Attorney/Deputy Application Form Power of Attorney Centre PO BOX 1109 Bradford BD1 5ZJ

Transcription

1 Page 1 of 5 Attorney/Deputy Application Form Power of Attorney Centre PO BOX 1109 Bradford BD1 5ZJ Please fill in the form using BLOCK CAPITALS and black ink. Tick any boxes which apply. Santander is able to provide literature in alternative formats. The formats available are: large print, Braille and audio CD. If you would like to register to receive correspondence in an alternative format please visit for more information, ask us in branch or give us a call. Completing this form For assistance in completing this form, please call our customer helpline on Opening hours are Monday to Friday 8am to 7pm and Saturday 9am to 1pm. To be completed when applying to register a Power of Attorney (PoA) or Court Appointed Deputy on a customer s account(s) and to be submitted in addition to the associated legal documentation. To be used for the registration of Court of Protection Orders and all types of Attorney including (but not limited to) an Enduring Power of Attorney where registered and stamped by the court, a Lasting/continuing Power of Attorney or a General Power of Attorney. All sections of this form must be completed in full to prevent delays in processing. To ensure you have all the correct documentation, please complete the checklist in section 7 before returning this form. Section 1: Type of document Court of Protection Order Enduring PoA registered and stamped by the court General PoA* Lasting/Continuing PoA Unregistered Enduring PoA* Guardianship Other* (provide details) *Customer MUST sign section 2 Section 2: Customer authorisation For all applications, the account holder must sign this section unless: n You are a Deputy appointed by the Court of Protection. n The Enduring Power of Attorney has been registered with the Court of Protection at the Office of Public Guardian. n You hold a Lasting/Continuing Power of Attorney registered with the Office of Public Guardian. By signing this application form I agree that I give my authorisation for the Attorney/Deputy as named on this application to open and operate an Account with Santander on my behalf. Full name Signature Section 3: Customer account numbers Please provide all account numbers where the Attorneys/Deputies are to be registered. Register Attorneys/Deputies on all holdings Account number 1 Account number 4 Account number 2 Account number 5 Account number 3 Account number 6 Would you like to be registered for Online Banking? Yes No If there are to be more than six accounts, please complete and attach additional application forms as necessary.

2 Page 2 of 5 Section 4: Attorney/Deputy details All attorneys/deputies requesting to transact on the account(s) must sign this section to prevent delays in processing. Anyone who wishes to transact on this account needs to be identified as an Authorised Signatory below. If you are not identified as an Authorised Signatory then we will not accept your signature as authorisation to carry out a transaction, e.g. on a letter, on a cheque, on a faxed request, etc. The following Authorised Signatories wish to operate this account ( the Account ) with Santander ( the Bank ). By signing this application form I/we confirm that: n My/Our personal information contained in the Attorney/Deputy details section of this application is true and correct. Attorney/Deputy 1 n I/We, the person(s) whose signature(s) appears on this form, declare that I/we have been appointed to act as Attorney/Deputy as evidenced by the document provided, for the above named account holder. n I/We agree to the data protection statement in section 5, and consent to my/our data being used in this way. n In my/our capacity as Attorney/Deputy, I/we will observe the Terms and Conditions of the Account. Attorney/Deputy 2

3 Page 3 of 5 Section 4: Attorney/Deputy details (continued) Attorney/Deputy 3 Attorney/Deputy 4

4 Page 4 of 5 Section 5: Attorney/Deputy data protection statement Using my personal information Whether or not I become a customer, you may use all the information I give to you, Santander UK plc, or you hold on me to provide and manage the account, policy or service I have applied for. This includes information about the conduct (including details of transactions) of any account or policy that I have with you, a group company or an associated company. You may also use my information to help you develop and improve your products and services. You will keep information about me after my account is closed or my policy has ended. Sharing my personal information You may share my information for the purposes described in this statement with the group of companies to which you belong (the Santander Group) and your associated companies, and with service providers or agents. These companies may be based in other countries. I understand that you will make sure that my information is only used in line with your instructions and your own strict policies on confidentiality. If you transfer my information to another country, you will also make sure that you give it the same levels of protection as needed under the UK Data Protection Act. You may also give essential information about my account and cards (if any) to others if needed to manage my account and/or renew my account or policy and for regulatory purposes. My marketing preferences You may invite me to take part in market research surveys and identify and let me know by post, telephone or electronic media (including and SMS) of products or services which your group of companies and its associated companies think may interest me. (If I am aged over 18, when deciding whether to provide me with details of a credit product you may search the files of credit reference agencies who will not make a record of this search available to other lenders who search my file.) If I don t want information on other products and services or to be included in market research, I can tick the following boxes: Please do not contact me: by telephone by electronic media Verifying my identity and fraud checks Before you can register me as an Attorney/Deputy, you will check my details with fraud prevention agencies, and may make searches at credit reference agencies who will supply you with information, including information from the electoral register, for the purposes of verifying my identity. Scoring methods may be used to verify my identity. A record of this process will be kept that may be used to help other companies to verify my identity. If I give you false or inaccurate information and fraud is identified, at application or at any stage, details will be sent to fraud prevention agencies. Law enforcement agencies may access and use this information. You and other organisations may search and use the records held by credit reference and fraud prevention agencies to prevent and investigate crime, fraud and money laundering and, for example: n To check details on applications for credit and credit related or other facilities. n To verify my identity if I or my financial associate applies for other facilities. n To undertake statistical analysis and system testing. n To manage credit and credit related accounts or facilities. n To recover debt and trace my whereabouts. n To check details on proposals and claims for all types of insurance. n To check details of job applicants and employees. You may also search and use your internal records for these purposes. You and other organisations may search and use from other countries the information recorded at fraud prevention agencies. Further information on the credit reference agencies and fraud prevention agencies you use is available by telephoning Access to my information I understand I have the right to see certain records you hold about me if I pay a fee and I can get an information sheet explaining my rights from any branch. by post for market research Unless I have said otherwise, by continuing with this application, I agree to you contacting me using any of the methods shown above.

5 Page 5 of 5 Section 6: Identification requirements Identification Please ensure you provide 2 forms of identification for each attorney/deputy to be registered*. 1 form of identification is required for the customer if you are opening a new account. Identification provided must include one type from List 1 and one type from List 2. If you do not hold any of these forms of ID - please call the Help line on to discuss other acceptable ID requirements. List 1 Unexpired Passport, or Unexpired UK/EEA (or Switzerland) photo card driving licence, or Northern Ireland Voters card AND List 2 Unexpired UK/EEA (or Switzerland) photocard driving licence (the date of the licence and photograph must be in date) *For the following types of application only one form of identification is required from List 1 Court of Protection order, Court registered enduring power of attorney, Guardianship order (Scotland). Section 7: Checklist Please ensure the following checklist is complete before returning this form in order to prevent any delays in processing. All sections of this form are completed in full The form has been signed by all the attorneys/deputies to be registered on the account(s) The form has been signed (where required) by the customer Relevant ID has been provided for all attorneys/deputies and the account holder Branch use only The relevant legal documentation has been included and all pages are present Once you have all of the above, please send to Power of Attorney Centre, PO Box 1109, Bradford, BD1 5ZJ. Alternatively, please bring all of the above into your local branch where an adviser will be able to check all the information is present and correct and send your request to be processed. This form should be returned using the checklist envelope to ensure the package has been fully and correctly completed. (MISC1707) to the Power of Attorney Centre, PO Box 1109, Bradford, BD1 5ZJ. A copy of this form (certified by the branch) should be retained in line with the current branch retention policy. form received in branch Partenon Centre Number Branch name Name of adviser completing form Adviser s E-number Alert placed on customer record MISC 0290 SEP 13 HF Santander UK plc. Registered Office: 2 Triton Square, Regent s Place, London, NW1 3AN, United Kingdom. Registered Number Registered in England. Telephone Calls may be recorded or monitored. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority, except in respect of its consumer credit products for which Santander UK plc is licensed and regulated by the Office of Fair Trading. Our Financial Services Register number is Santander UK plc is also licensed by the Financial Supervision Commission of the Isle of Man for its branch in the Isle of Man. Deposits held with the Isle of Man branch are covered by the Isle of Man Depositors Compensation Scheme as set out in the Isle of Man Depositors Compensation Scheme Regulations In the Isle of Man, Santander UK plc s principal place of business is at 19/21 Prospect Hill, Douglas, Isle of Man, IM1 1ET. Santander and the flame logo are registered trademarks.