Deposit Account Application Form

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Deposit Account Application Form Accounts only available to UK residents Account Number

Account Title

(for office use only) NB. If the account is held for the members of a Club, Society or Association, the word "Trust" must be part of the account title

I/We enclose the sum of

£

to open an Instant Access Deposit Account

Please provide details regarding the source of funds to be invested and the expected nature, amounts and levels of future transactions

Contact Name

Position Held

Contact Telephone Number

Extn

Fax Number

Type of Business Charity - Registered Charity Number

Limited Company - Registered Company Number Non Limited Company

Club or Society

Pension Scheme

Business Address

Other - Please Specify Correspondence Address (if different)

Post Code 1st Named Signatory

Post Code

Customer Number (for office use only)

Mr/Mrs/Miss or other (please specify) Forename(s)

Surname

Address

Post Code Tel. No(s)

Daytime

Evening

Mobile

Email Date of birth

Are you an existing account holder with the Loughborough? If 'Yes', please supply account number

Tax Residency (Please read the Information Section and declaration 5) 1. Are you a citizen and tax resident of the UK only? Yes or No? If no please answer questions 2 and 3. 2. Are you a citizen of the USA? Yes or No? 3. Please list the countries other than the UK of which you are tax resident, if any, together with associated tax reference number. Country/countries of tax residency

Tax Reference Number

01 January 2016

2nd Named Signatory

Customer Number (for office use only)

Mr/Mrs/Miss or other (please specify) Forename(s)

Surname

Address

Post Code Tel. No(s)

Daytime

Evening

Mobile

Email Date of birth

Are you an existing account holder with the Loughborough? If 'Yes', please supply account number

Tax Residency (Please read the Information Section and declaration 5) 1. Are you a citizen and tax resident of the UK only? Yes or No? If no please answer questions 2 and 3. 2. Are you a citizen of the USA? Yes or No? 3. Please list the countries other than the UK of which you are tax resident, if any, together with associated tax reference number. Country/countries of tax residency

3rd Named Signatory

Tax Reference Number

Customer Number (for office use only)

Mr/Mrs/Miss or other (please specify) Forename(s)

Surname

Address Post Code Tel. No(s)

Daytime

Evening

Mobile

Email Date of birth

Are you an existing account holder with the Loughborough?

If 'Yes', please supply account number Tax Residency (Please read the Information Section and declaration 5) 1. Are you a citizen and tax resident of the UK only? Yes or No? If no please answer questions 2 and 3. 2. Are you a citizen of the USA? Yes or No? 3. Please list the countries other than the UK of which you are tax resident, if any, together with associated tax reference number. Country/countries of tax residency

Tax Reference Number

01 January 2016

4th Named Signatory

Customer Number (for office use only)

Mr/Mrs/Miss or other (please specify) Forename(s)

Surname

Address Post Code Tel. No(s)

Daytime

Evening

Mobile

Email Date of birth

Are you an existing account holder with the Loughborough?

If 'Yes', please supply account number Tax Residency (Please read the Information Section and declaration 5) 1. Are you a citizen and tax resident of the UK only? Yes or No? If no please answer questions 2 and 3. 2. Are you a citizen of the USA? Yes or No? 3. Please list the countries other than the UK of which you are tax resident, if any, together with associated tax reference number. Country/countries of tax residency

Tax Residency

Please indicate the number of signatures (i.e. two from three, two from four, etc). All signatures must sign for any amendments to the account

Interest Bank Details

Added to account

Paid to bank (see below)

Bank name

Bank branch

Sort Code

A/c No.

Account name Interest on your account will be paid 'net' (after taking off tax at the basic rate) unless you can provide suitable evidence of your entitlement to receive interest gross (such as Charity Registration number for Charities; Constitution Rules or Memorandum & Articles of Association for clubs, friendly societies & corporate bodies; HMRC approval letter for pension schemes). INFORMATION SECTION Tax Residency: The UK government has, and will be signing, a number of inter-governmental agreements to share tax information, where applicable, with the tax authorities in other jurisdictions. The requirement to collect certain information about each customer's tax arrangement is part of UK legislation and as a financial service company we are legally obliged to collect it. We are asking for your tax residency and tax ID numbers (where applicable) and will record this on our records now, but will only disclose this information to the relevant tax authorities if and when we are required to under UK law. Your tax residence generally is the country in which you live for more than half a year. Special circumstances (such as studying abroad, working overseas, or extended travel) may cause you to be resident elsewhere or resident in more than one country at the same time (dual residency.) The country/countries in which you pay income tax are likely to be your country/countries of tax residence. If you are a US citizen or hold a US passport or green card, you will also be considered tax resident in the US even if you live outside the US. If you have any questions on how to complete this form we recommend that you speak to your tax or legal adviser.

DECLARATIONS - please read carefully before signing We are applying to open an investment account with the Society and I/we declare, consent that: 1. We have read the general terms and conditions relating to the account applied for as set out in the General Terms and Conditions for Savings Accounts. 2. We agree to be bound by the Society's rules, a copy of which is available upon request at any branch. 3. If required, you may make searches about us at credit reference agencies who supply you with information, including information from the Electoral register, for the purpose of verifying our identity. The agencies will records details of the search whether or not this application proceeds. The searches will not be seen or used by lenders to assess our ability to obtain credit. You may use scoring methods to assess this application and verify our identity. Credit searches and other information which is provided to you and/or the credit reference agencies, about us and those with whom we are linked financially may be used by the Loughborough Building Society and other companies for the prevention of money laundering as well as the management of your account. Alternatively, we may as you provide physical forms of identification. 4. An 'association' between signatories who are classed as financial partners, will be created at credit reference agencies, which will link their financial records. We and anyone else with whom you have a financial link understand that each other's information will be taken into account in all future applications by either or both of us. This linking will continue until one of us successfully files a "disassociation" at the credit reference agencies. 5. Tax Residency: I undertake to inform The Loughborough Building Society of any changes in my circumstances, such as moving outside of the UK, that may affect this declaration. Declaration continues overleaf

01 January 2016

6. Data Protection Act: I am aware that any information provided by me in this application form and any other information given during the normal operation of my account may be used by the Society to: · open and administer my account; · to prevent or detect fraud and financial crime; · for legal and regulatory compliance, business analysis; and for its own use in respect of marketing and market research, statistical analysis or similar purposes; and for its own use in promoting products of other companies; and · after closure of the account for statutory, regulatory, accounting and auditors or other lawful requirements. The Society may disclose my information to: · auditors, professional advisors or any person required or permitted by the law, any governmental or other regulatory authority; and to anyone appoint to administer or operate my account; and · to third party processors contracted to provide services to the Society (where there is a legitimate business need e.g. printing and mailing purposes). I consent to the Society holding and processing my personal information for the purposes explained above. I am aware that I have a right to access the personal information held by the Society and to have incorrect information corrected. I consent to the Society using the information contained in this form and analysing the operation of my account for marketing purposes to allow it to provide details of products or services it believes may be of interest to me . I am aware that I can request not to receive details about the Society's products and services. Please tick below if you do not wish to receive information about the Society's products & services. Applicant 1

Telephone

Post

Email

Applicant 2

Telephone

Post

Email

Applicant 3

Telephone

Post

Email

Applicant 4

Telephone

Post

Email

7. Financial Services Compensation Scheme (FSCS) We confirm that we have received and read the Information Sheet relating to the FSCS.

Signature 1

Date

Signature 2

Date

Signature 3

Date

Signature 4

Date

01 January 2016

Self certification declaration form for an entity 1. In relation to opening this account, is the entity: A financial institution (including a professionally managed trust) (if so, please provide your GIIN1) A registered UK pension fund

Yes

Yes

No

No

A registered UK charity2 with trustees (or directors in the case of a charitable company) who are tax resident only in the UK and/or the US3

Yes

No

If you answered yes to any of the above you do not need to fill out the rest of this form Actively Trading non-financial institution (go to Q2)

Yes

No

Non-trading investment body4 (go to Q2)

Yes

No

Other (please specify below and then go to Q2)

Yes

No

2. Is the entity a resident for tax purposes only in the UK5?

Yes (Go to Q5)

No (go to Q3) Yes (Go to Q5)

3. If you answered no to question 2, please state if the entity is resident for tax purposes in the US?

No (go to Q4)

4. If you have answered no to Q3, please list the country or countries in which the entity is resident for tax purposes, together with any tax reference number (s)/tax identification number(s) ("TIN"), if relevant: Country/countries of tax residency

Tax Reference Number

5. If the entity is a non-trading investment body, such as a non-professionally managed trust or an investment company, are all of the controlling persons6 of the entity resident for tax purposes only in the UK? Yes (stop)

No (go to Q6)

6. If you answered no to question 5, for each controlling person identified as part of AML/KYC, please list the controlling person's details and the county or countries in which they are tax resident, together with any tax reference number(s)/tax identification number(s) that may be relevant.

Full Name

Date of Birth

Full Address

What makes this a controlling person? Settlor, trustee, protector, beneficiary7, or class of beneficiaries, shareholders8

Country/Countries of Tax Residency

Tax Reference Number

Signature of Controlling Person

Information The UK government has, and will be signing, a number of inter-governmental agreements to share tax information, where applicable, with the tax authorities in other jurisdictions. The requirement to collect certain information about each customer's tax arrangement is part of UK legislation and as a financial services company we are legally obliged to collect it. We are asking for yout tax residency and tax ID numbers (where applicable) and will record this on our records now, but will only disclose this information to the relevant tax authorities if and when we are required to under UK law. If you have any questions on how to complete this form we recommend that you speak to your tax or legal adviser. I/We undertake to inform The Loughborough Building Society of any changes in circumstances that may affect this declaration. Name of entity: Your full name: Position: Date: Signature: Footnotes: 1. If you do not have a GIIN yet, please notify us when you have been issued one. GIINs are required from 1 January 2015. 2. If your charity is not a UK one, or the trustees are tax resident in a country other than the UK, the remainder of this form must be completed. 3. We expect that all UK registered charities will be exempt regardless of the tax residency of their trustees. We await official HMRC confirmation. 4. Includes a non-professionally managed trust. 5. Tax residency rules for entities vary from country to country, and can be quite complicated. For instance, companies will often be tax resident in the country where they are incorporated and may also be resident in any other countries in which they conduct business, while trusts may need to consider where their trustees are resident. If there is doubt about where an entity is tax resident, professional advice may be required. 6. Controlling persons - for a trust this includes settlor, trustees, protector (if any) beneficiary or class of beneficiaries. For any other entity, it includes a shareholder and any other natural person exercising ultimate control over the investment. 7. A beneficiary's details only need to be included if s/he owns or is entitled to at least 25% of the trust property 8. A shareholder's details only needs to be included if they own or control more than 25% of the shares or voting rights - or otherwise exercise control of the management e.g. the shareholder owns less than 25% but the percentage of ownership is significantly higher than other shareholders