Expression of Shareholding wishes Full Name*Postal Address*No of Shares Held and Numbers (if known)*Value (Calculate at £50.00 per share)*I would like to express the wish that on my death, my shareholding in FCLI be: Converted to FCLI as a donation Repaid to my estate. I understand there is an optional admin charge of £10.00 I agree to pay this admin charge of £10.00 which will be deducted from reimbursement Please re-isse to the beneficiary named below who has expressed an interest in the continuing support of the FCLI Name of BeneficiaryAddress of BeneficiaryBeneficiary Telephone NumberBeneficiary EmailChild Beneficiary - if the beneficiary is under 16 please give date of birth and contact details for supervising adultI hereby confirm this reflects in full my wishes and should be actioned on my passing* I confirm Date of ConfirmationPlease enter your details should you wish to receive further information regarding leaving a gift in your Will
