(UN enw y daflen / ONE name per form)

Enw - Name

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Cyfeiriad - Address
Tŷ - House

Stryd - Street

Tref - Town

Sir - County

Gwlad - Country

Cod Post - Postcode

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Rhif Ffon - Mobile-Telephone Number

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Cyfeiriad E-bost - E-mail Address

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Faint o gyfranddaliadau yr hoffech am £100 yr un:
Shares you would like to pledge to buy at £100 if you live in the Dyfed area, or £250 if you live outside Dyfed (on a 4% return):
£100 - Dyfed area£250 - Outside Dyfed area
Number of Shares (i.e 5)

Rwy'n bwriadu talu am gyfranddaliadau yr rwyf am addo prynu gyda:
** Arian Parod ** Gwirio ** Cerdyn Credyd / Debyd ** Arall
I plan to pay for the shares I want to pledge to buy in the form of:
**Cash **Cheque **Credit/Debit Card **Other
Arian Parod - CashGwirio - ChequeCerdyn Credyd/Debyd - Credit/Debit CardArall - Other

Arian Parod - CashGwirio - ChequeCerdyn Credyd/Debyd - Credit/Debit CardArall - Other

While this Pledge Form does not form any kind of legally binding agreement, we ask that people should take it seriously and not to make a pledge if they do not intend to go ahead and purchase shares in due course.
Gadewch y ffurflen yn y blwch yn y Clynfyw Farm neu danfonwch at Clynfyw, cyfeiriad isod:
Please return the form to the sealed box in Clynfyw Farm, post to Clynfyw at
the address below or email to ClynfywCBS@gmail.com :
Clynfyw Community Benefit Society, Clynfyw Farm, Abercych, Pembrokeshire. SA37 0HF
(contact Jim Bowen on 01239 841236 to discuss in confidence larger investment amounts)