REFERENCE AND ADDRESS VERIFICATION FORM

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Magnus Francis
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RE REFERENCE AND ADDRESS VERIFICATION FORM Date: Dear Sirs, I declare that Mr/Mrs/Miss whose permanent address is has been personally known to me for the past years/months.

2 RE REFERENCE AND ADDRESS VERIFICATION FORM Date: Dear Sirs, I declare that Mr/Mrs/Miss whose permanent address is has been personally known to me for the past years/months. He/She is desirous of opening an account with your Society. To the best of my knowledge, information and belief, he/she is of good character and in all respects a fit and proper person to conduct business with your organization. I also confirm that the name and address stated above are to the best of my knowledge true and correct. Yours faithfully, (Signature of Referee) (Telephone Number of Referee) (Name of Referee) Address of Referee (Occupation of Referee) VMBS Account No. of Referee (if any) Referee to place Stamp or Seal of Office above I am Referee to tick the appropriate circle Applicant s Employer Attorney at Law Permanent staff of VM Group School Principal / University Lecturer Justice of the Peace / Notary Public Director of a company within VM Group Medical Doctor Minister of Religion Existing Account Holder Army Officer (Major and above) Police Officer (Inspector and above) Consular Officer High Commission Manager / Senior Officer of a Regulated Financial Institution Manager Credit Union registered with the JCCUL.. Revision No. Toll free from JA. : YES VMBS ( ) : from US & CAN : : from UK : manager@vmbs.com

3 Customer Guide 1. The form should not be dated more than six months when presenting to your VM representative or branch. 2. The Referee must affix his stamp or seal of office on the form. 3. The Referee category of Attorney- at-law includes the following persons: Resident Magistrate (RM) Judge Chief Justice 4. For members of the JDF, the following ranks are above the rank of Major / Lt. Commander: Army Navy / Coast Guard Major General Rear Admiral Brigadier Commodore Colonel Captain (Naval) Lieutenant Colonel Commander (Naval) 5. For members of the Jamaica Constabulary Force, the following ranks are above the rank of Inspector: Commissioner (CP) Superintendent (SP) Deputy Commissioner (DCP) Deputy Superintendent (DSP) Assistant Commissioner (ACP) Assistant Superintendent (ASP) Senior Superintendent (SSP) 6. The Referee category of Manager / Senior Officer of a Regulated Financial Institution includes the following: Building Societies Commercial banks Insurance companies Stock Brokerage firms Security Dealers Investment houses 7. For the Referee category of Manager - Credit Union registered with the JCCUL, JCCUL refers to the Jamaica Cooperative Credit Union League. 8. For UK customers only, nurses may complete the form. The form must however bear the stamp /seal of the medical facility. 9. Existing account holders should be members of the Society for more than one year with active accounts and fully updated Customer Information records... Revision No. Toll free from JA. : YES VMBS ( ) : from US & CAN : : from UK : manager@vmbs.com

4 To: The Directors of the Victoria Mutual Building Society VICTORIA MUTUAL BUILDING SOCIETY New Account Application Form - Individuals I/We request that I/ we be admitted as members of the Society in respect of... shares. I/We request to be admitted as depositor(s) of the Society. A/C#: ACCOUNT INFORMATION CURRENCY: JA US CDN GBP DATE OPENED: PRODUCT TYPE: INITIAL DEPOSIT: RECEIPT NO: LOCATION: REFERENCE NO: TRANSFER... % of interest to A/C#... NO OF APPLICANTS: PURPOSE OF ACCOUNT: Business Education Savings Home Ownership Retirement Other... ACCOUNT MAILING ADDRESS MANDATE OF PAYMENT: SEND MAIL Yes No SOURCE OF FUNDS: Business Inheritance Sale of assets Gift Loan proceeds Tax refund Salary/wages Other... INTEREST DISPOSITION: Capitalize Pay by Cheque EXPECTED MONTHLY DEPOSITS:... EXPECTED MONTHLY WITHDRAWALS:... MANDATE FOR PLEDGING FUNDS: ACCOUNT HOLDER #1: CIF#: RELATIONSHIP CODE: NAME: DATE OF BIRTH: DD MM YYYY ACCOUNT HOLDER #2: CIF#: RELATIONSHIP CODE: NAME: DATE OF BIRTH: DD MM YYYY ACCOUNT HOLDER #3: CIF#: RELATIONSHIP CODE: NAME: DATE OF BIRTH: DD MM YYYY ACCOUNT HOLDER #4: CIF#: RELATIONSHIP CODE: NAME: DATE OF BIRTH: DD MM YYYY I/We confirm that the information given in this application is true and complete. I/We acknowledge receipt of the Terms and Conditions for this account I/We agree to be bound by the Terms and Conditions governing the operation of this account and by the Rules of the Society. Signature 1:... Verified by:... Signature 2:... Verified by:... Signature 3:... Verified by:... Signature 4:... Verified by:... Processed by:... Checked by:...

5 Signature scanned and associated by: Date: (Yr) (Mth) (Dy) Date: (Yr) (Mth) (Dy) (Yr) (Mth) (Dy) SSN / NI / TIN / SIN Name of Verifier Signature of Verifier

6 MEMBER INFORMATION FORM PERSONAL INFORMATION Title Mr. Mrs. Miss Other Please Specify INTERNAL USE ONLY Branch: CIF #: Last Name First Name Middle Name/s Marital Status Unmarried Married Divorced Widowed Other Maiden Name Gender Male Female Date of Birth / / D D M M Y Y Y Y Home Phone No. ( ) - Area Code CONTACT INFORMATION Mobile Phone No. ( ) - Address Area Code Father's Name FAMILY NAMES Mother's Name Mother's Maiden Name CITIZENSHIP and RESIDENCY INFORMATION of Birth of Residency of Citizen Residency Status Green Card Holder Other Dual Citizenship Yes No Green Card Number Expiry Date: List Dual Citizenship Countries 1 Residency Card: Yes No 2 PERMANENT ADDRESS PROOF OF ADDRESS (documents should be less than 6 months old) Bank Credit Card / Bank Statement Cable Bill Utility Bill Verified via Telephone Directory Mortgage Receipt Post Stamped/Marked Letter Tax Receipt Verified via EOJ Voter's List Other (subject to approval) CURRENT ADDRESS (If different from Permanent Address) MAILING ADDRESS (If different from Current/Permanent Address) PREVIOUS ADDRESS (If changed in the last 5 years) Page 1 MIF Form - June 30, 2014

7 MEMBER INFORMATION FORM CONTACT PERSON or NEXT OF KIN INFORMATION Title Mr. Mrs. Miss Other Please Specify Last Name First Name Middle Name/s Relationship Telephone #: ( ) - Area Code IDENTIFICATION INFORMATION Select ID Type Driver's Licence State ID Birth Certificate (for infants) Passport School ID Citizenship/Residency Card/Green Card Voter's ID ID Number Date of Issue / / Expiry Date / / D D M M Y Y Y Y D D M M Y Y Y Y of Issue TAXPAYER IDENTIFICATION INFORMATION Select Taxpayer ID Type (Circle) TRN SSN SIN TIN NIN ITIN Tax Forms Taxpayer ID # Documents Received: Form W-9 Form W-8 Waiver Other Taxpayer Exemption # EMPLOYMENT INFORMATION Employment Status Full time Student Self Employed - Registered Part time Unemployed Self Employed - Unregistered Retired If retired, please state previous occupation Occupation Employer/School Name Business Phone Ext.# Start Date (DD/MM/YYYY) Fax Phone No. Business Address SALARY INFORMATION Gross Annual Income Under 50,000 50, , , ,999 VM STAFF 600, ,999 1M M 5M M N/A - authorized signer only 10M and over Currency: JMD USD CAN GBP Page 2 MIF Form - June 30, 2014

8 MEMBER INFORMATION FORM SIGNATURES ACKNOWLEDGEMENT I acknowledge that information requested on this form is required for the purpose of the Society complying with its legal and regulatory requirements. In the event that full and adequate information is not provided to the Society, the Society hereby expressly reserves the right at its sole discretion to close the accounts upon giving at least fourteen (14) days prior notice in writing. DISCLOSURE The Society is hereby authorised to disclose to third parties any information about the account holder and the accounts held by the account holder and shall not be liable whatsoever in relation to any information disclosed in any or all of the following circumstances: a) To subsidiaries and affiliates of the Society including overseas operations b) To provide your personal and non personal information to credit agencies or credit bureaus as a credit information provider or in response to credit inquiries by other financial institutions, credit agencies or credit bureaus AND to request personal and non personal information from credit agencies or credit bureaus, financial institutions or any creditor in respect of your creditworthiness c) If the Society shall deem it necessary to make such disclosures to protect the interest of the Society from any harm, loss or injury d) To comply with any requirement for disclosure imposed by laws applicable to the business activities and operations of the Society, or pursuant to the directives of the court having jurisdiction in relation to the business activities and operations of the Society, or to such duly empowered government agency or department or in circumstances where applicable laws of a foreign jurisdiction applies to the business activities and operations of the Society, including but not limited to compliance with financial regulatory requirements and tax compliance laws e) In any other circumstances in which the account holder shall give written authorization to make such disclosure f) To government authorities in other countries where you hold residency or citizen status or you are subject to the applicable taxation laws in such other countries in respect of accounts held with the Society, in compliance with laws in respect to foreign account reporting requirements or any agreement entered into by the Society with such government agency I have reviewed, understood and agreed to be bound by the various terms and conditions of the account operation agreement and acknowledge that same may be amended by the Society in its sole discretion at any time and from time to time, as permitted under those terms and conditions Signature of applicant Signature and Seal or Stamp of Witness Date (dd/mm/yyyy) Date Witnessed (dd/mm/yyyy) FOR INTERNAL USE CUSTOMER TYPE: VMBS Employee VMBS Subsidiary Employee VMBS Director PEP Other PEP / OTHER APPROVED BY: NAME:... SIGNATURE DATE:... INTERNAL REFERENCE (EXISTING MEMBER ONLY) Applicable Not Applicable NAME OF AUTHORIZING OFFICER: POSITION OF AUTHORIZING OFFICER: SIGNATURE OF AUTHORIZING OFFICER: DATE:... Change of Name and / or Address (YES / NO )?: : Documents supporting the change presented (YES / NO )?: Comments Change of Account Status (YES / NO )?: If Yes, Complete the following: (i) A/C # status changed from to A/C # status changed from to (ii) Status changed by (Name) SIGNATURE DATE:... Change to Member records (YES / NO )?: If change to Member reocrd, complete the following: (i) Member record updated by (Name).. SIGNATURE DATE:... (ii) Member record checked by (Name). SIGNATURE DATE:... If No change to Member reocrd, complete below: Member record confirmed by (Name). SIGNATURE DATE:... FORM PREPARED BY: SIGNATURE DATE:... CHANGES APPROVED BY: SIGNATURE DATE:... CHANGES ENTERED BY: SIGNATURE DATE:... CHANGES CONFIRMED BY: SIGNATURE DATE:... Page 3 MIF Form - June 30, 2014

Account / Client Information Update Form

Account / Client Information Update Form Universal Client Number Assigned CUF082018 This form is to be used to make updates to Account and/or Client Information for JMMB Group clients. A separate form