

Offer for subscription for ‘A’ Ordinary Shares at €1 per share,
payable in full on application.
Number of shares applied for:
Amount enclosed: €
(Including 3% fee)
I declare that I have read and understood this application form and that I
am fully aware of the risks entailed in investing in the Company.
Title
First Name
Surname
Address
Town
Co.
 PPS Number:
Tax District
Contact Number
Email address
 
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