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Sole

/Joint Lloyds Bank account

Your application to open a

Bank use only

Date opened What will you be using the Account for?

First customer

Second customer

Your last name Your last name

Your first names Your first names Please write clearly in the white spaces with capital letters or cross the boxes.

Please complete all sections of this form.

Are

you: Male Female

Other (please explain) Other (please explain) Any other name you use/have used (if applicable)

Your nationality Your nationality If you are a student, you will only need to complete this form if you do not meet the criteria

for a Student account.

Self employed Self employed Are you: Employed Are you: Employed

Retired Student Retired Student

Unemployed Unemployed

Not working Not working

Part time Part time

Seeking work Seeking work Are you an existing Lloyds Bank customer? Yes No

Other (please specify) Your

title Mr Mrs Miss Ms

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 an existing Lloyds Bank customer? Yes No

Other (please specify) Your

title Mr Mrs Miss Ms

Any other name you use/have used (if applicable)

Staff file number TNT Code

Sort code Account number

D D M M Y Y

Your date of birth Your date of birth

D D M M Y Y

D D M M Y Y

If unemployed how long since you last worked?

Years Months

Y Y M M

If unemployed how long since you last worked?

Years Months

Y Y M M

Your personal details

1

Your country of birth Your country of birth

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 Your relationship to the first customer

Sanctions ref. no (if applicable) Sanctions ref. no (if applicable)

Bank use only –

Sanctions/NCCT.

This form is not to be used for an Added Value Account

*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.

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Your home address (where you live) Your home address (where you live)

When did you start living at this address?

Country

Postcode Postcode Country

Your telephone numbers and area dialling codes

Home Mobile Work

Your telephone numbers and area dialling codes

Home Mobile Work

Your previous address (if less than three years at current address)

Country

Postcode Postcode Country

Your previous address (if less than three years at current address)

Your correspondence address (if different from your home address) Your correspondence address (if different from your home address) When did you start living at this address?

When did you start living at this address? Month Year When did you start living at this address? Month Year

Month Year Month Year

I would like to apply for a debit card

Customer name to appear on card

Mother’s previous name (new debit card customers only)

Your date of birth

The type of card we give you depends on our assessment of your personal circumstances.

I would like to apply for a debit card

Customer name to appear on card

Mother’s previous name (new debit card customers only)

Your date of birth

The type of card we give you depends on our assessment of your personal circumstances.

Your personal details

continued

1

Your debit card details

2

1.1

Your contact details

1.2

Your residential details

M M Y Y Y Y

M M Y Y Y Y

M M Y Y Y Y

M M Y Y Y Y

D D M M Y Y

D D M M Y Y

Country

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Credit reference/Bureau search result

Bank use only

*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.

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.

Please write to me Yes No Please phone me

Please e-mail me Please text me

Your signature

Date

I do not wish to receive statements

First customer’s signature

Second customer’s signature

Date Date

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.

First Customer

Yes No

Please write to me Yes No Please phone me

Please e-mail me Please text me

Second Customer

Yes No

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.

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):

I confirm that I have received the following documentation: Your banking relationship with

us (the Personal Banking terms and conditions)

Welcome Pack

Banking Charges Brochure Advised and provided with

Interest Rates Applicable to this Account

Your agreement with us

3

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Please complete all sections of this form.

How long have you worked for your current employer?

How long did you work for your previous employer? Your occupation

Your employer’s name

Your employer’s address

Postcode (if known)

Are you working? Yes No

Is your employment pensionable? Yes No

Your occupation

Your employer’s name

Your employer’s address

Postcode (if known)

Are you working? Yes No

Is your employment pensionable? Yes No Years Months

Years Months

How long have you worked for your current employer?

How long did you work for your previous employer?

Years Months

Years Months

Second customer’s income

First customer’s income

If other please state type Salary/wages Benefits Pension Investments Other

Staff member: If unknown use customer notes to explain situation. Total net monthly income Amount expected through this account

per month

Source: If yes Frequency e.g. weekly Direct to a bank Cheque Cash Into this account

If other please state type Salary/wages Benefits Pension Investments Other

Staff member: If unknown use customer notes to explain situation. Total net monthly income Amount expected through this account

per month

Source: If yes Frequency e.g. weekly Direct to a bank Cheque Cash Into this account

Additional personal and employment details

4

Your monthly household income and expenditure details

5

Y Y M M

Y Y M M

Y Y M M

Y Y M M

£

£

£

£

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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

Second customer

Mortgage/rent

No

savings Lloyds Bank savings only

Non-Lloyds Bank savings only

Lloyds Bank and non-Lloyds Bank savings

What type of savings do you have? What type of savings do you have? HP/other loans

Total each month Lloyds Bank loans HP/other loans

Total each month Lloyds Bank loans

Mortgage/rent Amount Amount

What is the total amount of your savings

No

savings Lloyds Bank savings only

Non-Lloyds Bank savings only

Lloyds Bank and non-Lloyds Bank savings

What is the total amount of your savings

Is this a personal or business account? Personal Business

Do you hold a credit card? Are any Lloyds Bank?

What other card type(s) do you hold?

Chargecard Storecard Other (please specify) If yes, how many?

Do you have a mortgage?

If yes is it with Lloyds Bank?

Is this a personal or business account? Personal Business

If yes what is your credit limit?

What is the outstanding balance on

your mortgage? What is the value of your house? Which of the following facilities do you use: Cheque card Debit card

For how long have you banked there?

If no please explain why

Which of the following facilities do you use: Cheque card Debit card

Is the account to be closed? Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No Would you like us to transfer your account?

Do you hold a credit card? Are any Lloyds Bank?

What other card type(s) do you hold?

Chargecard Storecard Other (please specify) If yes, how many?

If yes what is your credit limit?

Do you have a mortgage?

If yes is it with Lloyds Bank? What is the outstanding balance on

your mortgage? What is the value of your house?

If no please explain why Is the account to be

closed?

Would you like us to transfer your account?

Years Months For how long have you banked there? Years Months

Your monthly household income and expenditure details

continued

5

Details of your savings

6

Your banking details

7

5.1

Monthly commitments

7.1

Other banking details

7.2

Your credit card details

7.3

Your mortgage details

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

£

Y Y M M

Y Y M M

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For bank use only

Proof of identity (cross one box only)

First customer

Second customer

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.

Correctly certified copy of documents attached

Standard Third party

What document has been seen? What is the reference number? Expiry date e.g. passport (available)

If required – Proof of address (cross one box only)

Standard Third party

What is the reference number? Expiry date e.g. passport (available) What document has been seen?

Secondary PHD Ref.

PHD Ref.

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. Staff indicator 041 inserted (if applicable)

Planned Overdraft limit loaded and facility letter sent (if applicable)

:

Time

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 Follow up to be completed by account manager.

Strict flag (LOA) loaded (if applicable)

Name of staff member completing this form Checker’s name (or Grade C equivalent) By signing this section, both staff members are confirming that the evidence attached meets the Banks identification requirements.

Date

Checker’s signature Correctly certified copy documents attached

Indicator 646 inserted

(if applicable) Disclosure (no marketing) indicator 040 inserted (if applicable)

Tax status amended (if applicable)

Date Meeting booked with

Date

Staff member’s signature

Does customer meet Single ID requirements? Yes No

Secondary

Proof of identity (cross one box only)

Correctly certified copy of documents attached

Standard Third party

What document has been seen? What is the reference number? Expiry date e.g. passport (available)

If required – Proof of address (cross one box only)

Standard Third party

What is the reference number? Expiry date e.g. passport (available) What document has been seen?

Secondary PHD Ref.

PHD Ref.

Correctly certified copy documents attached

Does customer meet Single ID requirements? Yes No

Secondary

10424-0114

Confirmation of customer’s identity

Account maintenance

For completion by the initial interview – 2 stage interviews only

Staff member’s details

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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.

11113-0913

Specimen signatures

Branch sort code

Account number(s)

Date completed

First customer’s signature Second customer’s signature Signing instructions:

Either party to sign ✓ Other – see attached ✓

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References

Related documents

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?.

Breakdown assistance cover provider or Breakdown assistance cover is no longer provided with Your Lloyds Bank Private Banking Premier Current Account Your Breakdown cover

For detailed information about the terms governing your deposit accounts at M&T Bank after the conversion date, please refer to the enclosed Deposit Account Terms and Conditions

For details of how we and others will use your information, please look in the Terms and Conditions for the appropriate product or contact The Royal Bank of Scotland plc,

If you need additional finance, our dedicated lending team can help you with a range of options from overdrafts on your Club Lloyds Private Banking Account and personal loans

25.1 You may ask us to close your Account at any time, subject to the Chosen Product Terms and Conditions, by writing to the branch where you opened the Account or to Bank

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For example, when you use online banking to access your OneUnited Bank checking account, you do so under the terms and conditions you agreed to in the OneUnited Bank Personal