Notification of Change of Contact Details PLEASE COMPLETE IN BLOCK CAPITALS AND RETURN WITH PROOF OF YOUR NEW ADDRESS TO BOI CHANGE OF CONTACT DETAILS, PO BOX 365, DUBLIN 18

BANK OF IRELAND ACCOUNT AND POLICY NUMBERS IMPORTANT: Please list all your Bank of Ireland account and policy numbers below to ensure that your personal details are updated throughout the Bank of Ireland Group.

BRANCH ACCOUNTS:

Branch: NSC: Acc No:

Branch: NSC: Acc No:

Branch: NSC: Acc No:

Branch: NSC: Acc No: CREDIT CARDS: Card No:

Card No:

BANK OF IRELAND MORTGAGES: NSC: Acc No:

NSC: Acc No:

TERM DEPOSIT ACCOUNTS: NSC: Acc No:

NSC: Acc No: BANK OF IRELAND FINANCE: Agreement No:

Agreement No:

BANK OF IRELAND LIFE: Policy No:

Policy No:

BANK OF IRELAND INSURANCE SERVICES: Policy No:

Policy No: CUSTOMER / SIGNATORY 1

First Name:

Surname: Date of birth: D D M M Y Y Y Y

NEW address: House name/number: Street:

Town: County:

Country: Post Code:

Home tel no: Mobile tel no: Email address:

(A) Are you a US Citizen? Yes No (B) Are you resident for tax purposes in any country Yes No or territory other than the Republic of Ireland? If you have answered “Yes” to questions (A) and/or (B) above, please list below all countries/territories in which you are tax resident, and provide your Tax Identification Number (TIN) for each country/territory (Please continue on a separate sheet if necessary). Country/Territory Tax Identification Number (mandatory)

CUSTOMER D D M M 2 0 Y Y SIGNATURE: Date:

Page 1 of 3 4-771R.12 (01/16) CUSTOMER / SIGNATORY 2

First Name:

Surname: Date of birth: D D M M Y Y Y Y

NEW address: House name/number: Street:

Town: County:

Country: Post Code:

Home tel no: Mobile tel no: Email address:

(A) Are you a US Citizen? Yes No (B) Are you resident for tax purposes in any country Yes No or territory other than the Republic of Ireland? If you have answered “Yes” to questions (A) and/or (B) above, please list below all countries/territories in which you are tax resident, and provide your Tax Identification Number (TIN) for each country/territory (Please continue on a separate sheet if necessary). Country/Territory Tax Identification Number (mandatory)

CUSTOMER D D M M 2 0 Y Y SIGNATURE: Date: CONFIRMATION

I would like to receive confirmation when this request has been actioned. SMS Yes No or Email Yes No

INTERNAL BRANCH USE ONLY  I confirm that I have verified the above customers and validated proof Insert branch brand of new address documentation provided.

 I confirm that I checked that the accounts listed are in this customers name(s).  I confirm that this instruction is signed in accordance with the mandate held for this account.

Verification method (Please tick) SIG: PIN: KNOWN: Staff signature:

PROOF OF NEW ADDRESS ATTACHED Yes

Staff number: VEC (sign off required below) Yes

Change of country noted:

FOR INTERNAL USE ONLY Page 2 of 3 4-771R.12 (01/16) TERMS AND CONDITIONS

 Proof of your new address is a mandatory requirement to fulfil Regulatory obligations  The address of Customer 1 above will be used as the primary address in all correspondence unless the Bank has been notified to the contrary.  Bank of Ireland may contact you to clarify any queries they may have regarding your instruction.  For address changes that involve a change of jurisdiction i.e. from one country to another please speak to a branch official as other information/documentation may be required e.g. proof of address, Certificate of Tax Residency etc.  Updates to your address and contact details will be processed within 3-5 working days of the completed form being received.

FATCA/CRS

 In accordance with the Foreign Account Tax Compliance Act (‘FATCA’) and the OECD Common Reporting Standard (‘CRS’), Bank of Ireland is required to establish where the account holder is resident for tax purposes. In certain circumstances, we may be required to report certain details to the Irish Revenue Commissioners who may, in turn, share this information with tax authorities in the relevant jurisdictions. Please note that Bank of Ireland does not provide tax advice and will not be liable for any errors contained in this form. If you have any questions about FATCA/CRS you should contact your tax advisor or the Irish Revenue Commissioners. Additional information on FATCA and CRS can be found at www.revenue.ie

Acceptable Documents: Examples of unacceptable documents include: ✔ Utility bill - Gas/Electric / Landline / Water / Household Charge ✗ P60 (Dated within the last 6 months) ✗ Letter ‘c/o address’ (unless the individual is ✔ Registered tenancy agreement from reputable agency / living at these premises e.g. nurses living in hospital registered landlord accommodation, employee living and working at ✔ Residential Mortgage offer letter with new address employers address) ✔ A current Irish / UK Driving Licence ✗ Public Service Card issued by the Department of Social Protection ✔ Current household/motor insurance document ✗ PPSN letter ✔ Current Revenue Commissioners documents (including tax credits, Balancing Statement, C2 certificate) ✗ Payslip ✔ Current Department of Social Welfare document relating to state ✗ Mobile phone bill pension and/or social welfare (cannot accept PPSN letter) ✗ Any document stamped as not to be used for ID ✔ Current financial institution statement purposes or not to be used other than for public service reasons ✔ Credit card statement (Dated within the last 6 months) ✔ E-statements - must include logo of recognised financial institution

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

FOR INTERNAL USE ONLY Page 3 of 3 4-771R.12 (01/16)