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.
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
CountryCredit 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
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
£
£
£
£
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
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)
:
TimeStage 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
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 ✓