Share Application Form

Share Application Form

Please complete required fields & submit the form to us.
Details of Purchaser
I would like to buy Community Shares in Cheriton Fitzpaine Community Shop Limited.

I am purchasing shares for:
Please complete the relevant sections below.
For Individuals
Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

Street Address Line 3County

Postcode
For Donor of a Gift
I am purchasing as a gift for someone else.

If purchasing as a gift, please insert details of the individual you are purchasing the shares for. If you are gifting to more than one person, please insert these same details for any additional donees in the box below.
Please note that they must meet the criteria for applicants as detailed in the share prospectus.
Donee's Name

First NameLast Name
Donee's E-mail
Donee's Phone Number

Area CodePhone Number
Donee's Address

Street Address

Street Address Line 2

Street Address Line 3County

Postcode
If you are gifting to more than one person, please insert these same details for any additional donees in the box below. Please note that they must meet the criteria for applicants as detailed in the share prospectus.
Purchasing For an Organisation
I am purchasing as a business, other incorporated organisation or unincorporated organisation or as an institutional investor.
Name of Organistion
J. Bloggs & Co Ltd
Company Registration Number
Is the company incorporated?
Contact Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

Street Address Line 3County

Postcode
Share Purchase
1 share costs £20. The minimum holding is 1 share.

The maximum shareholding for an individual is 1,250 shares costing £25,000.
For Individuals
I would like to buy no. of shares shares to the value of £ .
In the event of my death, I nominate the following person to receive my shareholding:
Nominee's Name

First NameLast Name
Nominee's E-mail
Nominee's Phone Number

Area CodePhone Number
Nominee's Address

Street Address

Street Address Line 2

Street Address Line 3County

Postcode
For Donor of a Gift
I would like to buy no. of shares shares to the value of £ .
For institutional investors/businesses/other incorporated or unincorporated organisations
We would like to buy no. of shares shares to the value of £ .
Terms and Conditions
Please tick each box and sign and date this form to confirm that you agree to the Terms & Conditions:
I have read the Share Offer document and understand and accept the terms and conditions of the Share Offer and the Rules of the Cheriton Fitzpaine Community Shop. *
I am over 16 years of age.*

I will give proof of identity and address, if necessary, for anti-money laundering purposes.*
Please also tick the following box if appropriate:
I have provided an email address, and I consent to receiving formal notices by e-mail and links to formal documentation on Cheriton Fitzpaine Community Shop’s website.
Method of Payment
Please tick one of the following boxes as appropriate:
Bank Transfer
I have paid via electronic bank transfer and put my surname, initials and SH25 as the reference. (eg Surname AB SH25)
Account Name: Cheriton Fitzpaine Community Shop Limited
Sort Code: 08-92-99
Account number: 65837438
Payment by cheque
I have sent a cheque made payable to Cheriton Fitzpaine Community Shop Limited
Data Protection
By buying these shares, I agree to all the information disclosed here being held on a computer database in compliance with the General Data Protection Regulation (GDPR). I understand that this information will be used by Cheriton Fitzpaine Community Shop Limited only and will not be passed to third parties. The Society has an obligation to notify HMRC of certain share interest payments.

Any member may ask to view the names and addresses of members on the Share Register.

The sum invested will be confidential to the Treasurer and Secretary of the Society.
Signature*

Powered by Jotform SignClear
Name and date signed*
Receipts will be issued by email wherever possible to reduce administration costs. Share certificates will be issued in due course.

Please click Submit to review your purchase request before it is sent to us.
Should be Empty:

Share Application Form

Details of Purchaser

For Individuals

For Donor of a Gift

Purchasing For an Organisation

Share Purchase

For Individuals

For Donor of a Gift

For institutional investors/businesses/other incorporated or unincorporated organisations

Terms and Conditions

Method of Payment

Data Protection