Application Form – Individual

APPLICATION TO BECOME AN INDIVIDUAL MEMBER
AND TO INVEST IN SHEFFIELD COMMUNITY MEDIA LIMITED

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1. ABOUT YOU >>>

Name

Address

Post Code

Email

Phone

2. SHARES >>>

How much do you want to invest in Community Shares?
(minimum £100, maximum £50,000)
£

If the investment offer is oversubscribed and/or we are unable to offer you any or all of the shares or bonds you have applied for, we will refund the difference by cheque to the address above, unless we are notified otherwise.

3. BONDS >>>

How much (if any) do you want to invest in Community Bonds?
(minimum £100, maximum not more than the total community shareholding of the investor)
1 year bonds (3%): £
3 year bonds (4%): £
5 year bonds (5%): £

4. PAYMENT >>>

How will you be paying?
A chequeBank transfer

Cheques should be made payable to Sheffield Community Media Limited and sent to Sheffield Community Media Limited, 42 Waingate, Sheffield S3 8LB.
Bank transfers to Sheffield Community Media Limited sort code 08-92-99 account number 65628265 using what you have written in 'NAME' above as the reference

5. CONSENT >>>

I confirm that: (this consent is required for us to accept your investment)

• I am 16 years old or older;
• I understand that the Board of Directors may reject my application, and will not be obliged to tell me why it has been rejected;
• I have read the share offer document and understand and accept the terms of the share offer and the society;
• I understand that the board may conduct such checks as necessary to comply with money laundering regulations

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