Personal Current/Savings Account

our application to open a Personal Current/Savings Account in the Channel Islands and Isle of Man with Lloyds Bank International Limited ( Lloyds Bank ) About this form This application form is for individuals or joint applicants. If there are more than two applicants, please complete details of additional applicants on a separate application form. If you wish to add a party to one or more existing s, please see Section 3.1 BEFORE completing this form. Please write clearly using black ink in the white spaces with capital letters or mark ( ) in the boxes. While we have tried to design this form so that we do not ask you to provide more information than we need, there may be circumstances in which we need to request further information from you. 1 our personal details First customer Second customer Title Mr Mrs Miss Ms Other (please specify) Title Mr Mrs Miss Ms Other (please specify) Last name Last name First name(s) First name(s) Have you used, or do you currently use any other name(s)? (e.g. maiden name, any other name used) Have you used, or do you currently use any other name(s)? (e.g. maiden name, any other name used) Nationality(s) Nationality(s) our relationship to the first customer 2 Accounts you already hold with Lloyds Bank ne If you will be opening (or will be added to) a current, you will need to complete ALL sections of this form. If you will be opening (or will be added to) one or more savings s only, you will not need to complete Section 5. Indicate here if you already have a Fixed Term Deposit, Call, Money Market Call, Incentive Saver or International Bonus Saver Account with Lloyds Bank in the Channel Islands or Isle of Man? My/our existing Lloyds Bank : Indicate here if you already have a Current with Lloyds Bank in the Channel Islands or Isle of Man? ou will NOT normally need to complete Sections 4 and 5 of this form (unless you are opening a Fixed Term Deposit, Call, Money Market Call, International Bonus Saver Account, in which case you will also need to complete Section 4). Please now go straight to Section 3 (or Section 3.1 if you are being added to an existing ) My/our existing Lloyds Bank : Indicate here if you already have any other Savings with Lloyds Bank in the Channel Islands or Isle of Man? (i.e. other than a Fixed Term Deposit, Call, Money Market Call, Incentive Saver, International Bonus Saver Account) ou will NOT normally need to complete Section 4 of this form (unless you are opening a Fixed Term Deposit, Call, Money Market Call, International Bonus Saver Account). Please now go straight to Section 3 (or Section 3.1 if you are being added to an existing ) My/our existing Lloyds Bank : If you have NOT indicated any of the boxes above, mark here if you have any s with a company within the Lloyds Banking Group elsewhere (e.g. in the UK) or if you have an Island Future Account. My/our existing Lloyds Bank : 1

3 Details of the (s) you would like to open I would like to open the (s) below. Where an existing is to be converted, I have indicated this. Current s Island Cheque (or Staff Classic) Island Gold Island Premier Island Student Island Graduate Island Future (if you are aged 16-18 and in full-time employment) Savings s Island Regular Savings te: you will need to set up a Standing Order for up to 2,000 a month into the. I would like my interest: added to the on the anniversary of opening (or next working day) credited to the following in my name on the anniversary of opening (or next working day): Island Instant Access I would like my interest: added to the on 9th monthly (or next working day) credited to the following in my name at the same branch on 9th monthly (or next working day): Island Premier Savings Minimum opening balance 5,000 te: ou will also need to hold an Island Premier Current Account I would like to receive my interest: annually on the anniversary of opening (or next working day) I would like my interest: monthly on the same date as the date of opening (or next working day) added to the credited to the following in my name at the same branch Island Bonus Saver Account Minimum opening balance 5,000 The Initial Period for the bonus rate is currently 12 months, which shall commence on the date of your welcome letter. Please convert my existing and transfer the entire balance into my new Island Bonus Saver Account (Please note in some circumstances this will result in a new number and sort code) Sterling Bonus Saver Interest will be added to the Island Bonus Saver Account on 9th monthly (or next working day) 2

3 Details of the (s) you would like to open (continued) International Bonus Saver Account Minimum opening balance 5,000/ US$5,000 The Initial Period for the bonus rate is currently 12 months, which shall commence on the date of your welcome letter. Please close my existing (sort code and number shown alongside), reopen as an International Bonus Saver on a new number and transfer the whole balance to the new Euro Bonus Saver US Dollar Bonus Saver Interest will be added to the International Bonus Saver Account on 10th monthly (or next working day) Island 30 Day Minimum opening balance 10,000 I would like my interest: added to the on 9th monthly (or next working day) credited to the following in my name at the same branch on 9th monthly (or next working day): Island Investment Minimum opening balance 50,000 I would like my interest: added to the half-yearly on 9th June and December (or next working day) credited to the following in my name at the same branch half-yearly on 9th June and December (or next working day): Call / Money Market Call Minimum opening deposit: 10,000 for sterling, $10,000 for US dollar, 10,000 for euro and for other currencies will vary. Currency Accounts in sterling, US dollar and euro are known as Money Market Call Accounts and interest is paid on 1st monthly. Accounts in all other currencies are known as Call Accounts and interest is paid half yearly on 1st January and 1st July. Fixed Term Deposit (and Call/Money Market Call Account if required*) Please note: The minimum deposit for a Fixed Term Deposit (and the associated Call/Money Market Call Account) is 10,000, 10,000, $10,000 and for other currencies will vary. The Fixed Term Deposit terms provide that the maximum deposit is 5,000,000 or 5,000,000 or US$5,000,000. Currency Unless otherwise indicated, interest will be credited to the on maturity. Term Six Months Fixed One ear Fixed Other (please specify) * Each Fixed Term Deposit requires a Call/Money Market Call Account in the same name and currency. If you do not already have a Call/Money Market Call Account in the same name and currency as the Fixed Term Deposit, by marking the box ( ) immediately above, you are requesting us to open one. If you already have a Call/Money Market Call Account in the currency of your Fixed Term Deposit we will use that and advise you accordingly. If you wish to specify an existing Call/Money Market Call Account that we should use, please do so in the space(s) below. 3

3 Details of the (s) you would like to open (continued) On maturity of my Fixed Term Deposit, please: Roll over principal and interest for the same term I wish my interest payments and/or maturity proceeds to be paid to the following : Name of bank Or Roll over principal and repay interest to my detailed below Name of branch and location (full address if not Lloyds Bank) Please note: In the absence of any written instructions received to the contrary, we will take the above action on the maturity of your Fixed Term Deposit. If you wish to give us alternative instructions, we require these in writing for sterling deposits by 4pm UK time the working day before the maturity date. For all other currencies, your instructions must be received by 4pm UK time three working days before maturity. Please refer to your Account Conditions to ascertain what will happen to your funds on maturity in the event of no instruction (including details of when we might reinvest your funds). Account type (for example current) Name in which is held Wherever possible, this should be an with a company in the Lloyds Banking Group. If you are not a customer at present, please provide the full name and address of the bank to which you may require the maturity proceeds and/or interest to be paid. 3.1 Adding a party to existing s Please indicate here if you wish to add another person to the existing (s) as follows: BOTH the existing and the new -holders should please: Complete Section 1 of this form Sign in Section 12 Sign the Specimen Signature section on the penultimate page The NEW -holder should also follow the instructions in Section 2 re which sections of the form do / do not need to be completed. 3.2 Politically Exposed Person (PEP) Are you a Politically Exposed Person (PEP)? Further information Are you related in any way to a PEP? If you are a new customer or you are opening a Fixed Term Deposit, Call, Money Market Call, International Bonus Saver Account, please now go to Section 4. Unless you are opening one of the s above, if you (or any new party being added to existing s) already hold a Lloyds Bank current in the Channel Islands or Isle of Man, please now go to Section 6. 4

4 Additional personal details This section should only be completed by NEW CUSTOMERS and any existing customer opening a Fixed Term Deposit, Call, Money Market Call, International Bonus Saver Account First customer Second customer Place of birth (Town/City) Place of birth (Town/City) Country Country Date of birth D D M M Date of birth D D M M Gender Male Female Gender Male Female What is your current Marital/Civil Partnership status? What is your current Marital/Civil Partnership status? Single Married/ Civil Partnership Divorced/dissolved Civil Partnership Single Married/ Civil Partnership Divorced/dissolved Civil Partnership Separated Widowed Separated Widowed Other (please explain) Other (please explain) Country of residence Country of residence Number of children under 18 Number of children under 18 Which countries are you tax resident in, or have been a resident of in the past 2 years? Which countries are you tax resident in, or have been a resident of in the past 2 years? 4.1 our contact details our telephone numbers and area dialling codes Home Mobile Work Email our telephone numbers and area dialling codes Home Mobile Work Email 4.2 our residential details our permanent residential address (where you live) our permanent residential address (where you live) When did you start living at this address? M M When did you start living at this address? M M 5

4.2 our residential details (continued) First customer our previous address (if less than three years at current address) Second customer our previous address (if less than three years at current address) When did you start living at this address? M M When did you start living at this address? M M If you lived at this previous address for less than three years, please provide details (either on the back page of this form or on a separate piece of paper) of any other previous addresses during the last three years. our correspondence address (if different from your permanent residential address) If you lived at this previous address for less than three years, please provide details (either on the back page of this form or on a separate piece of paper) of any other previous addresses during the last three years. our correspondence address (if different from your permanent residential address) What is your current residential status? What is your current residential status? Owner no mortgage Owner with mortgage Local authority tenant Owner no mortgage Owner with mortgage Local authority tenant Private tenant Living with parents Private tenant Living with parents Other (please explain) Other (please explain) If you have indicated above that you have a U.S. Nationality, U.S. Country of Residence, U.S. Country of Birth or are a resident in the U.S. for tax purposes, please provide your U.S. Taxpayer Identification Number (TIN) here U.S. TIN If you have indicated above that you have a U.S. Nationality, U.S. Country of Residence, U.S. Country of Birth or are a resident in the U.S. for tax purposes, please provide your U.S. Taxpayer Identification Number (TIN) here U.S. TIN 4.3 Additional addresses If you have any additional addresses that are not your permanent residential address or correspondence address please provide these here. Additional address Additional address If you only wish to open one or more Savings s, please now go to Section 6. If you wish to open a Current Account, please go to Section 5. If you only wish to be added to one or more Savings s, please now go to Section 6. If you wish to be added to a Current Account, please now go to Section 5. (If you already have a Current Account with us, please go to Section 6). 6

5 Additional personal details (Current s) This section is to be completed by NEW CURRENT ACCOUNT CUSTOMERS ONL (i.e. if you have indicated in Section 2 that you wish to open a Current Account and you do not already have a Lloyds Bank Current in the Channel Islands or Isle of Man) 5.1 our monthly household income First customer s income Second customer s income Source: Source: Salary/wages If yes Frequency e.g. weekly Salary/wages If yes Frequency e.g. weekly Benefits If yes Frequency e.g. weekly Benefits If yes Frequency e.g. weekly Pension If yes Frequency e.g. weekly Pension If yes Frequency e.g. weekly Investments If yes Frequency e.g. weekly Investments If yes Frequency e.g. weekly Other If yes Frequency e.g. weekly Other If yes Frequency e.g. weekly If other, please state type If other, please state type Total net monthly income Total net monthly income expected through this per month expected through this per month Staff member: If unknown use customer notes to explain situation. Staff member: If unknown use customer notes to explain situation. 5.2 Monthly commitments The total amount of any borrowing or credit facilities held on a joint basis should be shown in full against both holders. First customer Mortgage/rent HP/other loans Lloyds Bank loans Total each month Second customer Mortgage/rent HP/other loans Lloyds Bank loans Total each month 7

5.3 Details of your savings First customer Second customer What type of savings do you have? What type of savings do you have? savings Savings only with companies within the Lloyds Banking Group savings Savings only with companies within the Lloyds Banking Group Lloyds Banking Group and non-lloyds Banking Group savings Savings only with companies outside the Lloyds Banking Group Lloyds Banking Group and non-lloyds Banking Group savings Savings only with companies outside the Lloyds Banking Group What is the total amount of your savings? What is the total amount of your savings? 5.4 Other banking details Details of main with another bank or building society. Bank/Building Society name Details of main with another bank or building society. Bank/Building Society name How many other bank s do you hold with Lloyds Bank or any other banks? How many other bank s do you hold with Lloyds Bank or any other banks? ne 1 2 5 6 9 10+ ne 1 2 5 6 9 10+ Current Current Savings Savings Personal loan Personal loan Mortgage Mortgage Which of the following facilities do you use: Debit card Which of the following facilities do you use: Debit card For how long have you banked there? For how long have you banked there? M M M M Is the to be closed? Is the to be closed? 5.5 our 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 with a company within the Lloyds Banking Group? What other card type(s) do you hold? If yes, what is your credit limit? Chargecard Storecard Are any with a company within the Lloyds Banking Group? What other card type(s) do you hold? If yes, what is your credit limit? Chargecard Storecard Other (please specify) Other (please specify) 5.6 our mortgage details Do you have a mortgage? Do you have a mortgage? If yes, is it with a company within the Lloyds Banking Group? (e.g. Lloyds Bank, Cheltenham and Gloucester) What is the outstanding balance on your mortgage? What is the value of your house? If yes, is it with a company within the Lloyds Banking Group? (e.g. Lloyds Bank, Cheltenham and Gloucester) What is the outstanding balance on your mortgage? What is the value of your house? 8

6 Debit / Cashpoint Cards I wish to apply for a Lloyds Bank Debit Card on my Current (s) as follows: I wish to apply for a Lloyds Bank Cashpoint Card on my Savings (s) as follows: Island Cheque Island Student Island Instant Access Island Gold Island Graduate Island 30 Day Island Premier Island Future (if aged 16+ and in full time employment) Island Premier Savings I understand that the Terms and Conditions for my Lloyds Bank Debit /Cashpoint Card will be given to me with the card and I agree that if I use the card I will be bound by those Terms and Conditions. our Debit / Cashpoint Card(s) will be sent to your correspondence address. our mother s maiden name (first customer) our mother s maiden name (second customer) We may occasionally require your mother s maiden name to help confirm your identity, when a transaction authorisation is necessary (Debit Cards only). Upon acceptance of your application you will be issued with a separate confidential Personal Identification Number (PIN) for use on each on which you have applied for a Card. This / these will allow you to use your Card(s) to withdraw cash from cash machines. If you have a Debit Card the PIN may be required to authorise payments at some retail outlets. If you already have a PIN on your Lloyds Bank, please continue to use it. 7 Other details Do you require cheque books? (current s only) If yes, would you like them: Without counterfoils With counterfoils Do you require a personalised paying-in book? (five personalised paying-in slips are available in the back of your cheque book) Do you require left-handed chequebooks? 8 our initial deposit If you are making an initial deposit, please provide details below Please indicate only one box. If your initial deposit is a cheque or banker s draft, you will not be able to withdraw funds until the cheque has cleared. For Fixed Term Deposits only, if you are paying by cheque or banker s draft, your cannot be opened until the cheque or banker s draft has cleared. If it is in a currency other than sterling we may need to collect the cheque (see our leaflet our Banking Charges Guide ). If this is the case, the process may take several weeks and a charge may be incurred. I enclose a cheque or banker s draft for Currency made payable to the holder. OR Please transfer Currency from my Lloyds Bank or Bank of Scotland International : Name of branch and location Account type (for example current) OR I have instructed my bank to send you Currency by way of Method of transfer (Please do not send any funds until you have been advised of your number) If these funds are to be credited to more than one, please provide details in the tes section at the end of this form. 9

9 our employment details First customer Second customer Are you: Are you: Employed Self employed Unemployed Employed Self employed Unemployed Part time Retired t working Part time Retired t working Seeking work Student Seeking work Student Other (please explain) Other (please explain) If you are not working, how long since you last worked? If you are not working, how long since you last worked? M M M M our total annual income/salary our total annual income/salary our occupation our occupation our employer s name our employer s name How long have you worked for your current employer? How long have you worked for your current employer? M M M M How long did you work for your previous employer? How long did you work for your previous employer? M M M M Is your employment pensionable? Is your employment pensionable? 10 Additional information We are obliged to request the following additional information when an is opened. te: If you are opening more than one, please provide details in each box for EACH individual (except for the final box re Source of Wealth ). our reason for opening the (s), the intended use and the expected activity. Please provide details of the Bank / Company from which the initial deposit(s) will come Please provide details of the country from which the initial deposit(s) will come. The estimated amount which will be paid into the (s) each year (or approximate sterling amount if in another currency). 10

10 Additional information (continued) Source of funds please state the source of the initial deposit(s) and likely source of future deposits (e.g. savings, salary, bonus, sale of financial assets, sale of property, inheritance). Further evidence may be required. Source of wealth please explain how you have accumulated your total wealth (e.g. earnings during your lifetime, inheriting family wealth, managing your own business). Further documentary evidence may be required. 11 Other services Other services Save the Change I would like to set up Save the Change from my current to my savings. Mortgages I would like further information on the range of Lloyds Bank Mortgages Regular Savings I have at least 50 a month to save and would like further information on other savings options. I would like further information on lump sum investment opportunities from a minimum of 5,000 I would like to discuss my wider financial circumstances in a free, no obligation Financial Health Check. Buildings & Contents Insurance I would like further information on Lloyds Bank Home Protection (buildings and contents insurance). I would like further information on Lloyds Bank Structured Deposits. Lump Sum Investments Structured Deposits Financial Health Check 12 our agreement with us This section contains a lot of important information. Please take the time to read it carefully to ensure you understand it fully. If you have any questions please contact us. Please mark ( ) only one box. I wish to open my with Lloyds Bank in: Jersey Guernsey Isle of Man If you are applying for an Island Gold or Island Premier Account, please read this section and answer the six questions below (five questions if Island Premier). Travel Insurance Eligibility The travel insurance products which are provided as part of the Island Premier and Island Gold Accounts are underwritten and administered by AXA Insurance UK plc. Registered in England. 78950. Registered Office: 5 Old Broad Street, London EC2N 1AD (the insurer). AXA Insurance UK plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority under registration number 202312. Lloyds Bank International Limited is acting for and on behalf of the insurer(s) when marketing, offering and selling these policies. Please note that this policy does not cover anyone aged 80 or over. Island Gold Travel Insurance offers a maximum of 45 days cover in any one trip. A range of upgrades can be purchased. Island Premier Travel Insurance offers a maximum of 62 days cover per trip. Do you need to extend your cover? Do you require Winter Sports cover? (Island Gold only) Island Premier customers automatically receive family and winter sports cover at no extra cost. If you have answered yes to either of the above questions, please call the Customer Services Helpline before you book your travel or book your next trip. Exclusions relating to your health This policy is designed to provide medical emergency treatment solely as a result of accidents and illnesses occurring during your trip. This policy does not cover claims arising from any existing medical condition for which you have received, or are awaiting, tests, treatment, or consultation in the six months prior to opening this, or booking your trip, whichever is the later, or where you have received a terminal prognosis, unless the insurer expressly agrees to cover your condition. Please note if you, or anyone covered by this policy have any medical conditions and they all appear in the list of no screen conditions in the travel insurance Terms and Conditions document, then these will all be covered under the policy without the need to contact the insurer provided you can answer no to the following questions: ou are answering these questions on behalf of yourself and any other person who is to be covered by this policy. Have you or any other person on the policy been diagnosed as terminally ill? Are you or any other person on this policy on a waiting list for any tests, treatment or specialist referrals? Are you or any other person on the policy awaiting a diagnosis or the results of any tests? Have you or any other person on the policy had medication changed in the last six months? If you, or any other person on the policy, have answered yes to any of the above questions you may not be covered unless you contact the Customer Services Helpline to apply for cover in respect of any medical conditions. Cover may only be available for certain medical conditions if you pay an additional premium for claims arising from these conditions. 11

12 our agreement with us (continued) This section contains a lot of important information. Please take the time to read it carefully to ensure you understand it fully. If you have any questions please contact us. My Personal Data and Lloyds Bank Who we are our information will be held by Lloyds Bank International Limited which is part of the Lloyds Banking Group. More information on the Group can be found at lloydsbankinggroup.com How we share your information with Group companies our personal information will be shared within the Lloyds Banking Group to enable us to better understand your needs, run your s, and provide products in the efficient way that you expect. Using your information for fraud prevention We will share your personal information from your application with fraud prevention agencies. If false or inaccurate information is provided and fraud is identified, details of this fraud will be passed to these agencies to prevent fraud and money laundering. Further details explaining how information held by the fraud prevention agencies may be used can be obtained by reading the privacy notice at lloydsbank.com/international/privacy or contacting your local branch. Undertaking credit searches We may obtain information about you from credit reference agencies and Group records to check your credit status. The credit reference agency enquiries may be seen by other companies making their own enquiries and may affect your ability to obtain credit elsewhere in the future. We may also use credit scoring. Undertaking credit searches on a joint applicant If this is a joint application you are giving us permission to search and record information in respect of you both, and create a link between your financial records at credit reference agencies which will remain until you successfully apply for a notice of disassociation at these agencies. Checking your identity We may ask you to provide physical forms of identity verification or search the files of credit reference agencies which will keep a record of our search, whether or not your application proceeds. This is not seen or used by lenders to assess your ability to obtain credit. Sharing your personal information with Insurers and Register of Claims If you apply to us for insurance, we will pass your details to the insurer and their agents. If you make a claim, any information you give to us, or to the insurer, may be put onto a register of claims and shared with other insurers to prevent fraudulent claims. How we manage sensitive personal information If you apply to us for insurance, a pension, health insurance or life assurance, we may ask you for some sensitive details, for example your medical history. We will only use this information to provide the service you require and we will ask for your explicit consent. How we use your information to contact you about products and services Lloyds Banking Group companies may use your information to contact you by mail, telephone, email or text message about products and services that may be of interest to you. If you do not wish to receive this information please mark ( ) in the box below. I would prefer not to receive marketing information from you about products and services which you believe may interest me or benefit me financially. Please note that if I mark this box, you will be unable to notify me about any new products and services that may be of benefit to me. our consent to process your information To understand how the personal information you give us will be used, we strongly advise that you read our Privacy Statement, which you can find at lloydsbank.com/international/privacy or you can ask us for a copy. By signing this application you agree to your personal information being used in the ways we describe. Please contact us if you have any questions. Personal notice by email Occasionally we may need to send you personal notice of a change to the Agreement (as defined below). For example an amendment to the conditions of your such as a change in charges or how often we pay you interest. If you are happy to receive notice in this way, please mark the box below and provide your email address. I/We agree to receive such personal notice by email rather than by post. While we will do our best to send such email securely and to minimise personal information, you should ensure you maintain the security of your email systems. our email address If you have already provided your email address in Section 4.1, there is no need to repeat it here. Travel Insurance Declaration (Island Gold/Premier only) I declare that I have been informed of the important features of the Lloyds Bank Island Gold / Premier Travel Insurance policy, including the need to disclose medical conditions if I or anyone else to be insured under the policy wish to apply for cover in respect of them. I have been provided with a copy of the policy Terms and Conditions which I have read paying particular attention to the Exclusions relating to your health section. our statement to us 1 I/We understand: how to cancel this product(s) how to make a complaint 2 I apply for the (s) which I have chosen in Section 3 and, if applicable, a Cashpoint and/or Debit Card(s) (as indicated in Section 6). 3 Where I have indicated in Section 11 that I would like to set up Save the Change, I request you to set this up between the s I have indicated. 4 I agree to be bound by the published Agreement which includes this Application Form, the Customer Relationship Agreement and the Additional Conditions relating to the (s) and service(s) I have selected. I understand and agree to be bound by the personal data provisions set out in summary in this Application Form and more fully in the Privacy Statement on our website lloydsbank.com/international/privacy 5 I understand that you reserve the right to decline this application without being required to state any reason, and that no correspondence will be entered into in these circumstances. 6 I certify the accuracy of the information and statements given in this Application Form and authorise you to make any enquires which you may consider necessary for confirmation of these and for credit scoring and assessment. 7 I have ensured that any alterations made to this application by me/us have been signed by me/us. 8 I will notify you of any change(s) that occur at any time in relation to the information I have provided in this Application Form. 9 Where the (s) is / are (a) joint (s) (including where this Application Form is being used to make (an) existing sole (s) into (a) joint (s)) I understand and agree to be bound by any additional joint customers conditions within the Customer Relationship Agreement or any other document forming part of our Agreement. Signature of first customer (Please sign in black ink if possible) Date D D M M Signature of second customer (if this is a joint ) (Please sign in black ink if possible) Date D D M M Please retain a copy of the completed Application Form for future reference as this forms part of your Agreement. 12

13 What to do when you have filled in this form Please bring this application to a Lloyds Bank branch. If you are a new customer we will require proof of your identity and where you live. Please bring original documents with you (as shown below) and we will copy them for you. Please check that you have: Signed and dated this form Enclosed your cheque, bank transfer or payment details Taken a photocopy of this Application Form for future reference. For new customers only: Provided your original passport (or similar document) Provided confirmation of your address. How did you first become aware of our Accounts? Branch Personal recommendation Internet Direct mailing Advertisement/Comment in (name of publication) Account standing order authority (WHEN OPENING AN ISLAND REGULAR SAVINGS ACCOUNT) Please pay to my/our Island Regular Savings Account on the (Maximum 2,000 p.m.) day of each month First customer s signature Commencing on and debit my/our sort code and number D D M M Date Second customer s signature D D M M Name(s) of holder(s) Date D D M M FOR BANK USE ONL Sort code and Island Regular Savings Specimen signatures Branch (s) Date completed D D M M Signing instructions: Either party to sign First customer s name Second customer s name First customer s signature Second customer s signature

tes / Other Information 15

Lloyds Bank International Limited trading as Lloyds Bank. Registered Office and principal place of business: PO Box 160, 25 New Street, St. Helier, Jersey JE4 8RG. Registered in Jersey. 4029. Regulated by the Jersey Financial Services Commission. We abide by the Jersey Code of Practice for Consumer Lending. The Isle of Man branch of Lloyds Bank International Limited is licensed by the Isle of Man Financial Supervision Commission and registered with the Insurance and Pensions Authority in respect of General Business. The Guernsey branch of Lloyds Bank International Limited is licensed to conduct banking, investment and insurance intermediary business by the Guernsey Financial Services Commission under the Banking Supervision (Bailiwick of Guernsey) Law 1994, the Protection of Investors (Bailiwick of Guernsey) Law 1987 and the Insurance Managers and Insurance Intermediaries (Bailiwick of Guernsey) Law 2002. Cashpoint is a registered trademark of Lloyds Bank plc. OBI0128 (08/14)