Page 1 of 8 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 www.santander.co.uk/alternativeformats 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 0800 414 8414. 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 8 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 6 Section 2: 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 (as attorney) 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. Would you require a Card to operate this account? *Yes No *Subject to account type Please note where there is more than one attorney acting in a joint capacity and all signatures are required to transact, a card is not permitted.
Page 2 of 8 Section 3: Attorney/Deputy details Attorney/Deputy 1 Title (Mr, Mrs, Ms, Miss, other) First name Middle name(s) Surname Other names you re known by or commonly use (not nicknames) Address If not, please state of birth of Fiscal residence (i.e. the country in which you are (Tax identification number) if non-uk tax resident Do you make a tax contribution in any other country due to residence or citizenship? Yes No If yes, please specify the countries to which you make tax contributions and provide your corresponding (Tax Identification Number) Postcode How long have you lived at this address? Y Y M M Telephone number Email address Nationality Employment status Are you: Employed Unemployed Not employed homemaker Not employed student Second nationality (if you have dual nationality) Self-employed Retired Occupation (if employed or self-employed) Is your country of residence the UK? Yes No Attorney/Deputy 2 Title (Mr, Mrs, Ms, Miss, other) First name Middle name(s) Nationality Second nationality (if you have dual nationality) Is your country of residence the UK? Yes No If not, please state Surname of birth Other names you re known by or commonly use (not nicknames) Address Postcode How long have you lived at this address? Y Y M M Telephone number Email address of Fiscal residence (i.e. the country in which you are (Tax identification number) if non-uk tax resident Do you make a tax contribution in any other country due to residence or citizenship? Yes No If yes, please specify the countries to which you make tax contributions and provide your corresponding (Tax Identification Number)
Page 3 of 8 Section 3: Attorney/Deputy details continued Employment status Are you: Employed Unemployed Self-employed Not employed homemaker Not employed student Retired Occupation (if employed or self-employed) Attorney/Deputy 3 Title (Mr, Mrs, Ms, Miss, other) First name Middle name(s) Surname Other names you re known by or commonly use (not nicknames) Address If not, please state of birth of Fiscal residence (i.e. the country in which you are (Tax identification number) if non-uk tax resident Do you make a tax contribution in any other country due to residence or citizenship? Yes No If yes, please specify the countries to which you make tax contributions and provide your corresponding (Tax Identification Number) Postcode How long have you lived at this address? Y Y M M Telephone number Email address Nationality Employment status Are you: Employed Unemployed Not employed homemaker Not employed student Second nationality (if you have dual nationality) Self-employed Retired Occupation (if employed or self-employed) Is your country of residence the UK? Yes No Attorney/Deputy 4 Title (Mr, Mrs, Ms, Miss, other) Address First name Middle name(s) Postcode How long have you lived at this address? Y Y M M Telephone number Surname Email address Other names you re known by or commonly use (not nicknames) Nationality Second nationality (if you have dual nationality)
Page 4 of 8 Section 3: Attorney/Deputy details (continued) Is your country of residence the UK? Yes No If not, please state Employment status Are you: Employed Not employed homemaker of birth of Fiscal residence (i.e. the country in which you are Unemployed Not employed student Self-employed Retired Occupation (if employed or self-employed) (Tax identification number) if non-uk tax resident Do you make a tax contribution in any other country due to residence or citizenship? Yes No If yes, please specify the countries to which you make tax contributions and provide your corresponding (Tax Identification Number)
Page 5 of 8 Section 4: 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 email 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 0800 328 3280. 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.
Page 6 of 8 Section 5: Identification requirements Identification requirements for Powers of Attorney and Donors/Granters Powers of Attorney (POA) Attorneys If you need to either open a new account or request to be added to an existing Santander account as an attorney, you will need to provide us with a copy of the Power of Attorney document, and you must meet the following identification requirements. If you are an existing Santander customer please provide one item from List 1 (below). An existing customer is someone who already holds an active account with Santander excluding the following products: Sharesave, Paymentcare, Santander Shareholder Account, Basic Current Account, any General Insurance products and Royal London products. You may be asked to supply one item from List 2 if you have moved address and we have not been informed of the change. If you are not an existing Santander customer please provide two items: one from List 1 plus a separate item from List 2. Items from the same source cannot be used twice and one must include proof of address. List 1 n Unexpired Passport (if non UK/non EEA, must be accompanied by a valid visa). n Unexpired UK/EEA (or Switzerland) photocard driving licence n EEA or Switzerland national identity card. n Northern Ireland voters card. List 2 n Unexpired UK/EEA (or Switzerland) photocard driving licence. n Unexpired UK old style driving licence (not provisional). n Council tax bill/demand letter (Must be the most recently issued and less than three months old). n Bank/Credit card statement (not internet printed - Must be the most recently issued and less than three months old). n Most recent water/energy bill (less than three months old, or less than twelve months for water bills). n Instrument of a court appointment e.g. Probate or Court registered Power of Attorney. The above list is not exhaustive. For help and full information on acceptable types of identification, please call our customer helpline on 0800 414 8414, visit the Help and Support section of our website or talk to us in branch. Providing identification n If you are providing documentation in branch you must provide original identification n If you are providing documents via post, please do not send originals; please provide unaltered black and white photocopies of identification. This must include photocopies of pages that contain the following photographs, reference details, transactions and current UK entry/residence visas. Please also note that certified copies are not required. Occasionally, there may be additional checks and documents required. Donors and Granters Where the following Power of Attorney documents have been supplied, additional identification is not required: n Court of Protection order. n Court registered enduring Power of Attorney. n Guardianship order (Scotland). Donors or Granters (Scotland) linked to any other POA must meet the standard ID requirements outlined above.
Page 7 of 8 Section 6: 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 as named on this application to operate any existing accounts I have with Santander and to open and operate any new accounts with Santander on my behalf. Full name Date D D M M Y Y Y Y of birth of Fiscal residence (i.e. the country in which you are Countries in which you are a tax contributor due to citizenship or residence conditions (please list all countries) Signature Section 7: Attorney declaration 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. n I/We undertake to advise Santander UK plc within 30 days of any change in circumstances which affects my tax residency status or causes the information contained herein to become incorrect. 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 4, 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. n I/We have received the FSCS Information Sheet and Exclusions List. Attorney/Deputy 1 Signature Date D D M M Y Y Y Y Attorney/Deputy 2 Signature Date D D M M Y Y Y Y Attorney/Deputy 3 Signature Date D D M M Y Y Y Y Attorney/Deputy 4 Signature Date D D M M Y Y Y Y
Page 8 of 8 Section 8: Checklist To prevent any delays in processing, please ensure the following checklist is complete before returning this form: 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 (If applicable. See section 5) The relevant legal documentation to support the attorney arrangement (see section 1) has been included and all pages are present: Court of Protection with Court of Protection Order 2 pages minimum with official Court of Protection Stamp Enduring POA 4 pages minimum (part A, part B, part B continued, part C, part C continued). Signed by customer and all attorneys with all signatures witnessed Enduring POA registered with the Office of the Public Guardian/Court of Protection 4 pages minimum (as above) with an official court of protection stamp. Signed by all attorney s with all signatures witnessed Lasting POA Property and Financial Affairs 11 pages minimum with an Office of the Public Guardian (OPG) stamp. Signed by customer and all attorneys with all signatures witnessed General POA 1 page minimum. Signed by customer and witnessed Other (please specify): What to do next 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 a member of staff will be able to confirm all information is complete and correct and will send your request to be processed. Branch use only Date form received in branch D D M M Y Y Y Y Partenon Centre Number Branch name Alert placed on account Name of person completing form* E number Date D D M M Y Y Y Y Checked by E number Date D D M M Y Y Y Y *Declaration: by signing this form, you are confirming that complete and original documents, or officially certified copies have been seen and accepted. This information must be sent to Power of Attorney centre PO Box 1109 Bradford BD1 5ZJ. A copy of this form, and all associated documentation, must be retained in branch in line with current retention policy and archived at the appropriate time MISC 0290 JAN 16 HT SantanderUKplc.RegisteredOffice:2TritonSquare,Regent splace,london,nw13an,unitedkingdom.registerednumber2294747.registeredinenglandandwales.www.santander.co.uk.telephone 0800 389 7000. Calls may be recorded or monitored. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Our Financial Services Register number is 106054. Santander and the flame logo are registered trademarks.