Apply for The Share Republic plc Shares Online.

This application is in relation to the Share Republic Offer for Subscription, the full Document including the Terms and Conditions can be viewed or downloaded by clicking here.

By submitting the Application Form online, you irrevocably undertake, confirm and agree that:

a. you are not a national or resident of the United States of America (including its territories, its possessions and all areas subject to its jurisdiction) or Canada or Australia or a corporation, partnership or other entity organised under the laws of the United States of America or Canada (or any political sub-division of either) , Australia, Ireland, Japan or South Africa, and that you will not offer, sell or deliver directly or indirectly any of the New Ordinary Shares under the Offer in the United States of America or Canada or Australia, Ireland, Japan or South Africa or to the benefit of any person resident in the United States of America or Canada or Australia, Ireland, Japan or South Africa.

b. you are entitled to take New Ordinary Shares under the Offer comprised herein under the laws of all relevant jurisdictions which apply to you, and that you have observed such laws and obtained all governmental and other consents which may be required thereunder and complied with all necessary formalities; and

c. you have read the Section headed “Risk Factors” in section 8 of this Document and confirm that you understand the nature of the risks and that you could lose all your investment in the Company.

  • I hereby irrevocably offer (save for the circumstances set out in Section 87q of the FSMA – right of withdrawal) to subscribe for fully paid New Ordinary Shares in The Share Republic plc on the terms and subject to the conditions of application set out in the Document of which this Application Form is part
Title
Forename(s) (in full)
Surname
Email Address
?
Please enter your email address which we will use to send you further details.
Number of new ordinary shares in multiples of 2,500 ?
If you select other, please in the box provided how many shares you are applying for.
Other - Please state
I will send a payment for the amount payable, namely (Number of shares applied for above * 20 pence) ?
If you select Other, please state the amount below
Other - please state
Address (in full) ?
Please provide us with your full address
Post Code
?
Please provide your full postal code
Date of birth
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Please provide us with your date of birth so we can check your identity.
Country of birth ?
We need to know where your were born for regulatory purposes
Other country of birth:
?
We need to know where your were born for regulatory purposes
Nationality
Telephone number
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Please provide us your phone number so we can contact your with regards to this application