Opening your business account. Incorporated Society

Opening your business account Incorporated Society

Thank you for considering AIB as your business partner. We are committed to providing real value to every customer, and to delivering the highest standard of service in banking and financial services. Our success is reflected in that of our customers. The management team at your local AIB branch or business outlet has a great deal of experience in providing financial guidance to help businesses start up and expand. Use our experience to your advantage, by getting us involved in discussing your plans. We will work with you to identify your financial needs and advise you only of the products and services we consider will benefit you and your business. We will be delighted to help your business prosper and grow in any way we can.

Contents Opening your AIB Business Account... 4 Account Opening Form... 6 Products and Services required... 7 Foreign Account Tax Compliance Act (FATCA)... 8 Details of Incorporated Society Secretary and Management Committee Members... 9 Details of Beneficial Owners of the Incorporated Society... 11 Details of Beneficial Owners of a Shareholding Entity... 13 General Incorporated Society Mandate... 15 Bank Use Only... 18 This application pack sets out the steps which you should follow if you wish to apply to open a business account with AIB. The contents of this document do not constitute an offer to open a bank account. 3

STEP 1 STEP 1 STEP 2 STEP 2 STEP 3 STEP 3 Opening your AIB Business Account Gather together the following documents: Gather Original together Certificate the following of Acknowledgement documents: of the Registration of the Incorporated Society ( the Society ). Original Certificate of Acknowledgement of the Registration of the Incorporated Society ( the Printed Society ). version of the Rules of the Society Printed Most recent version audited of the accounts, Rules of the together Society with bank statements for the previous six months and a bank reference if these items are available. Most recent audited accounts, together with bank statements for the previous six months and a bank reference if these items are available. Complete the following forms included in this pack: Complete Account the Opening following Form forms to included give us your in this Incorporated pack: society details. Account General Opening Incorporated Form Society to give Mandate us your business to tell us details. what instructions we are to take to conduct transactions on your account. General Company Mandate to tell us what instructions we are to take to conduct transactions on Details your of business all Beneficial account. Owners*, Society Secretary and members of the Management Committee. We Details will only of Beneficial use personal Owners*, information Directors provided and Company by you in Secretary. these forms for the purpose of the We opening will search and conduct in the Companies of the Incorporated Office to verify Society s the accounts. Company s particulars. We *Any will individual only use who personal ultimately information owns or controls provided 25% by you or more in these of the forms shares for or the voting purpose rights of in the the opening Incorporated and conduct Society or of otherwise Company s exercises accounts. control over the management of the Incorporated Society. *Any A individuals member of who the ultimately Management own Committee or control 25% must or sign more and of the the Secretary shares or countersign voting rights (or in the Company another or otherwise member of exercise the Management control over Committee) the management to confirm of the that Company. the information provided A in Company respect Director of the Secretary, must sign Management and the Company Committee Secretary members countersign and Beneficial (or another Owners Director) of the to confirm Incorporated that the Society information is correct. provided in respect of the Beneficial Owners of the Company is correct. Where Where the no Company individual is owns a Guarantee or controls Company 25% or without more of Share the shares Capital or the voting individual(s) rights in could the be the Incorporated person with Society the casting or otherwise or deciding exercises vote, control e.g. Chairperson, over the management or another relevant of the Incorporated member (or Society, members) then of we the will Managing need details Committee/Board. for the two individuals who hold the greatest percentage of shares or voting rights in the Incorporated Society. Where no individual owns or controls 25% or more of the shares or voting rights in the Company or We otherwise will need exercises details of control the Beneficial over the Owners management of any of entity the Company, that itself then ultimately we will owns need or details controls for the 25% two or individuals more of the who shares hold or the voting greatest rights percentage in the Incorporated of shares or Society, voting or rights otherwise in the exercises Company. control over the management of the Incorporated Society. We will need details of the Beneficial Owner of any shareholding company that itself ultimately Financial owns Institutions or controls in Ireland 25% or are more required of the as shares a matter or voting of Irish rights law to in ask the certain Company, questions or for otherwise the purposes exercises of identifying control over those the management accounts which of are the reportable Company. to Irish Revenue for onward transmission to the US Internal Revenue Service in connection with the Foreign Account Tax Financial Compliance Institutions Act (FATCA). in Ireland On this are application required as form a matter you will of Irish be asked law to to: ask certain questions for the Confirm purposes the FATCA of identifying entity type those for accounts the Incorporated which are Society reportable (if you to need Irish Revenue more information please onward refer to transmission the Entity to Classification the US Internal Guide, Revenue available Service at http://business.aib.ie/help/fatca connection with the Foreign or from any Account AIB staff Tax member). Compliance Act (FATCA). On this application form you will be asked to: Confirm If relevant, the FATCA provide entity the type GIIN for (Global the Company Intermediary (if you Identification need more information Number) US please TIN refer (Tax to Identification the Entity Classification Number) or US Guide, Citizenship/tax available residency at http://business.aib.ie/help/fatca status together with US TIN or for from Beneficial any AIB Owners. staff member). Identification If relevant, requirements: provide the GIIN (Global Intermediary Identification Number) or US TIN (Tax Identification Number) or US Citizenship/tax residency status together with US TIN for In Beneficial order to Owners. comply with legislation to combat money laundering and terrorist financing we will need suitable proof of identity and residential address of the following: Identification least one requirements: member of the Management Committee of the Incorporated Society; and; In order at least to one comply person with authorised legislation to sign to combat any transactions money laundering on the account and of terrorist the Incorporated financing Society we will Identification need suitable procedures proof of identity are not required and residential for certain address listed of plc s, the following: for example companies listed one person the who Official is authorised List of the to Irish sign Stock any transactions Exchange. If on the the shareholding account(s) of company the Company is in this category, ( account please signatory ); let us know. one Those Director individuals will need to go to the branch where the account is being opened or any Those AIB branch individuals and produce: will need to go to the branch where the account is being opened or any AIB (1) branch Photographic and produce: ID: A valid Passport, Current Driver s License or National Identity Card. (2) Proof of Permanent residential address (Documents must be no more than 6 months old): 1). Photographic ID: A valid Passport, Current Drivers Licence or National Identity Card. A Utility Bill or Correspondence from a Regulated Financial Institution or a Government 2). Proof Department. of permanent residential address (Documents must be no more than six months old): There are A Utility alternative Bill or Correspondence arrangements from in place a Regulated for the Financial establishment Institution of or identity a Government and current Department. permanent There are residential alternative address arrangements of persons in place who for do not the possess establishment the documentation of identity and outlined current above. Please permanent talk to residential one of our address staff at your of persons local AIB who branch do not for possess details. the documentation outlined If any above. of the Please individuals talk to are one non-residents, of our staff at come your and local talk AIB to branch us as we for may details. require additional information. 4

Opening your AIB Business Account (Cont d) STEP 3 STEP 4 STEP 5 Identification requirements: (Cont d) The account will not become operational until we have centrally verified the identification documents. The Bank must be informed by notice in writing, signed by at least one member of the Management Committee and countersigned by the Secretary, as soon as may be, of any change in the Beneficial Owners, Management Committee members and Secretary of the Incorporated Society or any change in status of the Incorporated Society. In order to comply with our obligations under legislation, we may, at our discretion at any time, seek further information, documentation and confirmation as to the identity of individuals who ultimately own or control the shares or voting rights in the Incorporated Society or otherwise exercise control over the management of the Incorporated Society. Do you need Electronic Banking? Do you require advice from an ibusiness Banking Specialist? Do you require an ibusiness Banking application form? Telephone or call into your local branch and make an appointment to meet with a relationship manager: Don t forget to bring the following to your meeting: This application pack and all the necessary documents Your business plan (if available) Accounts (if available) Before your appointment, we recommend that you take a few minutes to read the relevant product terms and conditions. These are the rules and regulations for operating a business account with AIB. 5

ACCOunt OpenIng FOrm Please use BLOCK CAPITALS and indicate with a 3 where appropriate. Sections marked with an * are mandatory and must be completed in full. Incorporated Society Name* (as on the Certificate of Acknowledgement of the Registration of the Society/Rules of the Incorporated Society) Incorporated Society Address*: Please use BLOCK CAPITALS and indicate with a 3 where appropriate. Sections Address Line marked 1* with an * are mandatory and must be completed in full. Incorporated Address Line 2* Society Name* (as on the Certificate of Acknowledgement of the Registration of the Society/Rules of the Incorporated Society) Address Line 3 Incorporated County* Society Address*: Address Country* Line 1* Address Line 2* Correspondence Address: (if different to Incorporated Society Address) Address Line 3 Address Line 1* County* Address Line 2* Country* Address Line 3 Correspondence County* Address: (if different to Incorporated Society Address) Address Country* Line 1* Address Line 2* Contact person* Address Line 3 Work Fax number County* Society Activity* Country* no. of employees Years in Business Contact Business person* premises Status Owned Leased Rented (Please tick as appropriate) no. Work of Fax Outlets number Society main Purpose Banker Activity* of Account* nsc no. Incorporated Daily of Banking employees Society reg. no. Other Business Country Source of where premises Funding Incorporated* Status for the Account* Owned Leased Years in Business Rented (Please tick as appropriate) no. Operating Estimated of Outlets where Annual (i.e. Turnover Country)* of the account* main Auditors Banker name nsc Incorporated Irish tax reference Society number reg. no. Country Charity Status where number Incorporated* Operating Telephone where Details (i.e. Country)* Auditors Work mobile name phone number Irish Work tax phone reference number* number Charity E-mail/Web Status Details number Telephone Work e-mail Details Address Work Web mobile Address phone number Work phone number* E-mail/Web Details Work e-mail Address Work Web Address ACCOunt OpenIng FOrm 6

PRODUCTS AND SERVICES REQUIRED Please use BLOCK CAPITALS and indicate with a 3 where appropriate. Sections marked with an * are mandatory and must be completed in full. Account Type requirements*: Business Current Account Demand Deposit Account Other Account (If other, please specify) Statement Diary*: Frequency: Annually Quarterly Monthly Weekly Day of Month Date of Statement / / (Day/Month/Year) Cheque Book requirements*: Do you want your Society logo on your cheques? Yes No Yes (you will need to arrange artwork with your printer) Cheque Book required*: Yes No Cheque Book Type*: 25 cheques 50 cheques 100 cheques Lodgement requirements*: ExpressLodge Card required*: Yes No (ExpressLodge Cards allow lodgements to be made using AIB Cash & Cheque Lodgement machines) Number of ExpressLodge Cards required: *Please note ExpressLodge Cards can only be ordered on Current Accounts. The embossed name on the cards will match the customer account profile name. Lodgement Book required*: Yes No AIB Merchant Services requirements*: Will your business have a need now or in the future to offer credit/debit card payment options to your customers? Will your business have a need now or in the future to offer credit/debit card payment options in a Card not present or online environment? Yes Yes No No If not already indicated, can you please confirm the retail sector that your business operates in? Data Protection: By making this application to AIB, I consent to AIB passing the information provided on this form to AIB Merchant Services and for AIB Merchant Services to contact me in relation to same, and for AIB to be notified of the outcome of this referral. Yes No If not already indicated, can you please confirm the retail sector that your business operates in? 7

FOREIGN ACCOUNT TAX COMPLIANCE ACT (FATCA) Financial institutions in Ireland are required as a matter of Irish law to seek answers to certain questions for purposes of identifying those accounts which are reportable to Irish Revenue for onward transmission to the US Internal Revenue Service in connection with the Foreign Account Tax Compliance Act (FATCA). Customers of Financial Institutions such as AIB must provide the answers to specific FATCA questions. If customers do not provide all of the information requested, the Financial Institution may be obliged to include the account(s) details in the annual FATCA return to Irish Revenue. Please note that AIB is unable to offer taxation advice. For tax related questions please contact your professional tax advisor or Irish Revenue. Please indicate entity type Under FATCA Regulations you are required to identify the Entity Type applicable to your organisation. When providing answers to the questions below please refer to the Entity Classification Guide for descriptions of each entity type. This Guide is available at http://business.aib.ie/help/fatca 1. Is your organisation a US Person? (if yes please tick one of the options below. If no please go to question 2) Description Tick if applicable Description Specified US Person (Note 1) Other US Person Tick if applicable 2. Is your organisation a Financial Institution? (if yes please tick one of the options below. If no please go to question 3) Description Tick if applicable Description Certified Deemed Compliant Financial Institution Participating Financial Institution (Note2) Tick if applicable Registered Deemed Compliant Financial Institution (Note 2) Non-Participating Financial Institution Partner Jurisdiction Financial Institution (inc. Irish FI) (Note 2) 3. Is your organisation an Exempt Beneficial Owner? (if yes please tick below. If no please go to question 4) (Examples: Government Entity, Central Bank, Pension Trust, and International organisation such as World Bank, and IMF) Tick if Description applicable Exempt Beneficial Owner 4. If your organistation does not fall into one of the categories above, it is a Non-Financial Foreign (Non-US) Entity (NFFE). (please tick selection below) Typically an NFFE will be an Active NFFE if less than 50% of its gross income is from passive sources (including dividends, interest, annuities, and rent) AND less than 50% of its assets are held for the production of passive income. It is expected that the majority of organisations will fall into the Active NFFE category. A Passive NFFE is one that is not an Active NFFE. Description Tick if applicable Description Tick if applicable Active NFFE Passive NFFE (Note 3) Note 1: Please provide US TIN (US Tax Identification Number) Note 2: Please provide GIIN (Global Intermediary Identification Number) Note 3: If the Incorporated Society is a Passive NFFE, please also complete the relevant US citizenship/tax residency questions where applicable. Please include GIIN/US TIN where applicable. 8

details OF InCOrpOrAted SOCIetY SeCretArY And management COmmIttee members List hereunder the names of the Incorporated Society Secretary and all of the Committee of Management Members Insert the name of the Incorporated Society Where the Incorporated Society is a Passive NFFE (see page 8 and the Entity Classification Guide ), Beneficial Owners (including the Incorporated Society Secretary and Management Committee Members) must also complete questions marked ** Incorporated Society Secretary First Name* Surname* Home Address* Occupation*: Percentage Share/Control*. % Date of Birth*: / / (Day/Month/Year) Management Committee Member First Name* Surname* Home Address* Occupation*: Percentage Share/Control*. % Date of Birth*: / / (Day/Month/Year) Management Committee Member First Name* Surname* Home Address* Occupation*: Percentage Share/Control*. % Date of Birth*: / / (Day/Month/Year) 9

details OF InCOrpOrAted SOCIetY SeCretArY And management COmmIttee members (COnt d) Management Committee Member First Name* Surname* Home Address* Occupation*: Percentage Share/Control*. % Date of Birth*: / / (Day/Month/Year) Management Committee Member First Name* Surname* Home Address* Occupation*: Percentage Share/Control*. % Date of Birth*: / / (Day/Month/Year) 10

details OF BeneFICIAL OWnerS OF the InCOrpOrAted SOCIetY Insert the name of the Incorporated Society Please provide details of all Beneficial Owners, i.e. any individual who ultimately owns or controls 25% or more of the shares or voting rights in the Incorporated Society or otherwise exercises control over the management of the Incorporated Society. Where no individual is a Beneficial Owner, we will need details for two individuals (please refer to page 4 for guidance). Where the Incorporated Society is a Passive NFFE (see page 8 and the Entity Classification Guide ), Beneficial Owners must also complete questions marked ** Beneficiary Name: Home Address Occupation Date of Birth / / (Day/Month/Year) Percentage Share/Voting Rights/Control:. % Beneficiary Name: Home Address Occupation Date of Birth / / (Day/Month/Year) Percentage Share/Voting Rights/Control:. % Beneficiary Name: Home Address Occupation Date of Birth / / (Day/Month/Year) Percentage Share/Voting Rights/Control:. % 11

Beneficiary Name: Home Address details OF BeneFICIAL OWnerS OF the InCOrpOrAted SOCIetY (COnt d) Occupation Date of Birth / / (Day/Month/Year) Percentage Share/Voting Rights/Control:. % LISt BeLOW AnY SHAreHOLdIng entity OWnIng 25% Or more OF the InCOrpOrAted SOCIetY List below any shareholding entity that itself ultimately owns or controls 25% or more of the shares or voting rights in the Incorporated Society or otherwise exercises control over the management of the Incorporated Society. name of entity % Share/voting rights/control in the Society 1 registered number 2 registered number 3 registered number 4 registered number 12

Insert the name of the Incorporated Society details OF BeneFICIAL OWnerS OF A SHAreHOLdIng entity Please provide details of all Beneficial Owners, i.e. any individuals who ultimately own or control 25% or more of the shares or voting rights in the Shareholding Entity or otherwise exercise control over the management of the Shareholding Entity. Where the Incorporated Society is a Passive NFFE (see page 8 and the Entity Classification Guide ), Beneficial Owners must also complete questions marked ** Beneficiary Name: Home Address Occupation Date of Birth (Day/Month/Year) / / Percentage Share/Voting Rights/Control:. % Business Name: Registered Address: Beneficiary Name: Home Address Occupation Date of Birth (Day/Month/Year) / / Percentage Share/Voting Rights/Control:. % Business Name: Registered Address: 13

Beneficiary Name: Home Address details OF BeneFICIAL OWnerS OF A SHAreHOLdIng entity (COnt d) Occupation Date of Birth (Day/Month/Year) / / Percentage Share/Voting Rights/Control:. % Business Name: Registered Address: Beneficiary Name: Home Address Occupation Date of Birth (Day/Month/Year) / / Percentage Share/Voting Rights/Control:. % Business Name: Registered Address: We confirm that the details of the Secretary, Management Committee and Beneficial Owners of the Incorporated Society provided above is correct. (Signed by: One Management Committee member and countersigned by the Secretary/or another member of the Management Committee) 14

Complete in BLOCK CApItALS in black or blue pen. general Incorporated Society mandate Mandate to open accounts of all types including loan accounts with the Bank at any of its branches. This mandate does not apply to AIB ibusiness Banking or AIB Credit Cards, both of which are subject to separate Agreements and instructions. To: Allied Irish Banks, p.l.c. We certify that at a meeting of the Committee of Management of ^ ( the Society ) Insert Full Name held on the d d / m m / Y Y Y Y the following Resolutions were passed: RESOLVED: part I 1. That Allied Irish Banks, p.l.c. ( the Bank ), be and is hereby appointed to act as Bankers to the Society. 2. That the Bank be and is hereby requested and authorised to open, subject to the Bank s relevant Terms and Conditions for Current, Demand Deposit and Masterplan Accounts (a copy of which, together with the Bank s brochure Business Fees and Charges and the Bank s Terms of Business has been received by the Society), such account(s) in the name of the Society as may be considered appropriate for the receipt and disbursement of the Society s monies and to give effect to any order, direction, request or instruction expressed to have been made or given by the Society relating to drawings on or withdrawals or transfers from such account(s) from time to time originated by cheque, bill, note, acceptance, instrument, order (including a standing order and a banker s order), debit (including a direct debit), request, instruction or receipt, as the case may be, appropriate to the particular type of account, effected made or given in accordance with the drawing instructions set out in Part III hereof and notwithstanding that such account(s) be over drawn by such payments or otherwise. 3. That the Society do hereby certify the accuracy of all information provided to the Bank for the purpose of the opening of the account. 4. That the Bank be and is hereby requested to receive any monies lodged with the Bank or with the Bank s appointed agents or mandated to the Bank for credit of the account(s) of the Society and to collect payment for the Society for credit of such account(s) of all cheques, bills, notes, pay orders and other instruments, whether negotiable or not negotiable which may be lodged with the Bank or with the Bank s appointed agents from time to time. 5. That the Society do borrow from the Bank from time to time on foot of such account(s) or otherwise, and give security for such borrowing to such extent as may be arranged with the Bank. 6. In the event of any cheque, bill, note, pay order or other instrument lodged by the Society or on its instructions with the Bank or the Bank s appointed agents for collection and crediting to any such account(s) being dishonoured on presentment or of the Bank being obliged for any justifiable reason (of which your decision shall be conclusive) to repay the proceeds thereof after collection to any person whether claiming as true owner, drawer, drawee, payee, endorsee, or otherwise, to debit the amount to any such account(s), together with all fees and charges incurred in connection therewith. 7. That this mandate, having been notified to the Bank, shall remain in force unless and until altered or varied by new instructions given pursuant to a decision of the Management Committee advised to the Bank in writing (in the form of a certified extract from the minutes of the relevant meeting, or in the Bank s standard form of Society Supplemental Mandate, form AIB/MAN09), under the hand of a Committee Member and countersigned by the Secretary of the Society whereupon such new or supplemental instructions giving effect to such decision (to the extent that same shall be at variance or inconsistent therewith) shall replace or alter, as the case may be, the instructions herein contained. 8. That the Bank be furnished with the Certificate of Acknowledgement of the Registration of the Society (for sighting purposes only) and a printed version of the Rules of the Society, together with a list (see Part II below) containing full names and addresses of the Management Committee and of the Secretary of the Society or a memorandum in lieu signed by at least one Committee Member and countersigned by the Secretary, and that the Bank be informed by notice in writing, signed by at least one Committee Member and countersigned by the Secretary as soon as may be, of any change taking place from time to time in the Beneficial Owners Management Committee and Secretary of the Society. ^Enter the name of the Society as it appears in the Rules of the Society. 15

part II management COmmIttee members And SeCretArY Full Name (BLOCK CAPITALS) Residential Address Committee Position part III drawing InStruCtIOnS Authorised Signatories (mark X to indicate) Any One Any Two Both All of the following: or Other (specify in Special Instructions box below) Special Signing Instructions Special Signing Instructions: The following special signing instructions shall apply (if applicable): (e.g. Any one solely up to xxx, Any two jointly over that amount etc.). Special instructions are accepted at the discretion of the Bank and should be discussed and agreed with the Bank before this mandate is completed. Signatory Insert Full Name (BLOCK CAPITALS) Position Specimen Signature Sign within the box above Sign within the box above Sign within the box above Sign within the box above Sign within the box above 16

CertIFIed A true COpY Chairperson Secretary The mandate must be signed here by the Chairperson of the meeting at which the mandate resolutions were passed (the person must be a member of the Management Committee) and the Society Secretary (who must not be the same person as the Chairperson ) or another member of the Management Committee of the society. Dated the d d / m m / Y Y Y Y The date must be the same date or after the date of the meeting shown on the first page of the mandate. Note: Where more than one account is maintained a separate mandate should be completed for each account unless signing instructions are identical. 17

BAnK use OnLY Please use BLOCK CAPITALS and indicate with a 3 where appropriate. Sections marked with an * are mandatory and must be completed in full. Branch NSC: 9 3 Incorporated Society Name* (as on the Certificate of Acknowledgement of the Registration of the Society/Rules of the Incorporated Society) Business Classification*: Business Non Professional Business Professional Non-Commercial (Please tick as appropriate) Business Category* (Refer to InfoBank table) Business Type* (Refer to InfoBank) Complex Structure:* Yes No (Please tick as appropriate) Contact Details Salutation* (RM to specify salutation for customer correspondence) Products and Services* (Select the Account Types and Product Codes for each account to be opened) Product 1 Account Type: Product 2 Product 3 Product 4 Product 5 Product Code: Account Type: Product Code: Account Type: Product Code: Account Type: Product Code: Account Type: Product Code: Account No: Account No: Account No: Account No: Account No: Short Name* Signing Authority*: Any One Any Two Both All of the following or Other (Please tick as appropriate) Source of Funds Account Classification* Y (Company) P (Charity) X (Irish State Sponsored & Semi State) Q (AIB Subsidiary) } Sector* ^ Sector Group* ^ (^ Refer to Sector Codes Sector Sub Group* ^ (if applicable) on InfoBank) Central Bank Code* ^ Non Resident Declaration Held: Yes No (Please tick as appropriate) (Form 263 (37)) Exempt from DIRT: Yes No (Please tick as appropriate) Staff Referral Code Sub Office/Service Outlet (if applicable) 18

BANK USE ONLY (CONT D) Lodgement/Cheque Book Order (Please tick as appropriate) Lodgement Book: Yes No Cheque Book: Yes No Cheque Book Type:* 25 cheques 50 cheques 100 cheques Number of Cheque Books required* Name(s) to be Printed on Book Name(s) to be Printed on Book Signatory 1 ^^ Signatory 2 ^^ (^^Refer to Signatory table on InfoBank) Usage Code: High Medium Low (Please tick as appropriate) Triggerable: Yes No Expresslodge Card required* (ExpressLodge Cards allow lodgements to be made using AIB Cash & Cheque Lodgement machines): Yes No Number of ExpressLodge Cards required:* * Please note ExpressLodge Cards can only be ordered on Current Accounts. The embossed name on the cards will match the customer account profile name. Foreign Account Tax Compliance Act* Has the Unincorporated Society declared the entity type? Yes No If the Unincorporated Society is a Passive NFFE, have the relevant have additional the relevant questions additional been completed? questions been completed? Yes No Referral to AIBMS completed? Yes No Not applicable Referral to AIBMS completed? Yes No Not applicable Branch confirmation - Mandatory I confirm that all the mandatory fields have been completed. Branch Staff Name: Staff Number: Signature: Date: / / (Day/Month/Year) 19

AIB/BAO4 09/15