I/We enclose... to open... Account

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1 Please use black ink if the account is for more than two applicants please use an additional form. Under Society Rules, the first named account holder will be entitled to receive tices of General Meetings and to vote as appropriate on behalf of the joint account holders. I/We enclose... to open... Account All cheques to be made payable to the account holder(s) If you are an existing/previous account holder, please tick the relevant box. App 1 App 2 Mandatory Information Mandatory Information Title... Title... Forename(s)... Forename(s)... Surname... Surname... Address (including postcode)... Date of Birth... Address (including postcode) If address is same as applicant 1, please tick the box Date of Birth... National Insurance Number... National Insurance Number... Occupation... Nationality... Occupation... Nationality... Are you a citizen and tax resident of the UK only? Are you a citizen and tax resident of the UK only? If no please complete the Tax Residency Self Certification Declaration Form If no please complete the Tax Residency Self Certification Declaration Form Telephone Numbers Evening... Daytime... Mobile Telephone Numbers Evening... Daytime... Mobile We would like you to be the first to hear about the latest Market Harborough Building Society rates, products and services. We promise not to bombard you with information but will occasionally send updates about products and services that we think you will be interested in. Just tell us how you like to be contacted and we will keep this information on file until you inform us you have changed your mind. Please contact me by post by telephone by Rest assured, we take your privacy very seriously so we will not share our members details with any commercial organisations and, if at any time you feel you are receiving too much information or wish to stop marketing communication from the Society, please give us a ring and we can change your contact preferences instantly. Head of Sales & SG038 V8/01.16

2 How would you like your interest to be paid? Please pay my interest Annually Monthly (t available on all account types) Your interest will be added to your account unless specified below Please transfer to an alternative MHBS account number: Please pay into an external bank account number as detailed: Bank name... If you think you may be eligible to receive interest without the payment of tax, please tick the relevant box and we will send you a registration form For a no obligation discussion on your current mortgage options please tick the box For a no obligation home insurance quote, please enter your renewal date:... Customer Identification and Data Protection: We are required by law to check your identity before you open an account with the Society. All documents will be recorded and copied for audit purposes as part of our Anti Money Laundering requirements. We will need evidence of your name and address. If you are happy for us to do an Electronic check please tick the box Alternatively please provide a photocard driving licence (not provisional) with in-date photograph or one original item from each of the following, as appropriate. Photocopies of documents can be accepted, but must be certified by a professional (quoting name, address, profession, signature & date). PROOF OF NAME Full passport or EEA member state ID card; Full UK driving licence the old, paper version; HMRC Tax tification or tice of Coding less than 12 months old (not P45 or P60); Benefit Agency Payment Book or letter confirming right to benefits less than 12 months old, e.g. Pension or Child Benefit. PROOF OF ADDRESS (ONLINE DOCUMENTS ARE NOT ACCEPTABLE) Gas, electricity or telephone bill (excluding mobile phones) less than 3 months old; Mortgage statement or water bill less than 12 months old; Council tax bill or TV licence renewal notification less than 12 months old; UK-based bank, building society or credit card statement less than 3 months old. PROOF OF NAME FOR MINOR Full passport; Birth certificate; NHS Card; Sort Code Account name... Reference Number... You can access your account online; visit our website to register App App PROOF OF ADDRESS FOR MINOR (ONLINE DOCUMENTS ARE NOT ACCEPTABLE) Child Benefit or Child Tax Credit documentation; Birth certificate. I/We declare: can a of the and and and conditions; I/We the terms and to this account; This form has been to the best of and belief; I/We that I are UK resident(s); I/We to the using to verify if required; by be by for administration and and may be or with to protect the Society and its its customers against fraud, or to or to satisfy the the requirements of of of Codes of Practice and and statutory regulation. regulation. Withdrawals and changes to account information to be authorised by: Any one signature Signatures of all account holders Applicant 1 Applicant 2 YOU OR ON LET US Welland House, The Square, Market Harborough, Leicestershire, LE16 7PD Tel: Fax: Website: FOR USE Account Title:... Surname, Initials Account Number:... Number of Sides:... Date Opened:... Staff Number:... Face to Face Postal Online SG038 V8/01.16

3 Financial Services Compensation Scheme Information Sheet Basic information about the protection of your eligible deposits. Eligible deposits in Market Harborough Building Society are protected by: The Financial Services Compensation Scheme ( FSCS ). 1 Limit of protection: 75,000 per depositor per building society. 2 If you have more eligible deposits at the same building society: If you have a joint account with other person(s): Reimbursement period in case of building society failure: All your eligible deposits at the same building society are aggregated and the total is subject to the limit of 75, The limit of 75,000 applies to each depositor separately working days. 4 Currency of reimbursement: Pound sterling (GBP, ). To contact Market Harborough Building Society for enquiries relating to your account: Customer Support Team Welland House The Square Market Harborough LE16 7PD Tel: To contact the FSCS for further information on compensation: Financial Services Compensation Scheme 10th Floor Beaufort House 15 St Botolph Street London EC3A 7QU Tel: or More information: Additional information 1 Scheme responsible for the protection of your eligible deposit Your eligible deposit is covered by a statutory Deposit Guarantee Scheme. If insolvency of your building society should occur, your eligible deposit(s) would be repaid up to 75,000 by the Deposit Guarantee Scheme. 2 General limit of protection If a covered deposit is unavailable because a building society is unable to meet its financial obligations, depositors are repaid by a Deposit Guarantee Scheme. This repayment covers a maximum of 75,000 per building society. This means that all eligible deposits at the same building society are added up in order to determine the coverage level. If, for instance a depositor holds a savings account with 80,000 and a current account with 20,000, he or she will only be repaid 75,000. In some cases eligible deposits which are categorised as temporary high balances are protected above 75,000 for six months after the amount has been credited or from the moment when such eligible deposits become legally transferable. These are eligible deposits connected with certain events including: a) certain transactions relating to the depositor s current or prospective only or main residence or dwelling; b) a death, or the depositor s marriage or civil partnership, divorce, retirement, dismissal, redundancy or invalidity; c) the payment to the depositor of insurance benefits or compensation for criminal injuries or wrongful conviction. More information can be obtained under 3 Limit of protection for joint accounts In case of joint accounts, the limit of 75,000 applies to each depositor. However, eligible deposits in an account to which two or more persons are entitled as members of a business partnership, association or grouping of a similar nature, without legal personality, are aggregated and treated as if made by a single depositor for the purpose of calculating the limit of 75,000.

4 Financial Services Compensation Scheme Information Sheet 4 Reimbursement The responsible Deposit Guarantee Scheme is the Financial Services Compensation Scheme. It will repay your eligible deposits (up to 75,000) within 20 working days until 31 December 2018; within 15 working days from 1 January 2019 until 31 December 2020; within 10 working days from 1 January 2021 to 31 December 2023; and within 7 working days from 1 January 2024 onwards, save where specific exceptions apply. Where the FSCS cannot make the repayable amount available within 7 working days, it will, from 1 June 2016 until 31 December 2023, ensure that you have access to an appropriate amount of your covered deposits to cover the cost of living (in the case of a depositor which is an individual) or to cover necessary business expenses (in the case of a depositor which is not an individual or large company) within 5 working days of a request. Again, there are specific exceptions to this obligation. In the case of a depositor which is a large company, where the FSCS cannot make the repayable amount available within 7 working days, it will, from 3 July 2015 until 1 December 2016, ensure that you have access to your covered deposits within 15 working days of a request containing sufficient information to enable it to make a payment, save where specific exceptions apply. If you have not been repaid within these deadlines, you should contact the Deposit Guarantee Scheme since the time to claim reimbursement may be barred after a certain time limit. Further information can be obtained under Other important information In general, all retail depositors and businesses are covered by Deposit Guarantee Schemes. Exceptions for certain deposits are stated on the website of the responsible Deposit Guarantee Scheme. Your building society will also inform you of any exclusions from protection which may apply. If deposits are eligible, the building society shall also confirm this on the statement of account. Exclusions List A deposit is excluded from protection if: a) The holder and any beneficial owner of the deposit have never been identified in accordance with money laundering requirements. For further information, contact your building society. b) The deposit arises out of transactions in connection with which there has been a criminal conviction for money laundering. c) It is a deposit made by a depositor which is one of the following: Pension or retirement fund 5 Public authority, other than a small local authority. The following are deposits, categories of deposits or other instruments which will no longer be protected from 3 July 2015: deposits of a credit union to which the credit union itself is entitled deposits which can only be proven by a financial instrument 6 unless it is a savings product which is evidenced by a certificate of deposit made out to a named person and which exists in a Member State on 2 July 2014 deposits of a collective investment scheme which qualifies as a small company 7 deposits of an overseas financial services institution which qualifies as a small company 8 deposits of certain regulated firms (investment firms, insurance undertakings and reinsurance undertakings) which qualify as a small business or a small company 9 refer to the FSCS for further information on this category. For further information about exclusions, refer to the FSCS website at 5 Deposits by personal pension schemes, stakeholder pension schemes and occupational pension schemes of micro, small and medium sized enterprises are not excluded 6 Listed in Section C of Annex 1 of Directive 2014/65/EU 7 Under the Companies Act 1985 or Companies Act See footnote 3 9 See footnote 3 SI108 V2/12.15

5 Full Name Residential Address, including Post Code 1. Are you a citizen and tax resident of the UK only? If YES, please sign at the foot of the page, if NO, please answer questions 2 and Are you a citizen of the USA? 3. Please list the countries other than the UK of which you are tax resident, if any, together with associated tax reference number. Country/countries of tax residency Tax reference number Information The UK government has, and will be signing, a number of inter-governmental agreements to share tax information, where applicable, with the tax authorities in other jurisdictions. The requirement to collect certain information about each customer s tax arrangement is part of UK legislation and as a tax ID numbers (where applicable) and will record this on our records now, but will only disclose this information to the relevant tax authorities if and when we are required to under UK law. Your tax residence generally is the country in which you live for more than half a year. Special circumstances (such as studying abroad, working overseas, or extended travel) may cause you to be resident elsewhere or resident in more than one country at the same time (dual residency). The country/countries in which you pay income tax are likely to be your country/countries of tax residence. If you are a US citizen or hold a US passport or green card, you will also be considered tax resident in the US even if you live outside the US. If you have any questions on how to complete this form we recommend that you speak to your tax or legal adviser. I undertake to inform the Market Harborough Building Society of any changes in my circumstances, such as moving outside the UK that may affect this declaration. Signature Date

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