- Co-operative Care Colne Valley

Community Share Offer Application Form

In accordance with the rules of Colne Valley Equitable Care Society Limited, I apply for shares to the value stated below. The minimum investment is £50, the maximum investment is £15000.

Select an appropriate amount, or choose 'other amount' and key in the value of shares you wish to apply for without a comma (e.g. to apply for £4,000 worth of shares simply enter 4000).

If you wish to apply on behalf of an organisation or corporate body, please tick the relevant box below and provide details both for yourself as the initial point of contact, and for the organisation.

I'm applying on behalf of an organisation

On Behalf Of Organization

Organisation Name *

Telephone no. *

Contact email *

Address *

Address 2

Village/Town *

Postal Code *

Your details

First Name *

Last Name *

Please enter your date of birth using the format dd/mm/yyyy – or use the pop-up date picker to select the correct date.

Date of Birth *

Address *

Address 2

Village/Town *

Postal Code *

Please provide both a phone number and an email address wherever possible so that we can contact you.

Telephone no:

Email address *

For individual applications only: In the event of my death I nominate the following to receive the value of my shares.

please select:

*in the event of your death, or if you die before 31st August 2025, at the end of Year 5 (whichever is the later event) your investment will be paid to your legal representative on production of either a Grant of Probate/Letters of Administration or a Statutory Declaration confirming the identity of the person entitled to your estate under the Small Estate Act.

Payment Options

[x] I will send payment via bank transfer (BACS) or cheque following submission of this form. (Details will be emailed to you immediately.)

Declaration

I confirm that:

I have read the Share Offer Document, including the Risk Statement at the beginning of the document.
I wish to become a member of Colne Valley Equitable Care Society Limited.
I agree to be bound by the Terms and Conditions included in the Share Offer Document and the Rules of Colne Valley Equitable Care Society Limited.
I understand that the Board of Directors of Colne Valley Equitable Care Society Limited may reject my application, and are not obliged to tell me why it has been rejected.
I consent to receiving formal notices by email and links to formal documents on the Colne Valley Equitable Care Society Limited website. To reduce our administrative costs, we would like to be able to send you formal notices by email and refer you (by email) to documents posted on our website.
I consent to the use of my personal data in accordance with the Terms and Conditions stated below.

Declaration *

I have read and agree to the declaration statement.

Terms and Conditions

It is a condition of the offer that to ensure compliance with the Money Laundering Regulations 2003, Colne VaIley Equitable Care Society Limited may at its absolute discretion require verification of the identity of any person seeking to invest.

All applicant funds will be held in escrow in an account in the name of Colne VaIley Equitable Care Society Limited, and will be ringfenced to protect applicants’ money from any liabilities associated with our day-to-day financial activities.

In the event that the offer is unsuccessful, then all monies will be returned to applicants.

Data Protection

The personal data provided by you on this form will be stored by Colne Valley Equitable Care Society Limited in an electronic database and in accordance with the General Data Protection Regulation (GDPR). The data will only be used by Colne Valley Equitable Care Society Limited in relation to the governance of the Society and to communicate the activities of the Society to you. Your personal data will not be disclosed to any third party except for any body having a statutory right of inspection.

For more information about how we treat your personal data, please read our Privacy Notice.