Please print this form out, fill it in and sign it, and return it with your payment to the address at the foot of the page.

Shares cost £20 each. The maximum number of voting shares which any individual may hold is 200, but additional non-voting shares may be held above this level. There is no minimum share holding. If you are unable to contribute £20 in one lump sum then please consider our standing order option, whereby shares can be purchased in instalments. Details of this scheme and a standing order mandate can be obtained from the address at the foot of this page.

I wish to purchase ……..... shares in 6LDA.

I enclose a cheque/postal order for £…........……., payable to "6LDA".

Name:

Address:


Postcode:

Telephone No.:

email address:

Signature:

Date signed:

Please return your completed form to the 6LDA Secretary, Richard Weir, 63 Princes Street, North Shields, Tyne and Wear, NE30 2HN