AEOB House People – Share Application Form Your DetailsName* Mr.Mrs.MissMs.Dr.Prof.Rev. Title First Name(s) Last Name Date of Birth Address* Street Address Address Line 2 City Region Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Enter Email Confirm Email Phone*Shares and PaymentShare Value to Purchase*Amount you wish to purchase, from £50 - £20,000 in unit values of £1Donation*Amount of any Donation. If none, enter 0.Total Amount*Amount to be sent by cheque or BACSPayment Method*I am sending a cheque enclosedI am making a BACS electronic transferPayment method for the total amount. You will be provided with account details and a unique reference number for your bank transfer or a reference to write on your cheque.Additional Information and TermsCommunicationShare Certificates will be always sent to you by First Class Post. All other communications will be by email unless you specify by checking the box below. If you require all communications by Post, please tick this box: How did you hear about AEOB?By clicking submit you confirm and agree to the following: I am 16 or over. I have the right to invest this money. I have read and understood the entire Share Issue Document and agree to the Terms and Conditions of this offer. I agree to my personal information being held on a database, which will not be passed to third parties, in accordance with the Data Protection Act (1998). To ensure compliance with the Money Laundering Regulations (2003) AEOB may require verification of an applicants’ identity and I will cooperate with this if required. We will endeavour to resolve any issues ourselves. In the first instance any dispute resolution will be via direct contact, however our dispute resolution process is also party to the EU Online Dispute Resolution service. We may contact you using the email address you have supplied above I understand that submitting this form constitutes a binding contract and that all information has been agreed to be correct by the person to whom the shares will be allocated. Please Confirm Your Agreement* I have read and agree to the above conditions. NameThis field is for validation purposes and should be left unchanged.