Personal Account Application Form

Sole Personal Current Account

PLEASE COMPLETE IN BLOCK CAPITALS

For Bank Use Only

NSC

A/c No.

Purpose of A/c (Mandatory: Box must show an understanding of purpose and likely operation of account.)
Current Account:

Source of Funds

Source of Wealth

SECTION A: YOUR PERSONAL DETAILS

Title Mr

Mrs

Ms

Miss

Other

First Name
Surname
Address

Date of Birth
Email
Tel (Home)

Tel (Mobile)

Tel (Work)

Afternoon

Best time to contact Morning

Evening

Employment Details
Employee

Employer

Self Employed

Homemaker

Student

Retired

Occupation

Net Monthly Pay

Employers Name

Annual Gross Income

Other

Residential Details
Home Owner

With Parents

Year moved to address

Tenant

Monthly Rent/Mortgage

Other

Previous Address
if tenant
Marital Status

Married

Single

Widowed

Divorced

Separated

Civil Partner

SECTION B: YOUR RELATIONSHIP WITH US

Existing Bank of Ireland Customer

Yes

If Existing Bank of Ireland Customer - N.S.C

No
Sole A/C number

Will your salary be mandated to this account?

Yes

No

Are you switching your bank account from another financial institution?
(If yes please complete Switching your personal bank accounts made easy brochure Ref 37-769RU)

Yes

No

For the purpose of the Foreign Account Tax Compliance Act (FATCA), we are required to establish whether you are a US citizen and/
or resident in the US for tax purposes.
Are you a US citizen?

Yes

No

Are you resident in the US for tax purposes? Yes

No

If yes was answered to either question:

US TIN

(not mandatory)

Current legislation requires us to verify the true name and address of all new customers. You will therefore be requested to submit
formal identification documents with this application e.g. current passport or driving licence and current utility bill. If you do not have
any of these forms of identification please contact us and we can discuss alternative documentation. Ask for our leaflet Your account
and the implications of legislation (37-831RU).
Page 1 of 6
4-791R.22(07/14)

SECTION C: YOUR PERSONAL CHOICES

ATM/Debit Card

Card Type
Customer Name

(to appear on Card)

(Max 22 characters)

Registration for 365

Use Bank of Ireland 365 online to make payments, check your account or view transactions. Whats more, by using 365 online you
can benefit from a whole range of other convenient features including our Mobile App.
Phone and Online Banking
A 365 PIN will be posted to your address provided above, on receipt of this PIN please contact Banking 365 on 0818 365 365 to
activate and avail of our service.

AUTHORISATION, CONSENTS AND APPLICATION FOR ACCOUNT(S)

NOTE: YOU SHOULD ONLY SIGN BELOW WHEN YOU HAVE READ THIS SECTION AND THE CONSENTS AT APPENDIX 1
CAREFULLY AND AGREE TO BE BOUND BY THESE TERMS
To: The Governor and Company of the Bank of Ireland (the Bank, which term includes and shall be construed to include Bank
branches, its subsidiaries, agents and third parties appointed by the Bank)
I, the undersigned, authorise you to open one or more accounts in the name of

I authorise you to accept and to honour all withdrawal forms and orders drawn on the account and to act on all instructions relating to
the account.
I have received and read the following documents and, in consideration of your providing me from time to time with any of the products
and/or services requested under this Mandate Application Form, agree to be bound by their terms:
the Terms and Conditions and Terms of Business that apply to the relevant account;
the Schedule of Fees and Charges for Personal Customers;
the details of debit interest outlined in the table of Personal Overdraft Interest Rates sheet at Appendix 2 of this Authorisation
and Application Form;
where applicable, the Terms and Conditions relating to ATM / Debit cards.
I confirm that I have read each authorisation required by the Bank as set out in Appendix 1 to this Authorisation and Application Form
(a copy of which I have been furnished with and will retain) to hold, use, disclose, copy and process information and I understand
that by signing this application form I am giving my consent for the use of information provided by us for the purposes of (1) the Data
Protection Acts, 1988 and 2003; and (2) the Criminal Justice (Money Laundering and Terrorist Financing) Act 2010 and/or the Taxes
Consolidation Act, 1997, as any such legislation may be amended, varied or substituted from time to time.
Optional Data Marketing Consent
I consent to the details that I am being asked to supply being used to provide me with information about other products and services,
either from the Bank of Ireland Group or which the Bank of Ireland Group has arranged for us with a third party. I understand that at
any time I can ask you to stop or change the methods by which the bank may send me marketing materials. This can be done free of
charge by writing to my branch of the Bank.
Please tick this box if you would not like to receive this information.
By signing below I further agree that this Authorisation will remain in full force and effect until an amending Authorisation shall be
communicated to the Bank.
Customer Signature:
DATE:

WITNESS:

Page 2 of 6
4-791R.22(07/14)

SECTION D: BANK USE ONLY

Yes

Is person to be identified an existing Bank of Ireland Group Customer?

IF YES:

Name of Branch/Group Entity

Method used to check (Servicelink, etc.)

EXISTING CUSTOMER AS AT 2/5/95 Yes

9 0
NSC

No

A/c No.

Date Opened

Has AML Documentation Screen been completed for above account?

EXISTING CUSTOMER AFTER 2/5/95 Yes

9 0
NSC

Yes

A/c No.

Date Opened

Is AML ID&V documentation held and in order and has AML Documentation Screen been fully completed? Yes

No

If Yes and full AML ID&V is in order and AML screen has been fully completed then with the persons consent, as detailed in

the application form, you can request the Branch/Group entity who has established his/her identity to update the AML

Documentation Screen OR provide copies of the ID&V documentation for your records.
If No i.e. full AML ID&V documentation is not in order OR AML Documentation Screen is not fully completed the ID&V

documentation for the customer must be perfected in line with procedures and/or the AML Documentation Screen must be
created/corrected.

Has AML Documentation Screen been created for new account being opened?

Yes

NOTE: Whether customer is existing pre or post 95 a new AML Documentation Screen must be created for the new deposit
account being opened. If we are relying on AML ID&V documents held for another account that account must be referenced
on the AML Documentation Screen.

IF NO:

Name and current permanent address of person named overleaf must be verified in line with procedures.

Has there been face to face contact with the person being identified?

Yes

No

Was the account requested on a non face to face basis?

Yes

No

Is the customer resident in a high/very high risk country?

Yes

No

Is it evident from purpose of account that the customer intends transacting with a high/very high risk country?

Yes

No

If NO, specify method of contact

(Two separate forms of Address Verification must be obtained)

Methods used for the two separate forms of address verification

Has AML Documentation Screen been completed for new account?

Visa Debit Card Type:

Contactless

Yes

Contact

BRANCH CHECKLIST
Purpose of Account
Source of Funds

Source of Wealth

*If Yes to any of the above questions, relationship should be of higher risk. All higher risk rated accounts must be referred to Network
Governance and Control for sign off prior to account opening.
Overall Risk Rating*

Standard

High

Signed (Staff Member)

Date

Staff Number

2 0

The Governor and Company of the Bank of Ireland, incorporated by charter in Ireland with limited liability. A tied agent of
New Ireland Assurance Company plc. trading as Bank of Ireland Life. Bank of Ireland is regulated by the Central Bank of Ireland.
Registered No. C-1. Head Office, 40 Mespil Road, Dublin 4, Ireland.

Page 3 of 6
4-791R.22(07/14)

APPENDIX 1: CUSTOMER CONSENTS. Please give to the Customer to retain

A: DATA PROTECTION CONSENTS
1. Where this application is an application for facilities, I confirm that I am not less than 18 years of age. 2. I certify the accuracy
of the information given above together with the continued accuracy of such information in the event of any future applications by
me (whether oral or written) for a facility, unless I expressly advise you to the contrary at the time of any such future application. 3. I
understand that you reserve the right to decline this or any future application without being required to state any reason and that no
correspondence will be entered into it in such circumstances. 4. By signing this form I consent to the Bank of Ireland Group and its
contracted agents storing, using and processing my personal details: (a) to manage and administer my accounts, policies or other
financial products; (b) to process my applications for credit or financial services and any requests for payment services made by me;
(c) to carry out business and market research and compile statistics; (d) to help detect and prevent fraud and dishonesty including
through the use of information technology; (e) to form a single view of my entire relationship with the Bank of Ireland Group (whether
as a consumer or in connection with my trade, business or profession) to enable it manage and develop the relationship; (f) to enable
business units in the Bank of Ireland Group share or access my personal details for the purposes set out in this consent (but not for
the purposes of direct marketing where I have indicated to the Bank of Ireland Group I do not want it); (g) to contact me by post,
telephone, text message, electronic mail, facsimile or other means but not in a way contrary to my instructions to the Bank of Ireland
Group or contrary to law or regulation; (h) (where I apply for or avail of a credit facility) to carry out credit reviews including automated
credit decision processes and to obtain details of my credit history from the Irish Credit Bureau (ICB) or other credit rating agency;
(i) (where I have not indicated otherwise to the Bank of Ireland Group) to directly market the products and services of the Bank of
Ireland Group or of suppliers selected by the Bank of Ireland Group using a form of communication permitted by me under paragraph
(g) above; and (j) to establish and/or report my identity, residence and tax details to the extent necessary order to comply with law
and regulation concerning taxation, return of payments and the prevention of money laundering or terrorist financing. I consent to the
Bank of Ireland Group disclosing my personal details: 1) (where I apply for or avail of a credit facility) to the ICB or other credit rating
agency and I also consent to the ICB or other credit rating agency disclosing details of my credit history (and using those details for
credit scoring purposes) to the Bank of Ireland Group or other institutions to which I apply for credit facilities; 2) to facilitate a potential
or actual transfer of any loan or product provided to me or in connection with a securitisation; 3) to its contracted agents and to
recipients abroad but only for purposes indicated in this consent and only where the Bank of Ireland Group complies with Irish data
protection law in doing so. This consent does not limit any other consent I have given (or may give) to the Bank of Ireland Group to
process or disclose my personal details. In this consent: Bank of Ireland Group means the Bank of Ireland and its present and future
subsidiaries. contracted agents means entities which have contracted with the Bank of Ireland Group to assist it in the conduct of its
business or in providing services to me. I, me, my is a reference to each of us where more than one of us have signed this form.
personal details means information concerning me which Bank of Ireland Group has including information given by me or others
verbally or in writing, information contained in application forms and records of my transactions with the Bank of Ireland Group. 5. In
the event of a facility being approved I authorise you to make the facility available and to put the appropriate repayment schedule into
effect. 6. I agree that the facility (and any other facilities as may be granted by you at your discretion) shall be subject to the terms and
conditions and specific provisions detailed in your Facility Letter or Credit Agreement, once issued. 7. I understand that in opening the
account(s) that I may be automatically registered for Bank of Ireland 365 services as outlined in the terms and conditions attached. 8.
In consideration of my application for an account, I agree to the Terms and Conditions and Schedule of Fees and Charges for
Personal Customers Brochure (where applicable).

B: IDENTIFICATION CONSENTS
I hereby agree that any information and/or original documents and/or any copy documents supplied by me or on my behalf to the
Bank are accurate so as to enable the Bank to comply with any and all of the obligations of the Bank under law and regulations
concerning the prevention of money laundering and terrorist financing and to comply with taxation requirements. Such information or
documentation may at any time be disclosed by the Bank to, transferred to, or copies thereof sent by the Bank to any Bank branch,
any other member of the Bank of Ireland Group, or any other designated body (as defined in The Criminal Justice (Money Laundering
and Terrorist Financing) Act 2010 as may be amended, varied or substituted from time to time (the 2010 Act)) which may at any
time provide or be requested to provide any services to me. I hereby further agree that any information and/or any original documents
and/or any copy documents that have been supplied by or for me to any Bank of Ireland Group member to enable such Bank of
Ireland Group member and/or Bank of Ireland Group to comply with any and all obligations under or pursuant to the 2010 Act and/
or Part 38, Chapter 3A of the Taxes Consolidation Act, 1997 as amended, varied or substituted from time to time (the 1997 Act)
may at any time, by such Bank of Ireland Group member, be disclosed to any other Bank of Ireland Group member, or be transferred
to, or copies thereof sent to any other Bank of Ireland Group member, so as to enable such other Bank of Ireland Group member to
comply with the 2010 Act and /or the 1997 Act, and for the benefit of any Bank of Ireland Group member to which I have supplied
any such information, documents and/or copy documents aforesaid, I hereby confirm that such Bank of Ireland Group member may
act on this authorisation and consent as if it was specifically addressed to such Bank of Ireland Group member .i hereby confirm that
each authorisation contained herein to hold, use, disclose, copy and process information constitutes a consent for the purpose of
the Data Protection Acts 1988 and 2003 and any amending or extending legislation or any related European Communities regulation
or directive. For the purposes of this consent the terms Bank of Ireland Group and Bank of Ireland Group member each mean
and shall be construed to mean any and all of the following: the Bank; ICS Building Society; any branch of the Bank or ICS Building
Society; the separate legal entities that constitute the Bank of Ireland Group; any respective successors, assigns and transferees of the
Bank, ICS Building Society or entities aforesaid.

Page 4 of 6
4-791R.22(07/14)

Please give this rate sheet to the customer to retain.

TABLE OF PERSONAL OVERDRAFT INTEREST RATES SHEET

CURRENT RATE TABLE

Standard Overdraft Rate

FLAT RATE

APR WITHOUT FACILITY FEE

APR WITH 30 FACILITY FEE

13.25%

13.9%

16.2%*

The current variable standard overdraft interest rate (including the overdraft facility fee) is 16.2% APR. The Annual
Percentage rate quoted above is correct as at 25 August 2011 and is subject to change. The rate quoted is based on a
representative example of 1,500 over a 12 month period. Total cost of credit is 208.85.
Graduate Overdraft Rate

9.40%

9.7%

N/A

The current variable overdraft interest rate for Graduate Current Account is 9.7% APR. The Annual Percentage Rate
quoted above is correct as at 24 February 2010 and is subject to change. The rate quoted is based on a representative
example of 1,500 over a 12 month period. Total cost of credit is 146.05.
PENDING RATES
FLAT RATE

APR WITHOUT FACILITY FEE

APR WITH FACILITY FEE

Standard Overdraft Rate

None

None

None

Graduate Overdraft Rate

None

None

None

PENDING RATES EFFECTIVE ON

2 0

Notification to Bank of Ireland Personal Current Account

Customers Personal ATM/Debit Cards
Important Notice
This is an important notice and should be read.
Change to Visa Debit Card Terms and Conditions - Clause 2.6 as of 1st September 2014.
Current Version Clause 2.6
When you receive your Visa Debit Card you, you must activate it at one of our ATMs. The activation of your card is acceptance
of these Card terms and conditions.
Amended Version - Clause 2.6
When you receive your Visa Debit Card you, you must activate it at one of our ATMs. If activation does not take place within 60
days of the issue of the Card, in the interest of card security, the card will be cancelled an a new card will have to be applied for.
The activation of your card is acceptance of these Card terms and conditions.
If you do not accept the above change to the Terms and Conditions of your Card, you may end your Card contract with us.
To do this you must first pay us Government Duty (if any) that you owe concerning your Card. If you do not ask us to end your
Card contract, you will be deemed to have accepted the change on this effective date: 1st September 2014.
New terms and conditions are available at www.bankofireland.com from the 1st September 2014.

Bank of Ireland is regulated by the Central Bank of Ireland.

Page 5 of 6
4-791R.22(07/14)

Payroll Letter

PLEASE COMPLETE IN BLOCK CAPITALS

To: The Accounts/Payroll Department

Company name:

(your home address)

Company Address:

Date:

Request to credit my salary to my new bank account

My staff/employee number:
Dear Sir/Madam,
Please note from (date) D

Bank:

Y I wish to have my salary paid directly into the account detailed below:
Branch name:

Name of account:

BIC: (Bank Identifier Code)

IBAN (International Bank Account No.)

Branch NSC:

Account number:

Thank you for your help.

Yours faithfully
(your signature)

(your name printed)

Page 6 of 6
4-791R.22(07/14)