Current Account Opening Form

Customer Details (Confidential)

BIC IBAN IP B SIE2 D For Bank use only

Account Type IEIP B S
CIF No. 1 9 9 0
Branch
CIF No. 2

Customer Details (Applicant 1)

Customer Details (Applicant 2)

Name Name
Address Address

Address Since / / Address Since / /

Previous Address if at your current address less than three years Previous Address if at your current address less than three
years

Prev. Address Since Householder /Status Date

/ of Birth Gender
Marital Status Mother’s Maiden Name Home Phone
Mobile
Email
/ /
Female
Male

Prev. Address Since Householder /Status Date

/ of Birth Gender
Marital Status Mother’s Maiden Name Home Phone
Mobile
Email
/ /
Female
Male

Resident in U.S. for tax purposes or a U.S. citizen? Resident in U.S. for tax purposes or a U.S. citizen?
Yes No
Yes No
If yes, state U.S. TIN (Tax Identification Number) If yes, state U.S. TIN (Tax Identification Number)

9 9

Nationality Are you a non-resident for tax purposes? Yes No Do

If not Irish do you have a stamp 4/5? Yes No you want to switch your current account

Dont forget to sign the next page

Are you switching accounts? Yes No
Nationality
If yes fill out the Account Switching Form provided
If not Irish do you have a stamp 4/5? Yes No
Preferred home branch
Are you a non-resident for tax purposes? Yes No
Employment details
Do you want to switch your current account
Occupation
Are you switching accounts? Yes No
Income details
If yes fill out the Account Switching Form provided
Gross Annual Income
Preferred home branch

Employment details

Occupation

Income details

Gross Annual Income

Salary type Weekly

Fortnightly Monthly Salary type Weekly Fortnightly Monthly
Will you lodge your salary to this
new account? Yes No
Will you lodge your salary to this Yes No
new account?

Dont forget to sign the next page

 Important information

Payment Instructions
Direct Marketing, Third Party Products
If a joint application, please choose whether you want either or
Permanent TSB would like to use your personal data to provide you with
both account holders to sign when making in-branch
information about products, services or special offers (for example rewards,
withdrawals.
discounts and cashback programmes) from carefully selected third parties.
By Either or Survivor By Both or Survivor Permanent TSB will never share your personal data with these third parties for
marketing purposes.
I hereby consent to being contacted for direct marketing of third party products
Warning to Joint Account Holders: If you instruct the and services using the methods selected above:
Bank to allow payments from the account on the
instruction of any, but not all of you, funds in the Applicant 1 YES NO Applicant2 YES NO

account may be used and/or accessed without the
Source of Funds/Reason for opening
Under the Criminal Justice (Money Laundering and Terrorist Financing) Act
2010, all Financial Service Providers are obliged to obtain information on the
“purpose and intended nature of the relationship”, i.e. reason for opening an
account, along with details of where the funds to open the account have come
from i.e. “source of funds”. To ensure compliance with this obligation, can you
please complete both fields below in detail (see some examples provided)
Source of Funds
Please advise where has this money come from in the space below (e.g. Inheritance; retirement; redundancy; social welfare payments; children’s allowance; salary/wages; intern
Reason for Opening
Please detail what do you intend to use this account for, in the space below. (e.g. general savings;
Distance Marketing
If you are opening the account by post we recommend you read the information
under “Distance Marketing” on page 1 of our Terms and Conditions, Personal
& Business banking charges booklet prior to submitting the account opening
If at any time you change your mind and you wish to amend your direct
marketing preferences, you may contact us by writing to FREEPOST F4940,
Customer Data Quality (Direct Marketing ), Permanent TSB p.l.c., 56-59 St.
Stephen’s Green, Dublin 2, by phone on 1890 500 121 or +353 1 212 4101 or go
to your local branch.
Current Account Application
I/We hereby apply to permanent tsb p.l.c (The “Bank”) for a current account
of the type described above (the “Account”) to be operated in my/our
personal capacity and not in relation to my/our trade, business or profession.
I/We confirm that
the information given in the application is true and accurate. I/We have had the
necessary time to consider and query the information provided to me/us in
relation to my/our application.
I/We apply for the issue to me/us, of a Permanent TSB debit card and agree
that such debit card will be subject to the Bank’s terms and conditions
applicable
to such debitworking account;
card from time torainy
time.day account;
Please note interest rates;
debit card children’s
facilities education; retire
are not
available where the payment instructions provide for more than one person to
give instructions on the Account.
I/We have also received the Bank’s ‘Terms of Business’ letter.
I/We have also received the Bank’s current Terms and Conditions, Personal &
Business banking charges booklet and the summary Data Protection Notice.
I/We have read and have had an opportunity of becoming acquainted with,
have understood and agree to be bound by the said terms and conditions and
charges in relation to the facilities applied for above, which may be amended
from time to time.
I/We hereby acknowledge that the Bank may refuse to open the Account or
grant any of the other services requested above without stating any reason.
Signature (Applicant 1)

7
application.
Borrowing Rates & Charges
If you apply for an overdraft facility the following charges and interest will
apply: Date
• The borrowing/interest rate is Reference Rate A, currently 15%. This is
a variable rate and may change. Only for joint applications. Signature (Applicant 2)

7
• A Set-up fee/Renewal fee €25 will apply. We will notify you of any
changes to this fee by advertisement in a national newspaper or by
writing to you.
Where there is a debit balance on an account for which no facility has been
authorised, Surcharge interest of 12% per annum will apply, which you must pay Date
in addition to the borrowing rate of interest set out above.
Direct Marketing, Permanent TSB
Deposit Guarantee Scheme
Permanent TSB will use your personal data to identify our products, services
and benefits which we believe may be of interest to you. Please see the back of this pack for information on the Deposit Guarantee Scheme.

Based on your indicated direct marketing preferences below we will inform you I/We confirm that I/we have received the ‘Deposit Guarantee Scheme -
on how you can avail of these products and services using the following Depositor Information Sheet’ prior to completing this application to open an
methods: account with permanent tsb.

Applicant1 Applicant2 Applicant1 Applicant2

Applicant 1 Applicant 2
Y N Y N Y N Y N
Using your personal data
Post Online In providing personal banking services to you, we need to process personal data
about you. This involves asking you for specific personal data, processing this
Home phone Email personal data and storing it for a period of time. An explanation of how your
Text message personal data is used in the provision of our services to you, our running of the
bank and your rights in relation to your personal data is provided in the summary
Data Protection Notice included with this pack.
Please indicate your consent to be contacted by mobile phone
If you would like a copy of the full Data Protection Notice, please ask a
Applicant 1 YES NO Applicant2 YES NO branch staff member, call Open24 on 1890 500 121 or view it at
www.permanenttsb.ie
If at any time you change your mind and you wish to amend your direct
marketing preferences, you may contact us by writing to FREEPOST F4940,
Customer Data Quality (Direct Marketing ), Permanent TSB p.l.c., 56-59 St.
Stephen’s Green, Dublin 2, by phone on 1890 500 121 or +353 1 212 4101 or go to
your local branch.

permanent tsb p.l.c. is regulated by the Central Bank of BMK2545 (Rev