Personal Current/Savings Account

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Your 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

1 Your personal details

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 accounts, 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.

First name(s)

Have you used, or do you currently use any other name(s)? (e.g. maiden name, any other name used)

Last name

Mr Mrs Miss Ms Other (please specify)

Title First customer

Nationality(s)

First name(s)

Have you used, or do you currently use any other name(s)? (e.g. maiden name, any other name used)

Last name

Mr Mrs Miss Ms Other (please specify)

Title

Second customer

Your relationship to the first customer Nationality(s)

2 Accounts you already hold with Lloyds Bank

None

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?

Indicate here if you already have a Current account with Lloyds Bank in the Channel Islands or Isle of Man?

Indicate here if you already have any other Savings account 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) If you will be opening (or will be added to) a current account, you will need to complete ALL sections of this form.

If you will be opening (or will be added to) one or more savings accounts only, you will not need to complete Section 5.

Sort Code

My/our existing Lloyds Bank Account number:

My/our existing Lloyds Bank Account number: You 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 account)

You 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).

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3 Details of the account(s) you would like to open

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)

Please convert my existing account: Please convert my existing account: Please convert my existing account: Please convert my existing account: Please convert my existing account:

Sort Code Account number

I would like to open the account(s) below. Where an existing account is to be converted, I have indicated this.

Current accounts

Island Regular Savings Note: you will need to set up a Standing Order for up to £2,000 a month into the account.

Island Instant Access

Island Premier Savings Minimum opening balance £5,000 Note: You will also need to hold an Island Premier Current Account

Please convert my existing account:

Sort Code Sort Code Sort Code Account number Account number Account number

Savings accounts

added to the account on the anniversary of account opening (or next working day)

added to the account on 9th monthly (or next working day)

added to the account

monthly on the same date as the date of account opening (or next working day)

annually on the anniversary of account opening (or next working day) credited to the following account in my name on the anniversary of account opening (or next working day):

credited to the following account in my name at the same branch on 9th monthly (or next working day):

credited to the following account in my name at the same branch I would like my interest:

I would like my interest:

I would like to receive my interest:

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 account and transfer the entire balance into my new Island Bonus Saver Account

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3 Details of the account(s) you would like to open (continued)

Amount Amount Currency Currency Term Island 30 Day

Minimum opening balance £10,000

Island Investment

Minimum opening balance £50,000

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.

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.

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.

Please convert my existing account:

Sort Code

Account number

Account number added to the account on 9th monthly (or next working day)

added to the account half-yearly on 9th June and December (or next working day)

credited to the following account in my name at the same branch on 9th monthly (or next working day):

credited to the following account in my name at the same branch half-yearly on 9th June and December (or next working day):

I would like my interest: 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 account (sort code and account number shown alongside), reopen as an International Bonus Saver on a new account number and transfer the whole balance to the new account

Euro Bonus Saver US Dollar Bonus Saver

Interest will be added to the International Bonus Saver Account on 10th monthly (or next working day)

Unless otherwise indicated, interest will be credited to the account on maturity.

Six Months Fixed One Year Fixed Other (please specify)

Account number

* 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 account 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.

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3 Details of the account(s) you would like to open (continued)

Name in which account is held Name of bank

Postcode

Name of branch and location (full address if not Lloyds Bank)

Account type (for example current)

BOTH the existing and the new account-holders should please:

•

Complete Section 1 of this form

•

Sign in Section 12

•

Sign the Specimen Signature section on the penultimate page The NEW account-holder should also follow the instructions in Section 2 re which sections of the form do / do not need to be completed.

3.1 Adding a party to existing accounts

3.2 Politically Exposed Person (PEP)

Roll over principal and interest for the same term

Roll over principal and repay interest to my account detailed below Or

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).

On maturity of my Fixed Term Deposit, please: I wish my interest payments and/or maturity proceeds to be paid to the following account:

Wherever possible, this should be an account 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.

Please indicate here if you wish to add another person to the existing account(s) as follows:

Are you a Politically Exposed Person (PEP)?

Are you related in any way to a PEP?

Yes No

Further information

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 accounts above, if you (or any new party being added to existing accounts) already hold a Lloyds Bank current account in the Channel Islands or Isle of Man, please now go to Section 6.

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4 Additional personal details

4.1 Your contact details

4.2 Your residential details

Your permanent residential address (where you live)

Postcode

Your permanent residential address (where you live)

Postcode

Country of address Country of address

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

Country Country

Place of birth (Town/City) Place of birth (Town/City)

First customer Second customer

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?

D D

M M

Y Y Y Y

Date of birth

D D

M M

Y Y Y Y

Date of birth

What is your current Marital/Civil Partnership status? What is your current Marital/Civil Partnership status?

Single Single

Separated Separated

Married/

Civil Partnership Married/ Civil Partnership

Widowed Widowed

Divorced/dissolved

Civil Partnership Divorced/dissolved Civil Partnership

Male

Gender Female Gender Male Female

Other (please explain) Other (please explain)

Home Mobile Work Email Home Mobile Work Email

Your telephone numbers and area dialling codes Your telephone numbers and area dialling codes

M M

Y Y Y Y

When did you start living at this address?

M M

Y Y Y Y

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4.2 Your residential details (continued)

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

Postcode

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

Postcode

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.

Your 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.

Your correspondence address (if different from your permanent residential address)

Postcode Postcode

4.3 Additional addresses

Additional address

Postcode

Additional address

Postcode

If you have any additional addresses that are not your permanent residential address or correspondence address please provide these here.

What is your current residential status? What is your current residential status? Owner –

no mortgage Owner – no mortgage

Private tenant Private tenant

Owner –

with mortgage Owner – with mortgage

Living with parents Living with parents

Local authority

tenant Local authority tenant

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 U.S. TIN

M M

Y Y Y Y

M M

Y Y Y Y

If you only wish to open one or more Savings accounts, 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 accounts, please now go to Section 6.

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5 Additional personal details (Current accounts)

5.1 Your monthly household income

5.2 Monthly commitments

First customer

The total amount of any borrowing or credit facilities held on a joint basis should be shown in full against both account holders. Second customer This section is to be completed by NEW CURRENT ACCOUNT CUSTOMERS ONLY

(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 account in the Channel Islands or Isle of Man)

First customer’s income Source:

If yes

Salary/wages _{Direct to}

a bank Cheque Cash Into this account Frequency e.g. weekly

Amount expected through this account per month

Staff member: If unknown use customer notes to explain situation. Amount

If other, please state type

Total net monthly income Amount

£

Second customer’s income

Mortgage/rent Mortgage/rent

HP/other loans HP/other loans

Lloyds Bank loans Lloyds Bank loans

Total each month Total each month

Amount Amount

£

If yes Benefits _{Direct to}

If yes

Pension _{Direct to}

If yes

Investments _{Direct to}

If yes

Other _{Direct to}

Source: If yes

Salary/wages _{Direct to}

Amount expected through this account per month

Staff member: If unknown use customer notes to explain situation. Amount

If other, please state type

Total net monthly income Amount

£

If yes

Benefits _{Direct to}

If yes

Pension _{Direct to}

If yes

Investments _{Direct to}

If yes

Other _{Direct to}

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5.3 Details of your savings

5.4 Other banking details

Bank/Building Society name Bank/Building Society name

5.5 Your credit card details

If yes, how many? If yes, how many?

If yes, what is your credit limit? If yes, what is your credit limit?

£

Other (please specify) Other (please specify)

5.6 Your mortgage details

What is the outstanding balance

on your mortgage? What is the value of your house? What is the outstanding balance on your mortgage? What is the value of your house?

What type of savings do you have? What type of savings do you have?

No savings No savings

Lloyds Banking Group and

non-Lloyds Banking Group savings Lloyds Banking Group and non-Lloyds Banking Group savings Savings only with companies within

the Lloyds Banking Group Savings only with companies within the Lloyds Banking Group Savings only with companies

outside the Lloyds Banking Group 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?

Amount Amount

£

Details of main account with another bank or building society. Details of main account with another bank or building society.

How many other bank accounts do you hold with Lloyds Bank or any other banks? How many other bank accounts do you hold with Lloyds Bank or any other banks?

None 1 2–5 6–9 10+ None 1 2–5 6–9 10+

Current account Current account

Savings account Savings account

Personal loan Personal loan

Mortgage account Mortgage account

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

Y

M M

Y

M M

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

Yes No Yes No

Is the account to be closed? Is the account to be closed?

Yes No Yes No

Do you hold a

credit card? Do you hold a credit card?

Are any with a company within the Lloyds Banking Group?

Chargecard Storecard Chargecard Storecard

What other card type(s) do you hold? What other card type(s) do you hold?

Yes No Yes No

Do you have a mortgage? Do you have a mortgage?

If yes, is it with a company within the Lloyds Banking Group?

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6 Debit / Cashpoint Cards

Your mother’s maiden name (second customer) Your mother’s maiden name (first customer)

Island Cheque Island Student

Island Gold Island Graduate

Island Premier

I wish to apply for a Lloyds Bank Debit Card on my Current account(s) as follows:

Island Future (if aged 16+ and in full time employment)

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.

Your Debit / Cashpoint Card(s) will be sent to your correspondence address.

7 Other account details

8 Your initial deposit

Amount

Name of branch and location

Method of transfer Account type (for example current)

Currency

Currency I enclose a cheque or banker’s

draft for

Please transfer

I have instructed my bank to send you

OR

made payable to the account holder.

from my Lloyds Bank account or Bank of Scotland International account:

by way of

Yes Without counterfoils Yes Yes No With counterfoils No No Do you require cheque books? (current accounts only) Do you require a personalised paying-in book?

(five personalised paying-in slips are available in the back of your cheque book)

If yes, would you like them: Do you require left-handed chequebooks?

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 account 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 ‘Your Banking Charges Guide’). If this is the case, the process may take several weeks and a charge may be incurred .

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 account 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 account, please continue to use it.

Island Instant Access Island 30 Day Island Premier Savings

I wish to apply for a Lloyds Bank Cashpoint Card on my Savings account(s) as follows:

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9 Your employment details

Your total annual income/salary Your total annual income/salary

£

10 Additional information

Your reason for opening the account(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 account(s) each year (or approximate sterling amount if in another currency).

£ £

Are you: First customer Are you: Second customer Employed Employed

Part time Part time

Seeking work Seeking work

Self employed Self employed

Retired Retired

Student Student

Unemployed Unemployed

Not working Not working

Y

M M

Y

M M

If you are not working, how long since you last worked? If you are not working, how long since you last worked?

Your occupation Your occupation

Your employer’s name Your employer’s name

Y

M M

How long have you worked for your current employer? How long have you worked for your current employer? How long did you work for your previous employer? How long did you work for your previous employer?

Yes No Yes No

Is your employment pensionable? Is your employment pensionable?

We are obliged to request the following additional information when an account

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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 account, 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

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.

12 Your agreement with us

Save the Change Mortgages

Buildings & Contents Insurance Structured Deposits

Regular Savings Lump Sum Investments Financial Health Check Other services

I would like to set up ‘Save the Change’ from my current account to my savings account. I would like further information on the

range of Lloyds Bank Mortgages I would like further information on Lloyds Bank Home Protection (buildings and contents insurance).

I would like further information on Lloyds Bank Structured Deposits.

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.

I wish to open my account with Lloyds Bank in: Please mark ( ) only one box.

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 No. 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. Yes

Yes No

No

Do you need to extend your cover?

Have you or any other person on the policy been diagnosed as terminally ill?

Do you require Winter Sports cover? (Island Gold only)

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?

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 account, 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: You are answering these questions on behalf of yourself and any other person who is to be covered by this policy.

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

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12 Your 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

Your 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

Your personal information will be shared within the Lloyds Banking Group to enable us to better understand your needs, run your accounts, 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.

Your 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.

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.

Your statement to us

1 I/We understand:

• how to cancel this product(s) • how to make a complaint

2 I apply for the account(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 accounts 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 account(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 account(s) is / are (a) joint account(s) (including where this Application Form is being used to make (an) existing sole account(s) into (a) joint account(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

Y Y Y Y

Signature of second customer (if this is a joint account) (Please sign in black ink if possible)

Date

D D

M M

Y Y Y Y

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 account – such as a change in account 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. Your email address

If you have already provided your email address in Section 4.1, there is no need to repeat it here.

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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.

Branch

Personal recommendation Internet

Direct mailing

How did you first become aware of our Accounts?

Advertisement/Comment in (name of publication)

Account standing order authority (WHEN OPENING AN ISLAND REGULAR SAVINGS ACCOUNT)

First customer’s signature

Date

D D

M M

Y Y Y Y

Second customer’s signature

Date

D D

M M

Y Y Y Y

Please pay

(Maximum £2,000 p.m.)

£

to my/our Island Regular Savings Account on the

day of each month

and debit my/our sort code and account number Commencing on

D D

M M

Y Y Y Y

Sort code and Island Regular Savings Account number Name(s) of account holder(s)

Specimen signatures

Branch Sort Code

Account number(s)

Date completed

D D

M M

Y Y Y Y

Signing instructions: Either party to sign

First customer’s name Second customer’s name

First customer’s signature Second customer’s signature

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