Important: before completing this application you should read this Share Offer document, paying attention to the risks section and read the rules of Selce, available on our website.

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* 1. First name or mononym

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* 2. Surname (if applicable)

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* 3. Address

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* 4. Amount of investment requested (£)

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* 5. Desired term of investment (years)

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* 6. How did you find out about this share offer?

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* 7. Payment Reference – if you are paying by bank transfer, please select a reference now, such as your name or initials

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* 8. Account Name (please provide your bank details, this enables us to pay your interest via bank transfer)

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* 9. Sort Code

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* 10. Account Number

If you wish, you may nominate an individual to receive your shares in Selce in the event of your death. If you wish to do so, please provide the details of the beneficiary.

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* 11. Full Name

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* 12. Address

If the applicant is a nominee for a child:

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* 13. Child's name

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* 14. Child's date of birth

Date

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* 15. Child's Address (if different from above)

If the applicant is an organisation:

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* 16. Address

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* 17. Organisation Registration Number

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* 18. Amount of investment desired for the organisation

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* 19. We encourage members to be actively involved in Selce. Would you like to be contacted about volunteering with Selce?

Declaration

I confirm my understanding that this application, if and when accepted by South East London Community Energy forms a contract subject to English law and the terms and conditions in the share offer document.

· I have read the share offer document including the risk factors.
· I am over 16.
· I am not making an application for more than 20,000 shares.

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* 20. Full Name

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* 21. Date

Date

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