subscribe me
If you have any particular communication needs please provide details here:

Declaration

IMPORTANT: Please tick the boxes to indicate that you agree with the statements below. For joint applications all applicants must consent and sign.
I confirm that I am 16 years old or older *

Confirm
I agree that MaidEnergy Ltd may make such enquiries as are deemed necessary, including checks under Anti Money-Laundering Regulations, and will provide additional information if requested. *

Confirm
I wish to become a member *

Yes I'm already a member
Signature (use your mouse to digitally sign in the box) *

Clear
Date *

Day Month Year
Date

Individual Application Details