[APPLICANT NAME]
[APPLICANT ADDRESS]

The Directors,
Company Name Ltd
[REGISTERED OFFICE ADDRESS]

Dear Sirs,

Company Name Ltd (the "Company")

I hereby apply for [NO. OF SHARES, SHARE VALUE AND CLASS] Shares in the capital of the Company for cash on the basis of [AMOUNT] per share and request you to register the shares in my name. I enclose a cheque for the value of [AMOUNT] in respect of the said shares.

I acknowledge that my application is made on the basis that I will hold any such shares allotted to me subject to the Memorandum and Articles of Association of the Company.

Yours faithfully,

...........................................
[APPLICANT]

Dated [DATE]