. , . , . New Standing Order Instruction

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New Standing Order Instruction To Bank Please set up the following Standing Order and debit my/our account accordingly 1. Account details Account name Account number Account holding branch Sort code 2. Payee details Name of person or organisation you are paying Payment reference (if known) - this will appear on the bank statement of the person or organisation you wish to pay Sort code - the bank code of the person or organisation you are paying Account number - the account number of the person or organisation you wish to pay (Eight digits - if less place zeros at the front) 3. About the payment How often are the payments WeeklyX Two weeklyX Four weeklyX Monthly X to be made QuarterlyX Half yearlyX Yearly X Amount details Date and amount of first payment D DMMMY Y € €€€€€,.CC (please allow 3 working days for receipt) Date and amount of ongoing payments € €€€€€ (If different from the first payment) D DMMMY Y ,.CC Choose one of the following two options 1. Date and amount of final payment D DMMMY Y € €€€€€,.CC 2. Until further noticeX (payments will be made until you cancel this instruction) 4. Confirmation Customer signature(s) Date Date Ulster Bank Ireland Limited. A private company limited by shares, trading as Ulster Bank, Ulster Bank Group and Banc Uladh. Registered in Republic of Ireland. Registered No 25766. Registered Office: Ulster Bank Group Centre, George’s Quay, Dublin 2. Member of The Royal Bank of Scotland Group. ULS50000RI (19/01/2011) Ulster Bank Ireland Limited is regulated by the Central Bank of Ireland. 16500001 Page 1 of 2 Calls may be recorded. Originating Branch use only Staff Name Branch Name Staff Signature Date ULS50000RI (19/01/2011) Page 2 of 2.

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