The Share Republic plc Offer for Subscription Application Form

Before making an application to subscribe for New Ordinary Shares, you are recommended to consult your financial adviser or a person authorised under the FSMA, who specialises in advising on the acquisition of shares and other securities. The following instructions should be read in conjunction with the Application Form and the Terms and Conditions of Application set out in this Document. Applications must be for a minimum of 2,500 New Ordinary Shares and thereafter in multiples of 2,500 Ordinary Shares.

The distribution of this Document outside the UK may be restricted by laws of such other jurisdictions in which the Document is distributed and therefore persons outside the UK into whose possession this Document comes should inform themselves about and observe any restrictions in relation to the Ordinary Shares and the distribution of this Document. The Ordinary Shares have not been, nor will be, registered in the United States under the United States Securities Act of 1933, as amended, or under the securities laws of Canada, Australia, the Republic of Ireland, South Africa or Japan and they may not be offered or sold directly or indirectly within the United States, Canada, Australia, the Republic of Ireland, South Africa or Japan or to, or for the account or benefit of, US persons or any national, citizen or resident of the United States, Canada, Australia, the Republic of Ireland, South Africa or Japan. This Document does not constitute an offer to sell or an invitation to subscribe for, or the solicitation of an offer to buy or subscribe for, Ordinary Shares in any jurisdiction in which such offer or solicitation is unlawful.

Please complete the form below then click on SUBMIT button on the bottom left corner of the page. Thank you.

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
?
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
?
Please provide us your phone number so we can contact your with regards to this application