Equity Release Application Form

Rd10082 TMB 471/3 07/01/2008 14:31 Page 1 Equity Release Application Form To be completed by intermediary Trading Name Sales Consultant ICS Source Code Please confirm the following - was this application referred directly to you/your office by the applicants? YES If please confirm the details of the introducer below: NO Name Address Company TMB:471/3

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Rd10082 TMB 471/3 07/01/2008 14:31 Page 3 Please read through this form carefully and complete it in as much detail as possible. This will help us to respond to you quickly. Complete each section using BLOCK LETTERS. In the case of joint applicants, details regarding each applicant must be provided. If a question does not apply to you please enter N/A (not applicable). All figures mentioned will be assumed to be in euro. Personal details First applicant Second applicant First name(s) Surname Date of birth Marital status (Single, Married, Widowed, Separated, Divorced) Number of dependants Current address Age(s) of dependants Age(s) of dependants Telephone number H W H W Mobile number Email address Occupation and income P.A.Y.E. only Occupation Employer Employer s address Length of service years months years months Basic salary/wage Gross per annum Overtime Guaranteed Guaranteed Gross per annum Regular Irregular Regular Irregular Bonus Guaranteed Guaranteed Gross per annum Regular Irregular Regular Irregular Guaranteed Guaranteed Commission Gross per annum Regular Irregular Regular Irregular Last P60 figure Self employed only Business name Business address First applicant Second applicant Nature of business Date established Period of ownership Last two years annual income Last year Last year Previous year Previous year 1

Rd10082 TMB 471/3 07/01/2008 14:31 Page 4 Proof of income We need certain documents from you in order to process your application. They are: Self employed applicants For loans less than 85,000, we will need For loans greater than 85,000, we will need All other applicants For loans less than 85,000, we will need any one of For loans greater than 85,000, we will need any two of (1) An ICS Accountants Report (1) Your last 2 years certified/audited accounts (2) Confirmation that your ta affairs are up to date (1) P60 (2) ICS Salary Certificate (3) Your last 3 payslips (1) P60 (2) ICS Salary Certificate (3) Your last 3 payslips Financial commitments Please provide details of current personal borrowings, lease agreements etc. First or Financial Original Amount Repayment Repayment Purpose To be Second Institution/ loan now frequency amount of loan refinanced Applicant Card type amount owing (e.g. monthly) Please complete Credit Card details d d d Purpose Home improvements* Are your liable for maintenance payments If yes, please indicate monthly amount payable Mortgage amount required Amount Eisting ICS Mortgage Account number(s) Is planning permission required? Current ICS Building Society mortgage balance Education fees Please estimate the current value of your property 2 Medical fees Refinancing other debt (see Financial commitments on page 2) Other purposes* * Please provide details of Home improvements or Other purposes.

Rd10082 TMB 471/3 07/01/2008 14:31 Page 5 Type of mortgage required Repayment Endowment Interest Only (Pension backed Y N ) Term in years Fied rate Variable rate Repayment frequency Monthly Fortnightly If monthly, please state preferred payment date Do you require stage payments? (e.g. 17th day of the month) When do you require your loan cheque? Your solicitor details Name of solicitor Name of solicitor firm Address Help us to help you Please use this space to provide additional information which you feel is relevant to your application. 3

Rd10082 TMB 471/3 07/01/2008 14:31 Page 6 ICS Building Society Declaration, Authorisation and Consent HOME LOAN DETAILS First Applicant (Block Capitals) Loan Amount Mortgage Type Second Applicant Repayment Period Application Number CONSENT under Consumer Credit Act 1995 I hereby consent to ICS Building Society and its Agents being able to contact me at my place of work First Applicant I hereby consent to ICS Building Society being able to contact my employer for income verification purposes (please note the Society cannot process your application without this consent as we must be able to contact your employer to verify income details) First Applicant CONSENT under Data Protection Acts 1988 and 2003 I hereby consent to the details, information and personal data that I have supplied to ICS Building Society being used by the Society to provide me with information by way of direct marketing about other products and services supplied by it or members of the Bank of Ireland Group (of which the Society is a member) or arranged by the Bank of Ireland Group with third parties (this is optional - you do not have to give this consent) and/or I hereby consent to the disclosure by the Society of my details, information, personal data and documentation to any other member of the Bank of Ireland Group for the purposes of direct marketing about other products and services supplied by a Group member or arranged by a Group member with third parties (this is optional - you do not have to give this consent). First Applicant DECLARATIONS, AUTHORISATIONS AND CONSENTS Second Applicant Second Applicant Second Applicant Please read carefully before signing this form. Where there is more than one applicant, any references to I or my are to be construed as references to we or our respectively. The Society means ICS Building Society. 1. I apply to the Society for a mortgage advance and declare that the information given and documentation furnished by me is true and correct, to the best of my knowledge, information and belief. 2. I declare that I have never been insolvent and have never made arrangements with creditors and have never been involved in any court proceedings for debt. 3. I authorise the Society to make all reasonable enquiries of my accountant, solicitor, mortgage lender, broker or any credit reference bureau or agency or any other person, in connection with and arising from my application and any aspect thereof. 4. I authorise the Society to appoint an agent to act on its behalf in processing and administering this application. 5. I authorise the Society to disclose all and any details, information, personal data or documentation relating to my application to (A) any third party for the purposes of or in connection with processing and administering my application and (B) any person acting as an agent of the Society or any other third party engaged by the Society for general business purposes in connection with my application and (C) any credit reference bureau or agency AND I hereby further authorise and consent to the processing of all and any details, information, personal data or documentation as are herein referred to by the Society and any disclosee as is referred to herein. 6. I hereby confirm that each and every one of the foregoing authorisations and consents contained herein to disclose personal data and all or any other information to any third party constitutes a consent for the purposes of the Data Protection Acts, 1988 and 2003 and any amending or etending legislation or any European Union regulation or directive. 7. I declare and agree that I will pay any reasonable costs and epenses incurred by the Society in dealing with this application, whether or not a loan is received by me. 8. I declare that I have read the Consumer Credit Act tices, which are set out on the reverse hereof. First Applicant Second Applicant Date Date 4 ICS Building Society is regulated by the Financial Regulator. A Member of Bank of Ireland Group

Rd10082 TMB 471/3 07/01/2008 14:31 Page 7 Consumer Credit Act tices WARNING: YOUR HOME IS AT RISK IF YOU DO NOT KEEP UP PAYMENTS ON A MORTGAGE OR ANY OTHER LOAN SECURED ON IT. If your mortgage is at any time at a variable rate, please note: THE PAYMENT RATES ON THIS HOUSING LOAN MAY BE ADJUSTED BY THE LENDER FROM TIME TO TIME. Consumer Protection Code Warnings Warning: This new loan may take longer to pay off than your previous loans. This means you may pay more than if you paid over a shorter term Warning: The cost of your monthly repayments may increase - If you do not keep up your repayments you may lose your home. Warning: You may have to pay charges if you pay off a fied-rate loan early. Warning: The entire amount that you have borrowed will still be outstanding at the end of the interest-only period. ENDOWMENT LOANS If you choose an endowment loan, and the insurer does not guarantee that the proceeds of the policy will be enough to repay the loan when due, please note: WARNING: THERE IS NO GUARANTEE THAT THE PROCEEDS OF THE INSURANCE POLICY WILL BE SUFFICIENT TO REPAY THE LOAN IN FULL WHEN IT BECOMES DUE FOR REPAYMENT. You should also note that in the case of endowment loans, early surrender of the policy may mean that you get back less than you have paid in premia and other charges. EARLY REPAYMENT In the case of a fied rate loan, in the event of early repayment of the Loan in whole or in part for any reason, or conversion to a variable interest rate, or other fied rate within the initial fied rate period or any further or subsequent fied rate period, the Borrower will be liable to pay a sum to be calculated in accordance with the following formula (Amount (R-R1) Time) divided by 36500 and for the purposes of this formula, the variables are defined as follows: Amount means the average balance of the amount repaid early or converted from the date of repayment or conversion to the end of the fied rate term, allowing for scheduled repayments; in the case of an endowment loan, this will equal the full amount of the early repayment or conversion. R means the cost of funds for the Society for the fied rate period as incorporated in the eisting interest rate applying to the Loan. R1 means the interest rate available to the Society for funds placed in the money market on the date of early repayment or conversion for the remainder of the relevant fied rate period. Time means the number of days from the date of early repayment or conversion to the end of the relevant fied rate period. ARREARS Any sum not paid by its due date is subject to an additional interest charge at the rate of 0.5% per month or part of month (i.e. 6% per annum), subject to a minimum of 2.54 per month, from the due date until payment, and is charged monthly on the arrears balance at the end of that month. This additional interest charge is intended to cover the Society s increased administration and related charges due to the Borrower s default. Full details of this charge will be set out in any loan agreement with you. FEES and COSTS The Society requires that a valuation be carried out by a valuer acceptable to the Society (see below) and that the appropriate fee be paid by you directly to the valuer. The amount of the fee will be determined by reference to the value of the property, and if any loan agreement is withdrawn the payment will be refunded. Legal fees (ecluding costs associated with the Society s legal investigation of title for the purpose of the mortgage) are payable by the borrower to his or her solicitor. The amount will depend upon the arrangements made between these parties. VALUATION The Society requires that a valuation be carried out on the property(ies) offered as security. This valuation must be completed by a valuer acceptable to the Society and any such valuation or report remains the property of the Society. responsibility whatsoever is implied or accepted or warranty given by the Society for the value or condition of the property by reason of such valuation. The Borrower is strongly recommended to arrange an independent valuation and structural survey of the property. You are responsible for payment of the valuation fee. If the loan is refused the valuation fee will be refunded to you. Please note that a valuation report should only be arranged after you have received Approval in Principle. You are entitled to your own copy of the valuation report. ICS Building Society is regulated by the Financial Regulator. A Member of Bank of Ireland Group 5

Rd10082 TMB 471/3 07/01/2008 14:31 Page 8 Insurance/Assurance One of the conditions of your mortgage is that the property must be insured in the name(s) of the applicant(s) and the Society for an amount not less than the reinstatement value specified in the valuation report. The insurance must be in place at drawdown of the loan cheque. You must also have sufficient life assurance in place. The Society can arrange inde linked Home Insurance on your behalf through Bank of Ireland Insurance Services Limited. If you would like to avail of this insurance please complete the attached Home Insurance application form. Applicants may arrange insurance with any insurer or through any intermediary of the Applicant s choice provided it meets the Society s requirements, details of which are available on request. Building Society Block Policies - Statement of insurance practice The Society s arrangements with its insurers for Home Insurance do not require completion of detailed insurance forms. However, a contract of insurance requires disclosure of any facts which an insurer would regard as likely to influence the assessment and acceptance of an insurance proposal. Eamples would be: some types of criminal convictions of you or members of your household (e.g. arson, theft or fraud); previous refusal by an insurer to provide householders buildings or personal possessions insurance; or a history of a high level of claims under these types of insurance. If you consider that there are any facts which are, or might be, material, you should enclose a note with this application; failure to do so could invalidate the insurance. If however there is nothing to disclose and you have requested the Society to arrange insurance on your behalf, this application form is also deemed an Insurance Proposal Form. MORTGAGE REPAYMENT PROTECTION COVER Mortgage Repayment Cover covers your mortgage repayment in the event of accident and sickness, redundancy or hospitalisation. Mortgage Repayment Cover is only available to applicants taking a mortgage through ICS Building Society. It has been arranged through Bank of Ireland Insurance Services Limited. This plan is not compulsory and accepting or declining it will not affect your mortgage application in any way. If you would like to avail of this insurance please complete the attached Mortgage Repayment Cover application form. ACKNOWLEDGMENT I/We acknowledge that I/we have been offered Home Insurance and Mortgage Repayment Cover and life assurance by or through ICS Building Society in connection with this advance. I/We confirm that I/we have declined to accept: Home Insurance Mortgage Repayment Cover Life Assurance Signature(s) of applicant(s) First applicant Date Second applicant Date 6

Rd10082 TMB 471/3 07/01/2008 14:31 Page 9 Home Insurance & Mortgage Repayment Cover The questions on this form relate to facts considered material to underwriting the insurance. A material fact is one, which might affect the company s decision to give you insurance, and the premiums we may charge. If you are in any doubt as to whether a fact is material, you should disclose it. Failure to do so may invalidate your insurance. Home and Mortgage Repayment Cover are arranged through Bank of Ireland Insurance Services Limited. Bank of Ireland is regulated by the Financial Regulator. Bank of Ireland Insurance Services is a member of Bank of Ireland Group and is regulated by the Financial Regulator. To be continued as appears on the current application form. MANDATORY INFORMATION: ICS Consultant 1. Personal Details (please complete this section in full) ICS Source Code 9 0 RM Code Your Title Mr Mrs Ms Miss Your Partner s Title Mr Mrs Ms Miss First Name Surname First Name Surname Date of Birth: D D M M Y Y Y Y Date of Birth: D D M M Y Y Y Y Occupation Occupation Telephone: (H) (W) Mobile Email Telephone: (H) (W) Mobile Email PLEASE NOTE THAT DIFFERENT RATES APPLY TO BUILDINGS IN THE COURSE OF CONSTRUCTION/TENANTED PROPERTIES/ UNOCCUPIED PROPERTIES/HOLIDAY HOMES - Please contact our Home Insurance Team on 1890 60 60 60 for rates on the above properties 2. Home Insurance Cover - 3 months free cover (optional) Bank of Ireland Home Insurance is underwritten by Royal and Sun Alliance Insurance plc and Hibernian General Insurance Ltd. Royal and Sun Alliance Insurance plc registered office St Mark s Court, Chart Way, Horsham, RH12 1XL. Royal and Sun Alliance Insurance plc is authorised by the UK Financial Services Authority and regulated by the Financial Regulator for the conduct of business in Ireland. Hibernian General Insurance Ltd, One Park Place, Hatch Street, Dublin 2. Hibernian General Insurance Ltd is regulated by the Financial Regulator Description of property (Please tick) Private Dwelling House (if any rooms are let out please tick Tenanted Property bo) Purpose Built Apartment Holiday Home Buildings in the Course of Construction* Tenanted Property * Please note if property is for resale we cannot quote Date cover is required from: Buildings D D M M Y Y Y Y Contents & other sections D D M M Y Y Y Y ICS Mortgage Account Number: Please state the name and address of the Bank, Building Society or Party with an interest in the property to be insured (if applicable) Address of property to be insured Your postal address (if different) Please tell us why the postal address differs from the address of the property to be insured If you are moving to your insured property please advise us of the date until which the postal address is valid D D M M Y Y Y Y Will the insured property be occupied within 30 days of the date cover is required from If no please indicate reason why 1. Buildings Cover Required Please state the reinstatement value* of your home - building(s) Main Private Dwelling House & Buildings in the Course of Construction - Min 160,000: Dublin, Min 130,000: Country. Ma 700,000 : Dublin and Country. Tenanted Properties & Holiday Homes - Min 160,000: Dublin, Min 130,000: Country. Ma 400,000:Dublin, Ma 300,000: Country. *If the reinstatement value on the mortgage valuation is a higher figure we will automatically increase our Sum Insured on Buildings for reinstatement purposes. Please indicate the number of bedrooms Is the insured resident in the property? Please indicate the number of tenants* Is the property let to a family unit? *Please note if property is let to students we cannot quote. 7

Rd10082 TMB 471/3 07/01/2008 14:31 Page 10 Home Insurance Cover - 3 months free cover (Section 2 Continued) 2. Contents Cover Required Please state the amount you wish to insure your contents for Main Private Dwelling House - Min 27,000:Dublin, Min 22,000:Country. Ma 160,000:Dublin and Country. Tenanted Properties - Min 15,000:Dublin and Country. Ma 50,000:Dublin, Ma 35,000:Country. Holiday Homes - Min 27,000:Dublin, Min 22,000:Country. Ma 50,000:Dublin, Ma 35,000:Country. te: Please forward valuations for any High Risk items, valued at over 10,000 per item. 3: Optional Etensions to Contents (Only applicable to Main Private Dwelling House) The All Risks Package covers you for loss or damage to your personal belongings while they are within or outside your home, for eample, accidentally breaking your glasses or having sports equipment stolen from your car. You can avail of cover for Unspecified Items and/or Specified Items. The Maimum combined total for all risks (specified and unspecified) is 45,000. Unspecified Items Required (Ma 2,000 for any one item) Unspecified Items are covered up to a total value of 2,500 Plus: Loss of money up to 400 Loss of Credit Card up to 1,275 Pedal Cycles up to 385 (in any one year) Specified Items Required (Ma 15,000 for any one item) Specified Items worth more than 1,905 or individual items you wish to insure for All Risks cover must be named, for eample, an engagement ring, camera or a valuable piece of jewellery. Description Value te: Valuations are required if any item eceeds 10,000. For any item valued over 15,000 a photograph is required, and this must be referred to the underwriter for individual rates, terms and conditions. Discounts available (Only applicable to Main Private Dwelling House) Neighbourhood Watch/Smoke Alarm 5% 152 Voluntary Ecess* 5% Burglar Alarm 10% 250 Voluntary Ecess* 10% Centrally Monitored Burglar Alarm 25% Age 50 or over * Standard Ecess 100. Ecess is the amount the customer must pay in the event of a claim. 15% 3. Declaration I/We declare, ecept where stated to the contrary in the bo supplied, that A. The Home is: built of brick, stone or concrete and roofed with slates, tiles, concrete or asphalt or mineral felt provided that the mineral felt portion of the roof does not eceed 50% of the total roof area. well maintained and in a good state of repair not left unoccupied for more than 2 months a year in an area which is free from flooding, subsidence, heave, landslip, coastal or river erosion regularly occupied at night occupied solely by you or your family for residential purposes only and not used for business purposes other than - for keeping up to si paying guests - for the provision of a child minding service for up to 2 children not used to store commercial goods or used as a place of employment for any employee of your company or firm fitted with five lever mortice deadlocks on all eternal doors (applicable only for customers who live in the following areas: Dublin City & County, Co.Wicklow, Co.Kildare, Co.Meath, and including towns/villages within these counties). In the case of Buildings in the Course of Construction please complete the declaration on the basis of when the property is complete. B. I, or any member of my household, have not: suffered any loss, damage or liability during the last 5 years whether insured or not ever had a proposal for insurance declined, renewal refused, cover terminated or special terms or conditions imposed by any Insurer ever been convicted of, or have any prosecution pending for any criminal offence (other than minor driving offences) Eceptions to A and B Please use an etra sheet if necessary and please state if an etra sheet has been used. I/We declare that to the best of my/our knowledge and belief that the above statements made by me/us are true and complete. I/We agree that this proposal shall be the basis of the contract between me/us and the insurers. In the event of my/our default in paying any instalments on the date it becomes due, the insurance will cease from such date. My signature below acknowledges that I have read, and where appropriate, indicated my preference, in the Definitions and Data Protection Declaration, as set out in section 5 on page 10. Signature (1) Signature (2) X X 8 Date D D M M Y Y Y Y

Rd10082 TMB 471/3 07/01/2008 14:31 Page 11 4. Mortgage Repayment Cover - 6 months free cover Cover Required This covers your monthly repayments should you be absent from work due to accident & sickness, redundancy or hospitalisation. Even if you are paid from work while out sick, Mortgage Repayment Cover will still be paid. Terms and Conditions apply and these terms contain the relevant complaints procedures. The insurer who will issue your insurance is Genworth Financial. Protected Mortgage Repayment Cover I/we would like Bank of Ireland to make my/our mortgage repayments if I/we cannot work due to an accident, illness, redundancy (private employees only) or hospitalisation (state and self-employed only). I/We would like to avail of the first si months cover free and thereafter pay 4.75 per 100 mortgage repayment per month. Monthly mortgage repayment Amount of monthly cover required Date cover required from D D M M Y Y Y Y There are two cover options available, Single Cover and Joint Cover. Single cover is available where the mortgage is primarily covered by one income in the household. The amount of the monthly cover chosen will be paid in the event of a claim. Joint cover is available where there are two incomes contributing to the mortgage repayment. This means that if either party submits a claim 50% of the amount of the monthly cover chosen will be paid. Please select the cover option you require: Mortgage Repayment Cover Declaration I/We declare that I/we are in good health and in full time employment. My signature below acknowledges that I have read, and where appropriate, indicated my preference in the Definitions and Data Protection Declaration, as set out in section 5 on page 10. Signature (1) Please note that if you have selected the SINGLE COVER OPTION, the name of the income earner must appear as the first signatory. Signature (2) Date Unprotected Mortgage Repayment Cover Declaration I/We understand that I/we are responsible for making my/our monthly mortgage repayment if I/we are unable to work. My signature below acknowledges that I have read, and where appropriate, indicated my preference, in the Definitions and Data Protection Declaration, as set out in section 5 on page 10. Signature (1) Signature (2) Date X X X X D D M M Y Y Y Y D D M M Y Y Y Y Mortgage Repayment Cover is underwritten by Genworth Financial a trading name of Financial Insurance Company Limited (incorporated in England. 1515187). Registered in Ireland. E902818. Registered address: Building 11, Chiswick Park, Chiswick High Road, London, W4 5XR. Registered Irish Branch Office: 31-36 Golden Lane, Dublin 8. Single cover Joint Cover (50/50 Split) Financial Insurance Company Limited is regulated in the UK by the Financial Services Authority and in Ireland by the Financial Regulator. 9 Please turn over

Rd10082 TMB 471/3 07/01/2008 14:31 Page 12 5. Definitions and Data Protection Declaration BIIS means Bank of Ireland Insurance Services Limited. BOI Group means the Governor & Company of Bank of Ireland and any of its subsidiaries. Information means any information given by me in this proposal form and any further information, which I may give at a later stage either in writing, at a meeting or over the telephone. Marketing means direct marketing and cross-selling of the services and/or products provided by BIIS and/or any company within the BOI Group or arranged by the BOI Group with a third party. 1. I/We agree that BIIS may hold and use the information on computer file, in any other dematerialised form or in written hard copy on its own behalf and on behalf of other companies within the BOI Group and may pass the information to any other company within the BOI Group or third parties for administration, customer care and services purposes. 2. I/We agree that BIIS may also hold and pass the information on computer file for the purposes of marketing and cross selling of other services and products provided by BIIS or any company within the BOI Group or arranged by BOI Group with a third party. These purposes are referred to as marketing purposes. I/We agree that you may pass this information to other companies within the BOI Group or to a third party for marketing purposes. Tick this bo if you do not wish to receive direct marketing offers from BIIS. Tick this bo if you do not wish us to pass this information to the BOI Group or to a third party for marketing purposes. I understand that at any time I can ask you to stop or change the methods by which BIIS may send me marketing materials. This can be done free of charge by writing to Bank of Ireland Insurance Services, Hainault House, Tallaght, Dublin 24. A COPY OF THIS COMPLETED PROPOSAL FORM AND OF THE RELEVANT POLICY TERMS AND CONDITIONS ARE AVAILABLE ON REQUEST. te: Please indicate below whether the premiums payable for the cover(s) chosen should be debited from your account on a monthly/yearly basis following the relevant free periods. The free periods are as follows: Home Insurance Cover - 3 months, Mortgage Repayment Cover - 6 months. 10 6. Direct Debit Mandate To: The Manager, Name of Bank Address of Bank Name of account to be debited Current account number* Reference (for office use only) Signature(s) X X D D M M Y Y Y Y Payment Frequency Yearly NSC Monthly I instruct you to pay direct debits from my account at the request of: Bank of Ireland Insurance Services Limited. The amounts are variable and may be debited on various dates. I understand that Bank of Ireland Insurance Services Limited may change the amounts and dates only after giving me prior notice. * Please note Direct Debit Mandates can only be setup on acurrent account. Banks may refuse to accept instructions to pay direct from some types of accounts. Originator s Identification Number 3 0 0 1 7 8

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