Northern 3 VCT PLC Application Form - Clubfinance
Northern 3 VCT PLC Application Form - Clubfinance
Northern 3 VCT PLC Application Form - Clubfinance
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Notes on <strong>Application</strong> <strong>Form</strong><br />
<br />
BeforemakinganapplicationtoacquireOfferSharesyouarestronglyrecommendedtoconsultanappropriatefinancialadviserauthorisedunderthe<br />
FinancialServicesandMarketsAct2000.Itisessentialthatyoucompleteallpartsofthe<strong>Application</strong><strong>Form</strong>inaccordancewiththeinstructionsinthesenotes.<br />
Please send the completed <strong>Application</strong> <strong>Form</strong>, together with your cheque or banker's draft by post, or deliver it by hand, to <strong>Northern</strong>3<strong>VCT</strong><strong>PLC</strong>,<br />
NorthumberlandHouse,PrincessSquare,NewcastleuponTyneNE18ER.Ifyouhaveanyquestionsonhowtocompletethe<strong>Application</strong><strong>Form</strong>pleasecontact<br />
NVMon01912446000oryourfinancialadviser.<br />
<br />
Thefollowingnotesshouldbereadinconjunctionwiththe<strong>Application</strong><strong>Form</strong>andtheTermsandConditionsof<strong>Application</strong>.<br />
<br />
InsertinBox1inBLOCKCAPITALSyourfullname,permanentaddress,daytimetelephonenumber,dateofbirth,NationalInsurancenumberand,<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
1<br />
2<br />
3<br />
4<br />
5<br />
6<br />
ifyouhaveone,youremailaddress.Jointapplicationsarenotpermitted.<br />
<br />
<br />
<br />
Insert(infigures)inBox2thetotalamountyouwishtoinvestundertheOffer.Sharesubscriptionswillbeadjustedtoreflectanycommission<br />
waived(byagents)asextraOfferShares.<br />
<br />
Please note that the minimum investment is £5,000.Themaximuminvestment,onwhichtaxreliefsoninvestmentsin<strong>VCT</strong>sareavailable,is<br />
£200,000inthe2011/12taxyear.<br />
<br />
Attachyourchequeorbanker'sdrafttothe<strong>Application</strong><strong>Form</strong>fortheexactamountshowninBox2.Yourchequeorbanker'sdraftmustbemade<br />
payableto"<strong>Northern</strong>3<strong>VCT</strong><strong>PLC</strong>"andcrossed"A/CPayeeonly".Yourpaymentmustrelatesolelytothisapplication.<br />
<br />
Nomoneylaunderingverificationisrequiredtobeenclosediftheapplicationisforlessthan£12,000orifpaymentisbymeansofacheque<br />
drawnonanaccountinthenameoftheApplicant(providedthat(a)thechequeincludesdetailsoftheApplicant'sbankaccountorbuilding<br />
society account (as applicable) and (b) the cheque is drawn on a UK or European Union authorised bank or credit institution). Please note,<br />
however,thatNVMmay,initsabsolutediscretion,requireMoneyLaunderingverificationandthatMoneyLaunderingverificationwillberequired<br />
byintroducingfinancialadvisers.<br />
<br />
MoneyLaundering<br />
Iftheapplicationisformorethan£12,000andpaymentisnotbymeansofa chequedrawnonanaccountinthenameoftheApplicant,<br />
pleasesupply:<br />
<br />
(a) anIdentityVerificationCertificatefromyourauthorisedfinancialadviser.<br />
<br />
or<br />
<br />
(b) (i) acopyofyourpassportordrivinglicencecertificatedbyabankorsolicitorstatingthatitisa"truecopyoftheoriginalandatrue<br />
likenessoftheclient"followedbyyourname;and<br />
<br />
(ii) arecent(nomorethanthreemonthsold)originalbankorbuildingsocietystatement,orutilitybill,orrecenttaxbill,inyourname.<br />
<br />
<br />
Read the declaration and sign and date the <strong>Application</strong> <strong>Form</strong> in Box 3. If someone other than the Applicant named in Box 1 signs on such<br />
Applicant'sbehalf,suchsignatorymustensurethatthedeclarationgivenonbehalfofsuchApplicantiscorrect.Authorisedintermediarieswhoare<br />
entitledtoreceivecommissionshouldstampandcompletetheagent'sbox,givingtheirfullnameandaddress,telephonenumberanddetailsof<br />
theirauthorisationundertheFinancialServicesandMarketsAct2000.TherightisreservedtowithholdpaymentofcommissioniftheCompanyis<br />
not,atitssolediscretion,satisfiedthattheagentissoauthorised.<br />
<br />
<br />
Ifyouwishtohavedividendspaidintoyournominatedbankorbuildingsocietyaccount,pleasecompletethemandateinstructionform.<br />
<br />
<br />
<br />
Leaveblankifyouwishtoreceiveasharecertificateinrespectofyourinvestment.IfyourequireyourSharestobeissuedelectronicallytoaCREST<br />
account,pleasecompletetheboxes.<br />
To be completed by authorised intermediaries only. If you would like commission to be paid by BACS, please complete the relevant boxes.
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