The Bank of N.T. Butterfield & Son Limited

CORP 009-14 Ver 11-14 The Bank of N.T. Butterfield & Son Limited Son &of N.T. Butterfield Bank The Confidential Classification: Information Global intermediary identificationnumber Global entity: sponsoring intermediary of “ If Yes entity organisation sponsoredIs reportingthe for FATCA purposes registeredwith IRS thereporting(iffor FATCA purposes) Global identificationintermediary number: Country: Country: Country: below theeach countryandtaxlist please numberidentification corresponding held: entity/organisationthetax listed anya resident other than forpurposes inoneabove, If country the is identification Tax number: of Country business: IRS W-9(accessible from formsupported a completed by or US,thisentity under laws theinformation USofthebe incorporated theformed mustIf in was of Country incorporation/ formation: registrationCompany applicable):number (if incorporation of formation:Date / Telephone number: address:Correspondence of entity/organisation:Type of entity/organisation: Name APPLICATIONACCOUNT CORPORATE FORM Yes”

, name of sponsoringnameof, entity:

No No Non-profit corporation organisation / Limited partnership Company

SECTION 1 -GENERALSECTION 1 INFORMATION

office Registered address: Tax identification Tax number: identification Tax number: identification Tax number: of Country issue: number:Fax

www.IRS.gov

Other (please describebelow:)Other (please Limited liability partnership General partnership

CORP 009-14 Ver 11-14 CORPORATE ACCOUNT APPLICATIONACCOUNT CORPORATE FORM The Bank of N.T. Butterfield & Son Limited Son &of N.T. Butterfield Bank The Confidential Classification: Information (ii) (i) (iii) traded: If Yes Yes bearershares?anyof entitiesoftheform issued capital of the share in Is the If “Yes” pleasedetails theseof entities below necessary):“Yes”if (attach additional provide sheets If entity/organisation? any intermediary Are there involvedin entitiesownership of the structurethe company? entity/organisation’s Is the stock publiclytraded or affiliate is anof it a publicly traded in support of thisinofrequest) support (Please eachthese of anote individuals completethat also must equity excess inof interest 10% Listthat person is ultimateevery owner(s)an organisation/entitybeneficial of Name of entity/organisation Name Yes Full name Full , what is the name of the publicly traded company and on what stock exchange(s) are securities are exchange(s) stock what on and company traded publicly the of name the is what ,

Yes Yes SECTION 2 – BENEFICIAL OWNERSHIP INFORMATION OWNERSHIP SECTION 2 – BENEFICIAL

No No Yes Yes citizenship Country of

Countryincorporation/formation of

Country of Country residence DeclarationTax of (dd/mm/yy) Date of Date birth

Status Ownership % Shareholdin with anwith g (%) g

Form Page 2 of 7 CORP 009-14 Ver 11-14 CORPORATE ACCOUNT APPLICATIONACCOUNT CORPORATE FORM The Bank of N.T. Butterfield & Son Limited Son &of N.T. Butterfield Bank The Confidential Classification: Information (iii) (ii) (i) describePlease the principal activities/businesslines the entity/organisation:of f “e, o ut cnim ti o Btefed b umtig a submitting accessed be may at These by application. your with Butterfield appropriate) (as W-8EXP to or W-8BEN-E this confirm must FormIRScompleted you “Yes,” If (as a weighted forpassiveincome?)production of percentage)the (as average the from gains investments such or of sale annuities royalties, income, rental dividends, interest, such as income passive from earnings gross its of 50% than more derives that Company Holding “Investment an entity/organisation the is “No,” If e) d) c) b) a) doesentity/organisation:the“No”, If as organisation) international or governmental a US theRegulations sections in1.1471-6(b) Treasury (g)?described through Owner” as Beneficial (such “Exempt FATCA an be under to considered entity/organisation the Is . . affiliated is (or company company) that: areinsurancecaptive insurance withor reinsurance or insurance captive a as operate insurance assets an of annuities?values cashissues orpolicies withcompany) that surrender company such holding (or company insurance in an as operate interest any or securities, or options)? forwards, asfutures, or such (including derivatives commodities trading manager, or interests, reinvesting fund investing, or partnership of administrator business fund the in manager, engage portfolio a as act business? its of portion substantial a as others of account the for assets financial hold banking or provide similar deposit-taking services? el ie isrne plce, aniis r ay ohr fr f other policies reinsurance?that holdsconstitute assumption of form other any or annuities, greater value$50,000which a cash than or; has insurance policies, insurance life sells

www.IRS.gov and which has deployed more than 50% of its assets its of 50% than more deployed has which SECTION SECTION 3 – BUSINESS ACTIVITY ). ” , (i.e. one (i.e. ,

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Page No No No No No No No No 3 of

7 CORP 009-14 Ver 11-14 CORPORATE ACCOUNT APPLICATIONACCOUNT CORPORATE FORM The Bank of N.T. Butterfield & Son Limited Son &of N.T. Butterfield Bank The Confidential Classification: Information

If Yes anyintermediaryinvolvedWill management bethis account?the in of List with any the other bankList whichentity/organisationmaintains relationships: you What Butterfield?attractedto and being (if bank that exited Name location of is applicable): bankingrelationship: existing Exiting an its Diversifying banking existing arrangements: banking relationship time: for first Establishing the a entity/organisation: Is the applicable):(if shareIssued capital years, $mil) in (last 3 Annual turnover of Total assetsentity/organisation:

“Yes,”

No No please complete please table below: the Name of financial Name institution Name of intermediary Name $

Year: SECTION 4 –SECTION 4 BUSINESS HISTORY

been been registered? issue all shares Have in

Country

Relationship accountwith

$ Primary providedPrimary service

Year: Yes Yes

Page $

4 of 7 CORP 009-14 Ver 11-14 CORPORATE ACCOUNT APPLICATIONACCOUNT CORPORATE FORM The Bank of N.T. Butterfield & Son Limited Son &of N.T. Butterfield Bank The Confidential Classification: Information obtained? were funds How the funds:ofSource delivery:ofMethod amount Deposit withinoftothe reservesrightnot the if funded30 (Butterfield close opening.) account days of Detailsdepositinitial applicable):(if Cash transfer I received? the channels common mostwhich through creditsWhat are the future to beaccount will of counterparty Name counterpartiesPrincipalfrom deposits/securities which be will received: deposits: sourcePrincipal of future $ Expected of account Type nternational wire

Treasury CallFixed,orDeposit Treasury Notice to Subscription mutual Butterfield fund(s) account Custody account Chequing/Current Brokerage value of depositsfuture per month: (select all (selectall that apply) Country : City Name: Cash $ Wire Wire

: : ($2,500minimum)

% % fees/commissions SECTION 5 –REQUIREMENTSSECTION 5 ACCOUNT

Investment incomeInvestment Professional Retail sales Domestic chequesDomestic transfers Domestic Bank draft Bankdraft

Purpose of accountPurpose of month: Expected Fund administration/management Fund administration/management Administration security ofholdings Management personal/familywealthof partyclient Management third monies of Savings/Cash management Operating account Place of another business inPlacecountry) (if Internal transfer transfer Internal

number % %

Rental incomeRental Clientmonies premiumsInsurance/Reinsurance Direct deposit Direct (inter-account) transfersInternal of depositsfuture per

(select all (selectall that apply) Personal cheque Personal cheque Page

5 of % %

7 CORP 009-14 Ver 11-14 CORPORATE ACCOUNT APPLICATIONACCOUNT CORPORATE FORM The Bank of N.T. Butterfield & Son Limited Son &of N.T. Butterfield Bank The Confidential Classification: Information Banking Online initiating Anticipated methods banking of transactions Cash transfer I through willbe channelspaymentsprocessed: ofwhichAnticipated breakdown willpaymentsmade: which to counterparties Principal be currency): not these willbe whichtransactions made account (if in currencies Principal month: Expected cheques Overseas nternational wire

value Name of counterparty Name of

of transactionsdebit per % Fax /emailFax

% % % Domestic chequesDomestic deposit transfers/direct Domestic Bank drafts

% month: Average Centres Banking Place of another business inPlacecountry) (if

number % % %

Internal transfersInternal Other Bank Bank drafts (inter-account) of debit of transactions per % Mail

% 6 of % % % 7 CORP 009-14 Ver 11-14 CORPORATE ACCOUNT APPLICATIONACCOUNT CORPORATE FORM The Bank of N.T. Butterfield & Son Limited Son &of N.T. Butterfield Bank The Confidential Classification: Information entity/organisation Position to with respect authorised Name of signatory Date Signature entity/organisation Position to with respect authorised Name of signatory Date Signature of entitypaymentstheowner. thewhich partythat makeof income is can disburse or incomeofentityreceipt, theowner;control,custodythe(iii) any thatwhich any or of personhas is anywith to: behalfofButterfield (i) partyauthorised accountauthority anyon (ii)or authority; tax such and thisregarding formI/WeButterfield, its provide ofdiscretion, at sole a copy to information authorise 6. 5. 4. 3. 2. 1. (insert (insert date) dated appropriate) as (delete partners / trustees / directors its of Meeting a to pursuant and further understand and agree that any failure to do so shall entitle Butterfield to suspend the suspend to Butterfield entitle shall so do theto includingaccount providesterminationservices andtheit entity, anyprovided. up to of to failure any that agree and understand occurring, further changes and such of days 30 within request reasonably may discretion, sole its in Butterfield, that documentation additional any with together form updated an with Butterfield supply cause to entity the shall I/we interests. ownership beneficial respective their in or entity the of owners are that beneficial individuals the either in change any (ii) or; entity the of status tax the in change any (i) limited to): not (but including information, this in change any of immediately Butterfield notify shall I/we belief. and knowledge my/our of best the to accurate and complete is form this in provided information The maintainedandButterfield. atregulations its relating requirements toaccount(s) reporting will I/wewillcomplythat entityall andcontrolthe present confirm with future taxlaws, exchange and violationThisisbeing applicable law. inacquired not account(s) any of from obtained be may which of copy a website Butterfield’stime.mayatButterfield’sbe to whichamendedtime from and discretion sole Conditions, & Terms General Butterfield’s with accordance in operated be shall (“Butterfield”) affiliates or subsidiaries ofits of any or Bank Limited Son the & Butterfield N.T. by provided accounts future any and this that agree and account an open to apply I/We entity) of behalf on Declaration this sign to authorised properly been have I/we SECTION 6 – 6 DECLARATION– SECTION

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