AIB Visa Purchasing Card Application Form

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1 AIB Visa Purchasing Card Application Form 1. Business Customer Details ALL applicants must complete this section in BLOCK CAPITALS. Specific Business Details Business Type: Sole Trader Limited Company Incorporated Society Foreign Incorporated Body Partnership Statutory Body Other (Please state) Business Name: (BLOCK CAPITALS) Trading Name: (If any) Business Name to appear on card: (Max 26 Characters) Business Address: Business Telephone Number: Business Activity Description: Authorised Customer Contact Details: This is the name to whom all communications including summary statement will issue. First Name: (Please include Mr/Mrs/Miss/Ms/Other) Surname: Telephone Number: (If different to above business telephone number) Position in Business: Data Protection Use of Information Thi s Notice explains what AIB and AIB Group will with your that you can decide whether or not to provide that information to us. AIB refers to Allied Irish Banks, p.l.c. and AIB Group refers to Allied Irish Banks, p.l.c., its subsidiaries, affiliates and their respective parent and subsidiary companies. The personal information requested from you is required to enable AIB Group to effectively provide or administer product or service to you. Failure to supply AIB Group with sufficient information may result in AIB Group not being able to provide or meet your product/service needs. The information that you provide may be held by AIB Group on a computer database and/or in any other way. We may use this information: To administer the products and services that we supply to you and any future agreements that we may have with you and, to manage and develop AIB Group s relationship with you. For direct marketing purposes, where you have given your permission to do so, to advise you of products or services. If you wish to change your preferences at any time, please contact your local AIB branch or call us on To carry out searches (including verifying your identity and/or a credit search) and disclose information to credit reference agencies for the purpose of assessing applications for credit and credit related services and for ongoing credit review. Credit reference agencies will record details of each type of search AIB Group makes whether or not your application proceeds. We may use credit scoring techniques and other automated decision making systems to either partially or fully assess your application. To provide details of your financial indebtedness owing to the AIB Group and how you conduct your agreement(s)/account(s), to credit reference agencies on a regular basis. To review your financial position across the AIB Group, including debit and credit balances and security for advances. To provide your personal details to debt collection agencies and/or third party processors and contractors, who act on behalf of AIB Group, if it is necessary for the performance of a contract and/or to protect the legitimate interests of AIB Group. To prevent and detect fraud or other criminal activity and to trace those responsible. If you give us false or misleading information and we suspect fraud or other criminal activity, we will record this and may report the incident to the relevant regulatory authorities. To carry out statistical analysis and market research or to instruct a third party to perform this on our behalf. We may record telephone conversations to offer you additional security, resolve complaints and improve our service standards. Conversations may also be monitored for staff training purposes. Our websites use cookie technology. A cookie is a little piece of text stored by your browser on your computer, at the request of our server. We may use cookies to deliver content specific to your interests and to save your personal preferences so you do not have to re-enter them each time you visit our websites. In some circumstances, AIB Group may use the data collected to contact you in relation to a product or service that may be of interest to you. You must disable your cookies if you do not want AIB Group to access or store cookies on your computer. For more information on AIB s security policy, please visit Under the Data Protection Acts you have the right of access to personal information we hold about you on our records on payment of a nominal fee (currently 6.35). You can exercise this right by writing to your local AIB branch or to the Data Protection Unit, Allied Irish Banks, p.l.c., Bankcentre, Ballsbridge, Dublin 4. If any of your personal information held by us is inaccurate or incorrect, please let us know and we will correct it. There is no fee for such corrections. If you decide to proceed with this product/service or have any other communication with AIB Group through or in relation to its products and services, you consent to the use by AIB Group of your personal data as indicated above.

2 2. Schedule of Cardholders ALL applicants must complete this section in BLOCK CAPITALS and agree to the following Schedule of Cardholders. I/We hereby apply to you to grant me an AIB Visa Purchasing Card (the Card ) as an Additional Cardholder on the Card Account of the Principal Cardholder named above in accordance with the Terms and Conditions. I/We confirm that the information given herein is true, accurate and complete. I/We agree that I/We will use the Card solely for business purposes and accordingly I/We do not have the rights of a consumer under the Consumer Credit Act, 1995 of Ireland or the European Communities (Unfair Contract Terms in Consumer Contracts) Regulations, 1995 of Ireland. In order to comply with legisation to combat money laundering and terrorist financing, we will furnish you with suitable evidence of identity and permanent residence and hereby consent to you making such enquiries as you may deem necessary in connection with this application. I/We understand that if you sanction the facility you may register particulars including repayment details with any credit bureau to which you subscribe or are affiliated, and consent to such registration. I/We understand that you reserve the right to decline this application without giving a reason and without entering into correspondence. * see page 2 of brochure for details Total Business Credit Limit Requested: 3. AIB Visa Purchasing Card Information Management Solution (Provided by First Data Global Services) This is an optional feature. If you would like to avail of this service please select one of the following modules. The core module is free of charge. Pricing for the enhanced module is available on request. Core Free of Charge The Core module will provide you with daily access to your programme spend online at cardholder and card administrator levels. Enhanced The enhanced module includes all of the Core module PLUS automatic cost allocation of transactions, automatic and manual VAT processing, workflow approval, additional Management Information and reporting, comprehensive audit trails and customised export files for direct upload to accounting software. If you opt to avail of either solution above, AIB will exchange commercial information together with transactional information with First Data Global Services. This information will be exchanged with First Data Global Services for the purposes of providing the management information solution.

3 4. Company Resolution ONLY for Limited Companies and PLCs. It MUST be signed by the Secretary and Chairperson of the company. LTD COMPANY / PLC ONLY Minutes of the Meeting of the Board of Directors of (the Company ) Company Name: (BLOCK CAPITALS) Company Registration Number: duly held on the: (DD/MM/YYYY) Step 1: Who is Authorised to Sign? Provide at least one name and signature. At a meeting of the Directors (or equivalent) of the Principal Cardholder named in the attached AIB Visa Purchasing Card Application Form it was resolved that the following were authorised to sign the application form and make subsequent amendments and requests on behalf of the Principal Cardholder. The following people are authorised to sign and make changes on behalf of the Principal Cardholder: Authorised Signatory Name 1: (BLOCK CAPITALS) Signature 1: Authorised Signatory Name 2: (BLOCK CAPITALS) Signature 2: Step 2: How many people are required to authorise changes? Please indicate how many people you want to sign in order to authorise payments and make amendments. The following number of people are required to authorise any subsequent amendments and requests: One to Sign Two to Sign Step 3: Chairperson and Secretary Signatures This must be signed by both the Chairperson AND Secretary of the company. TWO different signatures are required. It is hereby certified that the foregoing is a true extract from the minutes of the Principal Cardholder. Chairperson Name: (BLOCK CAPITALS) Chairperson Signature: Secretary Name: (BLOCK CAPITALS) Secretary Signature: Date: (DD/MM/YYYY) AIBVPCAF 12/13

4 5. Confirmation of all Cardholder Facilities Requested Authorised Signatory 2 is ONLY required for a Partnership or company that specified 2 authorised signatories in section 4. Request to Open Account To Allied Irish Banks, p.l.c: I/We, the above described applicant hereby request you to provide an AIB Visa Purchasing Card (a Card ) to us and upon your so doing we authorise you to open a Card Account in our name in accordance with the Terms and Conditions. I/We, hereby request you to issue a Card to each of the persons named in the attached schedule(s) as an Additional Cardholder on our Card Account in accordance with the Terms and Conditions; and also from time to time to issue a Card to such other person or persons as we shall nominate in writing in a Supplemental Schedule furnished to you which, when signed or authenticated by us, shall be incorporated in and form part of the Agreement arising on acceptance of this application. I/We agree that we shall be solely liable for all liabilities incurred by each Additional Cardholder with the use of a Card irrespective of whether such liabilities are incurred as a result of a breach of the Terms and Conditions. I/We further agree: (i) to advise you if the Card of any Additional Cardholder is to be cancelled; and (ii) to assist you in recovering possession of any Card held by any such person. I/We agree that each Card may only be used for business purposes and that accordingly neither us nor any Additional Cardholder have the rights of a consumer under the Consumer Credit Act, 1995 of Ireland or the European Communities (Unfair Contract Terms in Consumer Contracts) Regulations, 1995 of Ireland. I/We accept and agree to be bound by the Terms and Conditions. I/We understand that you reserve the right to decline this application without giving a reason and without entering into correspondence. I/We declare that it is within our legal capacity and power to make this application and to enter into the contractual arrangements and obligations that will arise on acceptance thereof and confirm that the information given in this application (which will formulate the basis of any contract between us) is true, accurate and complete in all respects. I/We authorise you to make any enquiries that you deem necessary in connection with this application. In order to comply with legislation to combat money laundering and terrorist financing, we will furnish you with suitable evidence of identity and permanent residence and hereby consent to you making such enquiries as you may deem necessary in connection with this application. I/We understand that if you sanction the facility you may register particulars including repayment details with any credit bureau to which you subscribe or are affiliated, and consent to such registration. Authorised Signatory 1: Authorised Signatory Name 1: (BLOCK CAPITALS) Signature 1: Date: (DD/MM/YYYY) Authorised Signatory 2: ONLY complete this section if a partnership or if you have specified 2 authorised signatories in section 4. Authorised Signatory Name 2: (BLOCK CAPITALS) Signature 2: Date: (DD/MM/YYYY) 6. AIB SEPA Direct Debit Mandate *VISA Company Number: For Office Use Only OIN IE52SDD UMR OIN IE02SDD By signing this mandate form, you authorise (A) AIB to send instructions to your bank to debit (B) your bank to debit your account in accordance with the instructions from AIB. As part of your rights, you are entitled to a refund from your bank under the terms and conditions of your agreement with your bank. A refund must be claimed within 8 weeks starting from the date on which your account was debited. Your rights are explained in a statement that you can obtain from your bank. Please complete all the fields marked *. *Company Name: *Company Address: City: Post Code: Country: Type of Payment Recurrent payment or One-off payment *Customer Account Number IBAN: *Customer Bank Identifier code BIC: Creditor s Name: AIB Card Issuing Creditor s Address: PO Box 708, Sandyford, Dublin 18 *Date of Signature: D D M M Y Y Signature(s) *1. Signature: Authorised Signatory of above branch account must be signed here. *2. Signature: ONLY sign here if branch account requires 2 signatories

5 BRANCH USE ONLY Seller Number: Please read through the following list to check that you have completed the application correctly. CONFIRM ALL OF THE FOLLOWING: Please tick the boxes NAME: SIGNATORIES: RECOMMENDED LIMIT: The trading name of the applicant is correct as per its Certificate of Registration of business name. The form has been signed by the person(s) required to sign for maximum amounts in the Mandate for the operation of the customer s bank account. is the recommended credit limit I confirm that the overall credit facility limit is within our branch discretion The overall credit facility limit is outside our branch discretion and I have attached the relevant appropriate banking authority approval. RECOMMENDATION: Customer Grade is (If open for less than 6 months please provide additional information supporting this application in the the space below). CUSTOMER ID: CJA FOLIO: We have identified the customer or relevant parties in accordance with the Criminal Justice (Money Laundering and Terrorist Financing) Act Customer Due Diligence procedures have been completed for the business entity and its principals as required. FOR LIMITED COMPANY/PLC APPLICANTS ONLY: Please tick the boxes NAME: DELEGATION: BORROWING POWERS: The company name is correct as per its Certificate of Registration and Certificate of Incorporation. (Please insert no. of cert of incorporation). The directors of the company have power to nominate persons to sign cheques, etc and other negotiable instruments on behalf of the company. The directors of the company are empowered to borrow, and these additional powers are within their authorised borrowing powers OR the extent of the borrowing powers of the Board of Directors/ Committee of Management of the Society and their delegation of signing authority have been duly authorised as per the Society s book of rules. CONNECTED ACCOUNTS: Please give details of connected accounts (if any). SUPPORTING INFORMATION: Please tick relevant category & give details below. Existing AIB Customer (greater than 6 months banked): Non-system supporting info. E.g. Business Turnover Account Status (0, 3 or higher): Strong supporting rationale required Projected turnover for the next 12 months New Company/Non AIB: Brief profile of the business to include : 1) Track Record, 2) Information on the sector currently operating in, 3) 6 months bank statements, 4) Any other supporting documents N.B. Where appropriate for any of the options above, please provide written justification for requested limit. supported by an up-to-date Lender s Report attached to the application, detailing any recently sanctioned facilities across the AIB Group Authorised Branch Sign Off Staff Name: (BLOCK CAPITALS) Signature: Staff No. Signing No.

6 AIB VISA PURCHASING CARD APPLICATION FORM Complete and return this application form to your AIB branch

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