Personal Account Application Form Joint Personal Current Account PLEASE COPLETE IN BLOCK CAPITALS IPORTANT NOTE: This Authorisation and Application Form is only appropriate for requests to open a joint Standard Personal Current Account, and it permits full access and use of funds in the account requested below by any of the named parties. Where you do not wish the proceeds of the account to be payable to the survivor(s) on the account on the death of an accountholder please alert your branch before completing this Form. Where you wish for more than one person to sign for withdrawal (including clubs/societies) please use andate 1-20R (Current Account). For Bank Use Only Current Account: NSC 9 0 A/c No. Purpose of A/c (andatory: Box must show an understanding of purpose and likely operation of account.) Source of Funds Source of Wealth SECTION A: OUR RELATIONSHIP WITH US Will a salary be mandated to this account? No Are you switching your bank account from another financial institution? No (If yes please complete Switching your personal bank accounts made easy brochure Ref 37-769RU) SECTION B: OUR PERSONAL CHOICES - APPLICANT 1 SECTION B: OUR PERSONAL CHOICES - APPLICANT 2 Card Type AT/ebit Card Card Type AT/ebit Card Customer Name (to appear on Card - ax 22 characters) Customer Name (to appear on Card - ax 22 characters) Registration for 365 Use Bank of Ireland 365 online to make payments, check your account or view transactions. What s more, by using 365 online you can benefit from a whole range of other convenient features including our obile App. Applicant 1: Phone and Online Banking Applicant 2: Phone and Online Banking A 365 PIN will be posted to your address provided above, on receipt of this PIN please contact Banking 365 on 0818 365 365 to activate and avail of our service. Current legislation requires us to verify the true name and address of all new customers. ou will therefore be requested to submit formal identification documents with this application e.g. current passport or driving licence and current utility bill. If you do not have any of these forms of identifications above please contact us and we can discuss alternative documentation. Ask for our leaflet our account and the implications of legislation (37-831RU). Section C : FATCA Requirements For the purpose of the Foreign Account Tax Compliance Act (FATCA), we are required to establish whether you are a US citizen and/ or resident in the US for tax purposes. APPLICANT 1 Are you a US citizen? No APPLICANT 2 Are you a US citizen? No Are you resident in the US for tax purposes? No Are you resident in the US for tax purposes? No If yes was answered to either question above please provide US TIN (not mandatory) If yes was answered to either question above please provide US TIN (not mandatory) Page 1 of 10
SECTION : OUR PERSONAL ETAILS - APPLICANT 1 Title r rs s iss Other First Name Surname Address ate of Birth Email Tel (Home) Tel (Work) Best time to contact orning Afternoon Evening Tel (obile) Employment etails Employee Employer Self Employed Homemaker Student Retired Other Occupation Net onthly Pay Employer s Name Annual Gross Income Residential etails Home Owner With Parents Tenant Other ear moved to address onthly Rent/ortgage Previous Address if Tenant arital Status arried Single Widowed ivorced Separated Civil Partner SECTION : OUR PERSONAL ETAILS - APPLICANT 2 Title r rs s iss Other First Name Surname Address ate of Birth Email Tel (Home) Tel (Work) Best time to contact orning Afternoon Evening Tel (obile) Employment etails Employee Employer Self Employed Homemaker Student Retired Other Occupation Net onthly Pay Employer s Name Annual Gross Income Residential etails Home Owner With Parents Tenant Other ear moved to address onthly Rent/ortgage Previous Address if Tenant arital Status arried Single Widowed ivorced Separated Civil Partner Page 2 of 10
AUTHORISATION, CONSENTS AN APPLICATION FOR ACCOUNT(S) NOTE: OU SHOUL ONL SIGN BELOW WHEN OU HAVE REA THIS SECTION AN THE CONSENTS AT APPENIX 1 CAREFULL AN AGREE TO BE BOUN B THESE TERS To: The Governor and Company of the Bank of Ireland (the Bank, which term includes and shall be construed to include Bank branches, its subsidiaries, agents and third parties appointed by the Bank) We, the undersigned, authorise you to open one or more accounts in the name(s) of and. We authorise you to accept, from any one of us, monies for the credit of the account and to accept the signature of any one of us or survivor/s of us as a good and sufficient discharge for any monies outstanding in the account from time to time, and to honour all cheques, bills, debits and orders drawn on the accounts and to act on instructions relating to the accounts signed by any one of us, notwithstanding that, where applicable, such action may lead to borrowing or cause any account to be overdrawn or any overdraft to be increased. We jointly and severally undertake to certify that the other party/ parties to the account is/are alive if required to do so. We agree with you and with one another that in the event of the death of any one or more of us any monies outstanding in any accounts in our joint names shall be payable to or held for the survivor or survivors and in the event of the death of the last survivor for the personal representative(s) of the last survivor. We agree to hold ourselves severally as well as jointly liable for all monies due and liabilities incurred under the above authorisation in any manner whatsoever. We have received and read the following documents and, in consideration of your providing me from time to time with any of the products and/or services requested under this andate Application Form, agree to be bound by their terms: the Terms and Conditions and Terms of Business that apply to the relevant account; the Schedule of Fees and Charges for Personal Customers ; the details of debit interest outlined in the table of Personal Overdraft Interest Rates sheet at Appendix 2 of this Authorisation and Application Form; where applicable, the Terms and Conditions relating to AT / ebit cards. We confirm that we have read each authorisation required by the Bank as set out in Appendix 1 to this Authorisation and Application Form (a copy of which we have been furnished with and will retain) to hold, use, disclose, copy and process information and we understand that by signing this application form we are giving our consent for the use of information provided by us for the purposes of (1) the ata Protection Acts, 1988 and 2003; and (2) the Criminal Justice (oney Laundering and Terrorist Financing) Act 2010 and/or the Taxes Consolidation Act, 1997, as any such legislation may be amended, varied or substituted from time to time. Optional ata arketing Consent We consent to the details that we are being asked to supply being used to provide us with information about other products and services, either from the Bank of Ireland Group or which the Bank of Ireland Group has arranged for us with a third party. I/we understand that at any time I/we can ask you to stop or change the methods by which the bank may send me/us marketing materials. This can be done free of charge by writing to my/our branch of the Bank. Please tick this box if you would not like to receive this information. By signing below we further agree that this Authorisation will remain in full force and effect until an amending Authorisation shall be communicated to the Bank under our joint signatures. Customer 1 Signature: Customer 2 Signature: ATE: 2 0 WITNESS: Page 3 of 10
SECTION : BANK USE ONL - APPLICANT 1 Is person to be identified an existing Bank of Ireland Group Customer? No IF ES: Name of Branch/Group Entity ethod used to check (Servicelink, etc.) EXISTING CUSTOER AS AT 2/5/95 NSC 9 0 A/c No. ate Opened Has AL ocumentation Screen been completed for above account? EXISTING CUSTOER AFTER 2/5/95 NSC 9 0 A/c No. ate Opened Is AL I&V documentation held and in order and has AL ocumentation Screen been fully completed? No If and full AL I&V is in order and AL screen has been fully completed then with the person s consent, as detailed in the application form, you can request the Branch/Group entity who has established his/her identity to update the AL ocumentation Screen OR provide copies of the I&V documentation for your records. If No i.e. full AL I&V documentation is not in order OR AL ocumentation Screen is not fully completed the I&V documentation for the customer must be perfected in line with procedures and/or the AL ocumentation Screen must be created/corrected. Has AL ocumentation Screen been created for new account being opened? NOTE: Whether customer is existing pre or post 95 a new AL ocumentation Screen must be created for the new deposit account being opened. If we are relying on AL I&V documents held for another account that account must be referenced on the AL ocumentation Screen. IF NO: Name and current permanent address of person named overleaf must be verified in line with procedures. Has there been face to face contact with the person being identified? No If NO, specify method of contact (Two separate forms of Address Verification must be obtained) ethods used for the two separate forms of address verification Has AL ocumentation Screen been completed for new account? Visa ebit Card Type: Contactless Contact Page 4 of 10
SECTION : BANK USE ONL - APPLICANT 2 Is person to be identified an existing Bank of Ireland Group Customer? No IF ES: Name of Branch/Group Entity ethod used to check (Servicelink, etc.) EXISTING CUSTOER AS AT 2/5/95 NSC 9 0 A/c No. ate Opened Has AL ocumentation Screen been completed for above account? EXISTING CUSTOER AFTER 2/5/95 NSC 9 0 A/c No. ate Opened Is AL I&V documentation held and in order and has AL ocumentation Screen been fully completed? No If and full AL I&V is in order and AL screen has been fully completed then with the person s consent, as detailed in the application form, you can request the Branch/Group entity who has established his/her identity to update the AL ocumentation Screen OR provide copies of the I&V documentation for your records. If No i.e. full AL I&V documentation is not in order OR AL ocumentation Screen is not fully completed the I&V documentation for the customer must be perfected in line with procedures and/or the AL ocumentation Screen must be created/corrected. Has AL ocumentation Screen been created for new account being opened? NOTE: Whether customer is existing pre or post 95 a new AL ocumentation Screen must be created for the new deposit account being opened. If we are relying on AL I&V documents held for another account that account must be referenced on the AL ocumentation Screen. IF NO: Name and current permanent address of person named overleaf must be verified in line with procedures. Has there been face to face contact with the person being identified? No If NO, specify method of contact (Two separate forms of Address Verification must be obtained) ethods used for the two separate forms of address verification Has AL ocumentation Screen been completed for new account? Visa ebit Card Type: Contactless Contact Page 5 of 10
BRANCH CHECKLIST Purpose of Account Source of Funds Source of Wealth Was the account requested on a non face to face basis? No Is the customer resident in a high/very high risk country? No Is it evident from purpose of account that the customer intends transacting with a high/very high risk country? No *If to any of the above questions, relationship should be of higher risk. All higher risk rated accounts must be referred to Network Governance and Control for sign off prior to account opening. Overall Risk Rating* Standard High Signed (Staff ember) ate 2 0 Staff Number The Governor and Company of the Bank of Ireland, incorporated by charter in Ireland with limited liability. A tied agent of New Ireland Assurance Company plc. trading as Bank of Ireland Life. Bank of Ireland is regulated by the Central Bank of Ireland. Registered No. C-1. Head Office, 40 espil Road, ublin 4, Ireland. Page 6 of 10
APPENIX 1: CUSTOER CONSENTS. Please give to the Customer to retain A: ATA PROTECTION CONSENTS 1. Where this application is an application for facilities, I/we confirm that I/we am/are not less than 18 years of age. 2. I/we certify the accuracy of the information given above together with the continued accuracy of such information in the event of any future applications by me/us (whether oral or written) for a facility, unless I/we expressly advise you to the contrary at the time of any such future application. 3. I/we understand that you reserve the right to decline this or any future application without being required to state any reason and that no correspondence will be entered into it in such circumstances. 4. By signing this form I/we consent to the Bank of Ireland Group and its contracted agents storing, using and processing my/our personal details: (a) to manage and administer my/ our accounts, policies or other financial products; (b) to process my/our applications for credit or financial services and any requests for payment services made by me/us; (c) to carry out business and market research and compile statistics; (d) to help detect and prevent fraud and dishonesty including through the use of information technology; (e) to form a single view of my/our entire relationship with the Bank of Ireland Group (whether as a consumer or in connection with my/our trade, business or profession) to enable it manage and develop the relationship; (f) to enable business units in the Bank of Ireland Group share or access my/our personal details for the purposes set out in this consent (but not for the purposes of direct marketing where I/we have indicated to the Bank of Ireland Group I/we do not want it); (g) to contact me/us by post, telephone, text message, electronic mail, facsimile or other means but not in a way contrary to my/our instructions to the Bank of Ireland Group or contrary to law or regulation; (h) (where I/we apply for or avail of a credit facility) to carry out credit reviews including automated credit decision processes and to obtain details of my/our credit history from the Irish Credit Bureau ( ICB ) or other credit rating agency; (i) (where I/we have not indicated otherwise to the Bank of Ireland Group) to directly market the products and services of the Bank of Ireland Group or of suppliers selected by the Bank of Ireland Group using a form of communication permitted by me/us under paragraph (g) above; and (j) to establish and/or report my/our identity, residence and tax details to the extent necessary order to comply with law and regulation concerning taxation, return of payments and the prevention of money laundering or terrorist financing. I/we consent to the Bank of Ireland Group disclosing my/our personal details: 1) (where I/ we apply for or avail of a credit facility) to the ICB or other credit rating agency and I/we also consent to the ICB or other credit rating agency disclosing details of my/our credit history (and using those details for credit scoring purposes) to the Bank of Ireland Group or other institutions to which I/we apply for credit facilities; 2) to facilitate a potential or actual transfer of any loan or product provided to me/us or in connection with a securitisation; 3) to its contracted agents and to recipients abroad but only for purposes indicated in this consent and only where the Bank of Ireland Group complies with Irish data protection law in doing so. This consent does not limit any other consent I/we have given (or may give) to the Bank of Ireland Group to process or disclose my/our personal details. In this consent: Bank of Ireland Group means the Bank of Ireland and its present and future subsidiaries. contracted agents means entities which have contracted with the Bank of Ireland Group to assist it in the conduct of its business or in providing services to me/ us. I/we, me/us, my/our is a reference to each of us where more than one of us have signed this form. personal details means information concerning me/us which Bank of Ireland Group has including information given by me/us or others verbally or in writing, information contained in application forms and records of my/our transactions with the Bank of Ireland Group. 5. In the event of a facility being approved I/we authorise you to make the facility available and to put the appropriate repayment schedule into effect. 6. I/we agree that the facility (and any other facilities as may be granted by you at your discretion) shall be subject to the terms and conditions and specific provisions detailed in your Facility Letter or Credit Agreement, once issued. 7. I/we understand that in opening the account(s) that I/we may be automatically registered for Bank of Ireland 365 services as outlined in the terms and conditions attached. 8.In consideration of my/our application for an account, I/we agree to the Terms and Conditions and Schedule of Fees and Charges for Personal Customers Brochure (where applicable). B: IENTIFICATION CONSENTS I hereby agree that any information and/or original documents and/or any copy documents supplied by me or on my behalf to the Bank are accurate so as to enable the Bank to comply with any and all of the obligations of the Bank under law and regulations concerning the prevention of money laundering and terrorist financing and to comply with taxation requirements. Such information or documentation may at any time be disclosed by the Bank to, transferred to, or copies thereof sent by the Bank to any Bank branch, any other member of the Bank of Ireland Group, or any other designated body (as defined in The Criminal Justice (oney Laundering and Terrorist Financing) Act 2010 as may be amended, varied or substituted from time to time (the 2010 Act )) which may at any time provide or be requested to provide any services to me. I hereby further agree that any information and/or any original documents and/or any copy documents that have been supplied by or for me to any Bank of Ireland Group member to enable such Bank of Ireland Group member and/or Bank of Ireland Group to comply with any and all obligations under or pursuant to the 2010 Act and/ or Part 38, Chapter 3A of the Taxes Consolidation Act, 1997 as amended, varied or substituted from time to time (the 1997 Act ) may at any time, by such Bank of Ireland Group member, be disclosed to any other Bank of Ireland Group member, or be transferred to, or copies thereof sent to any other Bank of Ireland Group member, so as to enable such other Bank of Ireland Group member to comply with the 2010 Act and /or the 1997 Act, and for the benefit of any Bank of Ireland Group member to which I have supplied any such information, documents and/or copy documents aforesaid, I hereby confirm that such Bank of Ireland Group member may act on this authorisation and consent as if it was specifically addressed to such Bank of Ireland Group member.i hereby confirm that each authorisation contained herein to hold, use, disclose, copy and process information constitutes a consent for the purpose of the ata Protection Acts 1988 and 2003 and any amending or extending legislation or any related European Communities regulation or directive. For the purposes of this consent the terms Bank of Ireland Group and Bank of Ireland Group member each mean and shall be construed to mean any and all of the following: the Bank; ICS Building Society; any branch of the Bank or ICS Building Society; the separate legal entities that constitute the Bank of Ireland Group; any respective successors, assigns and transferees of the Bank, ICS Building Society or entities aforesaid. Page 7 of 10
Please give this rate sheet to the customer to retain. TABLE OF PERSONAL OVERRAFT INTEREST RATES SHEET CURRENT RATE TABLE FLAT RATE APR WITHOUT FACILIT FEE APR WITH 30 FACILIT FEE Standard Overdraft Rate 13.25% 13.9% 16.2%* The current variable standard overdraft interest rate (including the overdraft facility fee) is 16.2% APR. The Annual Percentage rate quoted above is correct as at 25 August 2011 and is subject to change. The rate quoted is based on a representative example of 1,500 over a 12 month period. Total cost of credit is 208.85. Graduate Overdraft Rate 9.40% 9.7% N/A The current variable overdraft interest rate for Graduate Current Account is 9.7% APR. The Annual Percentage Rate quoted above is correct as at 24 February 2010 and is subject to change. The rate quoted is based on a representative example of 1,500 over a 12 month period. Total cost of credit is 146.05. PENING RATES FLAT RATE APR WITHOUT FACILIT FEE APR WITH FACILIT FEE Standard Overdraft Rate None None None Graduate Overdraft Rate None None None PENING RATES EFFECTIVE ON 2 0 Notification to Bank of Ireland Personal Current Account Customers Personal Visa ebit Cards Important Notice This is an important notice and should be read. Change to Visa ebit Card Terms and Conditions - Clause 2.6 as of 1st September 2014. Current Version Clause 2.6 When you receive your Visa ebit Card you, you must activate it at one of our ATs. The activation of your card is acceptance of these Card terms and conditions. Amended Version - Clause 2.6 When you receive your Visa ebit Card you, you must activate it at one of our ATs. If activation does not take place within 60 days of the issue of the Card, in the interest of card security, the card will be cancelled an a new card will have to be applied for. The activation of your card is acceptance of these Card terms and conditions. If you do not accept the above change to the Terms and Conditions of your Card, you may end your Card contract with us. To do this you must first pay us Government uty (if any) that you owe concerning your Card. If you do not ask us to end your Card contract, you will be deemed to have accepted the change on this effective date: 1st September 2014. New terms and conditions are available at www.bankofireland.com from the 1st September 2014. Bank of Ireland is regulated by the Central Bank of Ireland. Page 8 of 10
Payroll Letter PLEASE COPLETE IN BLOCK CAPITALS FOR SALAR ANATE - APPLICANT 1 To: The Accounts/Payroll epartment Company name: (your home address) Company Address: ate: 2 0 Request to credit my salary to my new bank account y staff/employee number: ear Sir/adam, Please note from (date) 2 0 I wish to have my salary paid directly into the account detailed below: Bank: Branch name: Name of account: BIC: (Bank Identifier Code) IBAN (International Bank Account No.) Branch NSC: Account number: Thank you for your help. ours faithfully (your signature) (your name printed) Page 9 of 10
Payroll Letter PLEASE COPLETE IN BLOCK CAPITALS FOR SALAR ANATE - APPLICANT 2 To: The Accounts/Payroll epartment Company name: (your home address) Company Address: ate: 2 0 Request to credit my salary to my new bank account y staff/employee number: ear Sir/adam, Please note from (date) 2 0 I wish to have my salary paid directly into the account detailed below: Bank: Branch name: Name of account: BIC: (Bank Identifier Code) IBAN (International Bank Account No.) Branch NSC: Account number: Thank you for your help. ours faithfully (your signature) (your name printed) Page 10 of 10