Equity Release Application Form

Equity Release

Application

Form

To be completed by intermediary

Sales Consultant

Please confirm the following - was this application referred directly to you/your office by the applicants? YES NO

Trading Name

ICS Source Code

TMB:471/3 If ‘No’ please confirm the details of the introducer below:

s s e r d d A e m a N Company

Occupation and income

P.A.Y.E. only

Occupation Employer Employer’s address First name(s) Surname Date of birth

Marital status (Single, Married, Widowed, Separated, Divorced)

Number of dependants Age(s)ofdependants Age(s)ofdependants Current address

Telephone number Mobile number Email address

First applicant

Second applicant

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

H W H W

Self employed only

Business name Business address Nature of business Date established Period of ownership r a e y t s a L r a e y t s a L e m o c n i l a u n n a s r a e y o w t t s a L r a e y s u o i v e r P r a e y s u o i v e r P

First applicant

Second applicant

€ €

€

€

1

years months years months

Length of service Basic salary/wage Overtime Bonus Commission Last P60 figure

Gross per annum

Gross per annum Gross per annum

Gross per annum €

€ € Guaranteed Regular Irregular Guaranteed Regular Irregular € € € Guaranteed Regular Irregular € € € € Guaranteed Regular Irregular Guaranteed Regular Irregular Guaranteed Regular Irregular

Financial commitments

Please provide details of current personal borrowings, lease agreements etc.

€ € € € € € € € € € € € € € € € € € Yes No Yes No Yes No Yes No Yes No Yes No

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)

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} (1) An ICS Accountants Report

For loans greater than _{€85,000, we will need} (1) Your last 2 years certified/audited accounts (2) Confirmation that your tax affairs are up to date

All other applicants

For loans less than _{€85,000, we will need any one of} (1) P60

(2) ICS Salary Certificate (3) Your last 3 payslips

For loans greater than _{€85,000, we will need any two of} (1) P60

(2) ICS Salary Certificate (3) Your last 3 payslips

Purpose Amount

) s ( r e b m u n t n u o c c A e g a g t r o M S C I g n i t s i x E * s t n e m e v o r p m i e m o H

Is planning permission required? Current ICS Building Society mortgage balance Education fees Please estimate the current value of your property Medical fees

Refinancing other debt Other purposes* € € € € €

(see ‘Financial commitments’ on page 2)

* Please provide details of ‘Home improvements’ or ‘Other purposes’.

Mortgage amount required

€ € Yes No

2

d € d € d € Yes No Yes No Yes No Are your liable for maintenance payments Yes No

If yes, please indicate monthly amount payable € Please complete Credit Card details

Please use this space to provide additional information which you feel is relevant to your application.

Type of mortgage required

Repayment Endowment Interest Only (Pension backed Y N ) Term in years

Fixed rate Variable rate

Repayment frequency Monthly Fortnightly If monthly, please state preferred payment date Do you require stage payments?

When do you require your loan cheque?

Yes No

Help us to help you

(e.g. 17th day of the month)

Your solicitor details

Name of solicitor Name of solicitor firm Address

First Applicant Date

Second Applicant Date

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 extending legislation or any European Union regulation or directive.

7. I declare and agree that I will pay any reasonable costs and expenses 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 Notices, which are set out on the reverse hereof.

ICS Building Society

Declaration, Authorisation and Consent

x

x

I hereby consent to ICS Building Society and its Agents being able to contact me at my place of work

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

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).

x

x

First Applicant Loan Amount Mortgage Type € Second Applicant Repayment Period Application Number

HOME LOAN DETAILS

CONSENT under Consumer Credit Act 1995

CONSENT under Data Protection Acts 1988 and 2003

DECLARATIONS, AUTHORISATIONS AND CONSENTS

(Block Capitals)

Second Applicant

First Applicant

x

Second Applicant

x

x

x

Second Applicant

First Applicant

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.

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.

In the case of a fixed 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 fixed rate within the initial fixed rate period or any further or subsequent fixed rate period, the Borrower will be liable to pay a sum to be calculated in accordance with the following formula (Amount x (R-R1) x 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 fixed 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 fixed rate period as incorporated in the existing 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 fixed rate period. “Time” means the number of days from the date of early repayment or conversion to the end of the relevant fixed rate period.

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.

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 (excluding 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.

ENDOWMENT LOANS

EARLY REPAYMENT

ARREARS

FEES and COSTS

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. No 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.

VALUATION

Consumer Credit Act Notices

5

ICS Building Society is regulated by the Financial Regulator. A Member of Bank of Ireland Group

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 fixed-rate loan early.

Warning: The entire amount that you have borrowed will still be outstanding at the end of the

interest-only

period.

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 index 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. Examples 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 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

MORTGAGE REPAYMENT PROTECTION COVER

Signature(s) of applicant(s) Firstappilcant Date e t a D t n a c il p p a d n o c e S

x

x

6

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

1. Personal Details (please complete this section in full)

e l t i T s ’ r e n t r a P r u o Y e l t i T r u o Y

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)

Mr Mrs Ms Miss Mr Mrs Ms Miss

D D M M Y Y Y Y

D D M M Y Y Y Y

First Name Surname Date of Birth: Occupation Telephone: (H) (W) Mobile Email First Name Surname Date of Birth: Occupation Telephone: (H) (W) Mobile Email ICS Consultant ICSSourceCode

9 0

RMCode MANDATORY INFORMATION:

7

Description of property(Please tick) Private Dwelling House

(if any rooms are let out please tick Tenanted Property box) PurposeBuiltApartment HolidayHome y t r e p o r P d e t n a n e T * n o i t c u r t s n o C f o e s r u o C e h t n i s g n i d l i u B

*Please note if property is for resale we cannot quote

Date cover is required from: Buildings Contents&othersections 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) ) t n e r e f f i d f i ( s s e r d d a l a t s o p r u o Y d e r u s n i e b o t y t r e p o r p f o s s e r d d A

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 Will the insured property be occupied within 30 days of the date cover is required from Yes No If no please indicate reason why

1. Buildings Cover Required Yes No 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. Max 700,000 : Dublin and Country. Tenanted Properties & Holiday Homes - Min 160,000: Dublin, Min 130,000: Country. Max 400,000:Dublin, Max 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? Yes No Please indicate the number of tenants* Is the property let to a family unit? Yes No *Please note if property is let to students we cannot quote.

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

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.

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

3. Declaration

I/We declare, except where stated to the contrary in the box 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 exceed 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 six 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 external 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).

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)

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) Date

Exceptions to A and B

Please use an extra sheet if necessary and please state if an extra sheet has been used.

X X

In the case of Buildings in the Course of Construction please complete the declaration on the basis of when the property is complete.

D D M M Y Y Y Y

8

3: Optional Extensions 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 example, 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 Maximum combined total for all risks (specified and unspecified) is 45,000.

Unspecified Items Required Yes No (Max 2,000 for any one item) Unspecified Items are covered up to a total value of £2,500

o t p u y e n o m f o s s o L : s u l P 400

Loss of Credit Card up to 1,275

Pedal Cycles up to 385 (in any one year) Specified Items Required Yes No (Max 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 example, an engagement ring, camera or a valuable piece of jewellery.

e u l a V n o i t p i r c s e D

Note: Valuations are required if any item exceeds 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)

% 5 m r a l A e k o m S / h c t a W d o o h r u o b h g i e N 152 Voluntary Excess* 5% % 0 1 m r a l A r a l g r u B 250 Voluntary Excess* 10% % 5 1 r e v o r o 0 5 e g A % 5 2 m r a l A r a l g r u B d e r o t i n o M y l l a r t n e C

* Standard Excess 100. Excess is the amount the customer must pay in the event of a claim. 2. Contents Cover Required Yes No

Please state the amount you wish to insure your contents for

Main Private Dwelling House - Min 27,000:Dublin, Min 22,000:Country. Max 160,000:Dublin and Country. Tenanted Properties - Min 15,000:Dublin and Country. Max 50,000:Dublin, Max 35,000:Country. Holiday Homes - Min 27,000:Dublin, Min 22,000:Country. Max 50,000:Dublin, Max 35,000:Country. Note: Please forward valuations for any High Risk items, valued at over 10,000 per item.

4. Mortgage Repayment Cover - 6 months free cover

Please turn over

9

Cover Required Yes No

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

Yes 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 six months cover free and

4.75 per 100 mortgage repayment per month. Monthly mortgage repayment

Amount of monthly cover required Date cover required from

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:

Single cover Joint Cover (50/50 Split)

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)

Mortgage Repayment Cover is underwritten by Genworth Financial a trading name of Financial Insurance Company Limited (incorporated in England No. 1515187). Registered in Ireland No. E902818.

Registered address: Building 11, Chiswick Park, Chiswick High Road, London, W4 5XR. Registered Irish Branch Office: 31-36 Golden Lane, Dublin 8.

Financial Insurance Company Limited is regulated in the UK by the Financial Services Authority and in Ireland by the Financial Regulator.

X X X X

D D M M Y Y Y Y

D D M M Y Y Y Y

D D M M Y Y Y Y

Date thereafter pay

To: The Manager,

Name of Bank

Address of Bank

Payment Frequency

Yearly Monthly

Name of account to be debited

Current account number*

Reference (for office use only)

• 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.

Signature(s)

* Please note Direct Debit Mandates can only be set-up on acurrent account. Banks may refuse to accept instructions to pay direct from some types of accounts.

Originator’s Identification Number

NSC

6. Direct Debit Mandate

“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 box if you do not wish to receive direct marketing offers from BIIS. Tick this box 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.

Note: 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.

A COPY OF THIS COMPLETED PROPOSAL FORM AND OF THE RELEVANT POLICY TERMS AND CONDITIONS ARE AVAILABLE ON REQUEST.

X X

D D M M Y Y Y Y

3 0 0 1 7 8

10