East Wells Community Benefit Society Membership/Share application form - Second Offer

Shares are priced at £1 each. Minimum Investment £50, Maximum £34,000.
PLEASE COMPLETE A SEPARATE FORM FOR EACH INDIVIDUAL APPLICANT

THE EAST WELLS COMMUNITY BENEFIT SOCIETY SHARE OFFER PROSPECTUS

PLEASE TRANSFER THE TOTAL VALUE OF SHARES APPLIED FOR TO: EAST WELLS COMMUNITY BENEFIT SOCIETY LIMITED Sort
Code 08-92-99 Account Number 67354553 or post a cheque with this form to: The Treasurer, EWCBS Ltd, 27 Churchill Road
WELLS Somerset BA5 3HZ. PLEASE WRITE YOUR NAME AND ADDRESS ON THE REVERSE OF CHEQUES.

The data provided by you on this form will be stored within a computerised database. The data will only be used for East Wells
Community Benefit Society purposes and will not be disclosed to any other party.

Amount of shares you wish to purchase at £1 each *

Full Name *

Full Address *

Phone Number *

Email *

If applying for an ORGANISATION, what is the name of that organisation:

Bank Details

Sort Code *

Account Number *

We need your bank details so that we can repay your investment if we are unable to purchase the Britannia Inn and to pay interest when due.

Agreement

I have read the EWCBS Share Offer Prospectus including the risk factors.
I wish to become a Member of the East Wells Community Benefit Society Ltd.
I am 18 years of age or over
I agree to be bound by the Terms & Conditions contained in the Share Offer Prospectus and the Rules of the society
I understand that submission of my application does not guarantee acceptance into the share scheme

*I prefer to receive notices and documents

Post

Insert Signature below

Clear

I will make the payment via: *

Bank Transfer

Cheque

EAST WELLS COMMUNITY BENEFIT SOCIETY LIMITED
Sort Code 08-92-99
Account Number 67354553

Payment reference number: *

Using the first(up to) 6 characters of your surname followed by your Date of Birth DOB in DDMMYY format, e.g.
“Anders280258” as your reference, also please insert this above as your Ref No. to correlate your application and payment.
To pay by cheque, write your name, address and reference number on the reverse of the cheque and post with this form to:
The Treasurer, EWCBS Ltd, 27 Churchill Road WELLS Somerset BA5 3HZ.