Your application to open a Sole /Joint Lloyds Bank account This form is not to be used for an Added Value Account Please write clearly in the white spaces with capital letters or cross the boxes. Bank use only Please complete all sections of this form. opened Staff file number TNT Code What will you be using the Account for? D D M M Y Y Sort code Account number 1 Your personal details First customer Are you an existing Lloyds Bank customer? Second customer Are you an existing Lloyds Bank customer? Your title Mr Mrs Miss Ms Other (please specify) Your title Mr Mrs Miss Ms Other (please specify) Your last name Your last name Your first names Your first names Any other name you use/have used (if applicable) Any other name you use/have used (if applicable) Your date of birth D D M M Y Y Are you: Male Female Your date of birth D D M M Y Y Are you: Male Female If you are a student, you will only need to complete this form if you do not meet the criteria for a Student account. Are you: Employed Self employed Part time Unemployed If you are a student, you will only need to complete this form if you do not meet the criteria for a Student account. Are you: Employed Self employed Part time Unemployed t working Seeking work Retired Student t working Seeking work Retired Student Other (please explain) If unemployed how long since you last worked? Years Months Y Y M M Other (please explain) If unemployed how long since you last worked? Years Months Y Y M M Your country of birth Your nationality Your country of birth Your nationality Your additional nationalities (if applicable): Your additional nationalities (if applicable): Your country of residence Your country of residence Which countries are you tax resident* in or have you been a resident of in the past two years? Which countries are you tax resident* in or have you been a resident of in the past two years? If you have a United States (US) Taxpayer Identification Number (TIN) please provide details below Please note: This may be your US Social Security Number If you have a United States (US) Taxpayer Identification Number (TIN) please provide details below Please note: This may be your US Social Security Number *Please note: tax resident relates to countries where you have the obligation to file a tax return or where you are subject to income tax in the UK or in another country. You must provide at least one country. Your relationship to the first customer Bank use only Sanctions/NCCT. Sanctions ref. no (if applicable) Sanctions ref. no (if applicable)
1 Your personal details 1.1 Your contact details continued Your telephone numbers and area dialling codes Home Mobile Work Your telephone numbers and area dialling codes Home Mobile Work 1.2 Your residential details Your home address (where you live) Your home address (where you live) When did you start living at this address? Month Year When did you start living at this address? Month Year M M Y Y Y Y M M Y Y Y Y Your previous address (if less than three years at current address) Your previous address (if less than three years at current address) When did you start living at this address? Month Year When did you start living at this address? Month Year M M Y Y Y Y M M Y Y Y Y Your correspondence address (if different from your home address) Your correspondence address (if different from your home address) 2 Your debit card details I would like to apply for a debit card The type of card we give you depends on our assessment of your personal circumstances. Customer name to appear on card I would like to apply for a debit card The type of card we give you depends on our assessment of your personal circumstances. Customer name to appear on card Mother s previous name (new debit card customers only) Mother s previous name (new debit card customers only) Your date of birth Your date of birth D D M M Y Y D D M M Y Y
3 Your agreement with us Current Accounts and Other Services Thank you for opening your account with us. Your agreement is with Lloyds Bank plc. Our agreement with you is made up of general conditions (contained in the Personal Banking terms and conditions leaflet) and additional conditions. These include the conditions below and the Banking Charges guide which contains our standard fees. If there is any overlap or conflict between the additional conditions and the Personal Banking terms and conditions, the additional conditions apply. Eligibility To have the account you must be 18 or over. Joint Accounts All account holders can operate their accounts individually and are individually and jointly liable for all amounts owed to us on those accounts. It is important that you read the Personal Banking terms and conditions as these explain how we deal with joint accounts and your responsibilities. If you ask, we will tell you which CRAs and FPAs we (and other Lloyds Banking Group companies) have used so you can get a copy of your details from them. You are legally entitled, on payment of a fee, to see any information held about you by any credit reference agency. For more information about how Lloyds Banking Group companies use your personal information, please refer to the terms and conditions for your product. You can ask us for another copy of these terms at any of our branches or by calling Telephone Banking, or you can find them on www.lloydsbank.com. Marketing permissions Your data is safe with us we do not share your data for marketing outside the Lloyds Banking Group. We would like to tell you about offers, products and services that may be of specific interest to you. If you choose no for all of these options, we will not be able to send you this information. Please confirm how we may contact you (if more than one applicant, please use separate sections indicated): Bank statements: We will send account statements to both of you unless one of you signs here to say that you do not want us to send statements to you. You can cancel this arrangement at any time by writing to us and we will then send separate statements to both of you. I do not wish to receive statements First Customer Please write to me Please phone me Please e-mail me Please text me Your signature Second Customer Please write to me Please e-mail me Please phone me Please text me My personal data and Lloyds Banking Group The Lloyds Banking Group includes us and a number of other companies using brands including Lloyds Bank, Halifax and Bank of Scotland, and their associated companies. More information on the Lloyds Banking Group can be found at www.lloydsbankinggroup.com. We need to perform searches to decide whether to accept your application, including checks to confirm your identity. We make these checks, including electoral register checks, through European credit reference agencies ( CRAs ) and fraud prevention agencies ( FPAs ). The CRA will record the searches, even if an application does not go ahead or is unsuccessful. This may affect your ability to borrow from other lenders within a short period. Lloyds Banking Group companies may also tell CRAs how you run your relationship with them (such as whether or not you pay anything you owe on time), which may also affect your ability to borrow from other lenders. If the information you provide is false or inaccurate, or we suspect fraud, we may provide details to FPAs and other relevant organisations. Law enforcement agencies may access and use this information. You will be financially linked by CRAs to any other names you use or have used, and any joint applicants. This means joint applicants financial affairs may be treated as affecting each other, and will be revealed whenever CRAs are searched, until one of you successfully files a disassociation with the CRAs. I confirm that I have received the following documentation: Your banking relationship with us (the Personal Banking terms and conditions) Advised and provided with Interest Rates Applicable to this Account First customer s signature Second customer s signature Welcome Pack Banking Charges Brochure Bank use only Credit reference/bureau search result *Prompt screen print voters roll Lloyds Bank plc. Registered Office: 25 Gresham Street, London EC2V 7HN. Registered in England and Wales, no. 2065. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority under registration number 119278.
4 Additional personal and employment details Please complete all sections of this form. Are you working? Are you working? Your occupation Your occupation Your employer s name Your employer s name Your employer s address Your employer s address (if known) (if known) How long have you worked for your current employer? How long did you work for your previous employer? Years Months How long have you worked for your current employer? Years Months Y Y M M Y Y M M Years Months How long did you work for your previous employer? Years Months Y Y M M Y Y M M Is your employment pensionable? Is your employment pensionable? 5 Your monthly household income and expenditure details First customer s income Source: Direct to If yes Frequency e.g. weekly a bank Cheque Cash Into this account Salary/wages Benefits Pension Investments Other If other please state type Total net monthly income Amount expected through this account per month Staff member: If unknown use customer notes to explain situation. Second customer s income Source: Direct to If yes Frequency e.g. weekly a bank Cheque Cash Into this account Salary/wages Benefits Pension Investments Other If other please state type Total net monthly income Amount expected through this account per month Staff member: If unknown use customer notes to explain situation.
5 Your monthly household income and expenditure details 5.1 Monthly commitments continued The total amount of any borrowing or credit facilities held on a joint basis should be shown in full against both account holders. First customer Mortgage/rent HP/other loans Lloyds Bank loans Amount Second customer Mortgage/rent HP/other loans Lloyds Bank loans Amount Total each month Total each month 6 Details of your savings What type of savings do you have? What type of savings do you have? savings Lloyds Bank savings only Lloyds Bank and non-lloyds Bank savings savings Lloyds Bank savings only Lloyds Bank and non-lloyds Bank savings n-lloyds Bank savings only What is the total amount of your savings n-lloyds Bank savings only What is the total amount of your savings 7 Your banking details Is this a personal or business account? Personal Business Is this a personal or business account? Personal Business 7.1 Other banking details Which of the following facilities do you use: Cheque card Debit card Which of the following facilities do you use: Cheque card Debit card For how long have you banked there? Years Months For how long have you banked there? Years Months Y Y M M Y Y M M Is the account to be closed? If no please explain why Is the account to be closed? If no please explain why Would you like us to transfer your account? Would you like us to transfer your account? 7.2 Your credit card details Do you hold a credit card? If yes, how many? Do you hold a credit card? If yes, how many? Are any Lloyds Bank? If yes what is your credit limit? Are any Lloyds Bank? If yes what is your credit limit? What other card type(s) do you hold? Chargecard Storecard Other (please specify) What other card type(s) do you hold? Chargecard Storecard Other (please specify) 7.3 Your mortgage details Do you have a mortgage? Do you have a mortgage? If yes is it with Lloyds Bank? If yes is it with Lloyds Bank? What is the outstanding balance on your mortgage? What is the value of your house? What is the outstanding balance on your mortgage? What is the value of your house?
For bank use only Confirmation of customer s identity Please note that the Retail Procedures on Interchange Identification of Customers should be referred to and copies of ID should be taken, dated and signed as true copies of the original. First customer Does customer meet Single ID requirements? Second customer Does customer meet Single ID requirements? Proof of identity (cross one box only) Proof of identity (cross one box only) Standard Third party Standard Third party Secondary PHD Ref. Secondary PHD Ref. What document has been seen? What is the reference number? Expiry date e.g. passport (available) What document has been seen? What is the reference number? Expiry date e.g. passport (available) Correctly certified copy of documents attached Correctly certified copy of documents attached If required Proof of address (cross one box only) If required Proof of address (cross one box only) Standard Third party Standard Third party Secondary PHD Ref. Secondary PHD Ref. What document has been seen? What is the reference number? Expiry date e.g. passport (available) What document has been seen? What is the reference number? Expiry date e.g. passport (available) Correctly certified copy documents attached Correctly certified copy documents attached Account maintenance Please note, no credits can be accepted until all necessary ID requirements have been met. Until ID has been completed an 646 indicator should be inserted. Indicator 646 inserted (if applicable) Follow up to be completed by account manager. Tax status amended (if applicable) Disclosure (no marketing) indicator 040 inserted (if applicable) Staff indicator 041 inserted (if applicable) Planned Overdraft limit loaded and facility letter sent (if applicable) Strict flag (LOA) loaded (if applicable) For completion by the initial interview 2 stage interviews only Meeting booked with Time : D D M M Y Y Stage One What Happens Next card given If decline result telephone call made to advise Decline letter sent If accept result note diarised to call 24 hours before the appointment Staff member s details By signing this section, both staff members are confirming that the evidence attached meets the Banks identification requirements. Name of staff member completing this form Checker s name (or Grade C equivalent) Staff member s signature Checker s signature 10424-0114
IMPORTANT INFORMATION PLEASE READ CAREFULLY On completion, the Specimen Signature slip below must be detached and sent to the MPC daily in the grey polylope. Please ensure all sections are completed fully using black ink. Please do not mark or write on the front of the Specimen Signature slip except in designated boxes. Please remove the Specimen Signature slip and send to MPC before sending the form to AQCU. Specimen signatures Branch sort code completed Account number(s) Signing instructions: Either party to sign Other see attached First customer s name Second customer s name First customer s signature Second customer s signature 11113-0913
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