23

* PPSN

* First name(s)

* Surname

* Date of birth

* Address line 1

* Address line 2

Address line 3

Eircode

* Country of residence

* Nationality

* Place of birth

Gender

Contact Phone no.

E-mail address

DD MM YYYY

Male Female

DD MM YYYY

Male Female

Unless otherwise agreed with you all Correspondence will be sent to the address in Panel 1 – All fields marked with asterisk must be completed.

Panel 1 First named holder Panel 2 Second named holder

Section 5 – Holder(s) Details

Section 2. – Other Products you may hold

Section 4. – Method of First Payment (Cheques to be made payable to NTMA State Savings)

Payment Methods Fill in Deposit Amount Payment Methods Fill in Deposit Amount

Cash € Personal Cheque €

Total €

Source of Funds (Please tick appropriate option below)

Personal Savings Other (Please specify)

Inherited Funds

Sole Complete Section 5 Panel 1

Child under 7 yrs

Minor 7 to under 18 yrs

Joint Complete Section 5Panels 1, 2

Please tick Account type required above (Tick one box only)

Consent Signature of nominated Parent/Guardian

FOR OFFICIAL USE ONLY

RECEIPT NO. GROF

Office Name

PLEASE ENDORSE ALL CHEQUES WITH THE RECEIPT NUMBER

Signature of Officer:

Date:

DATE STAMP

Variable Interest Rate subject to change by the Minister for Finance acting through the NTMA

(a) With Pass-Book (Deposit/Withdrawals in Post Offices) (b) Statement based (withdrawals by postal application only)

If you hold any of the following 3 categories of product tick the relevant box, providing any account/customer reference to link this purchase to existing records.

Savings Bonds/Cert/National Solidarity Bond etc. Yes Deposit Accounts Yes Prize Bonds Yes

Existing Reference

Section 3. – Type of Holder (Note - this form is for individuals only. For other application forms telephone 1850 30 50 60 / +353 1 705 7200)

Application form for Variable Rate Deposit Account

Name

Signature

(Block Letters)

*Subject to the prevailing rate of DIRT (deposit interest retention tax).

There are two types of deposit accoun

t to choose from

(a) with a Pass-B

ook where deposits and w

ithdrawals

usually take place in a post office. U

nder the 1921 POSB

Regulations this Pass-B

ook account can be operated by

an account holder(s) aged 7 years or m

ore withou

t the consen

t of the child’s parent or guardian

.

(b) a Statemen

t based account w

here withdraw

als can only be m

ade by postal application and minors (aged less than

18 years) m

ay only operate the account w

ith the written

consen

t of the parent or guardian

.

2

Wh

at are State Savings?

• State Savings form

part of the N

ational Deb

t of Ireland

which

is managed by th

e National Treasury M

anagemen

t A

gency.

• Wh

en you

save with

State Savings you

are placing your

mon

ey directly with

the Irish

Governm

ent.

• The repaym

ent of all State Savin

gs mon

ey is a direct, un

conditional obligation

of the Irish

Governm

ent.

• Repaym

ent

of your

mon

ey in

cludes

principal,

interest

and b

onus paym

ents if du

e.

How

can I buy State Savings Products?

• Call in

to any Post Offi

ce.

• Onlin

e at StateSavings.ie

The com

plete range of State Savin

gs products are listed on

our w

ebsite StateSavings.ie. Cu

stomers can

buy Fixed Term

Produ

cts and Prize B

onds onlin

e.

To buy, online or by mail, you m

ust be an existing State Savings custom

er for whom

we already have the necessary

evidence of identity. Please contact us for further information

– contact details are on page 4.

If you are n

ot an existin

g custom

er or if your last purchase of State Savin

gs products w

as prior 05 Octob

er 2014 you

mu

st first register by com

pleting a purchase at a Post O

ffice

or by postal application

to State Savings, G

PO Freep

ost, D

ublin 1, D

01 F5P2.

DEPO

SIT ACCO

UN

TS*

(a) W

ith Pass-B

ook

(b) Statem

ent B

ased0.15%

GRO

SSReturn before D

IRT

Signature of 1st Named Holder Date Signature of 2nd Named Holder Date

Section 6 – Declaration and Signature I /We have read and accept the notes 1 to 3 on the reverse of this application form and agree to the use of my/our PPSN. I/We acknowledge that this account is operated pursuant to the POSB Regulations, 1921 (as amended). Please sign and date.

Section 1 – Product options (Please select one)

Deposit Account with Pass Book(Deposit/Withdrawals in Post Offices)Account can be operated by a 7 year old without the consent of the child’s parent or guardian

Minors (aged less than 18 years) may only operate the account with the written consent of the parent or guardian.

(A) (B) Deposit Account Statement based (Withdrawal by Postal Application only)

Variable Rate Deposit A

ccounts*

All Panels marked with an asterisk must be completed in order to purchase State Savings Products.

BR1C

3418 [5p].indd 206/04/2018 15:21

NOTES1. Evidence of Identity1.1 You are required to confirm your identity to us (including your surname, first name, date of birth and address) for the purposes of:

(a) the Agreement (including any Transaction);

(b) the administration of your Product(s) and any other State Savings Product(s) that you may hold now or in the future, and

(c) associated legal purposes, including compliance with statutory anti-money laundering obligations and account security and fraud prevention,

1.2 We may verify your identity:

(a) electronically (by reference to information supplied by you, including your Personal Public Service Number (PPSN)); or

(b) manually (by reference to acceptable original or certified copy documentation supplied by you, which may include documents such as your current passport, current EU driving licence, recent utility bill, recent account statement from a bank, building society or credit union, and/or your Public Services Card or other official documentation issued to you by the Revenue Commissioners or the Department of Employment Affairs and Social Protection).

2.3 Where you have not provided evidence of your identity to our satisfaction, we will advise you and we will not proceed with your application to purchase the Product until evidence of your identity has been verified to our satisfaction. For the avoidance of doubt, no interest, bonus or other amount shall accrue in respect of a Product during the period when evidence of identity is being verified under this condition.

2. Personal Data 2.1 The NTMA is the Data Controller (for the purpose of the General Data Protection Regulation (GDPR)) for all personal data supplied by you. The Minister for Finance and

the NTMA are each a ‘specified body’ for the purposes of sections 262 to 270 and schedule 5 of the Social Welfare Consolidation Act 2005, as amended, under which the NTMA and the Minister for Finance are both authorised to process personal data including PPSNs for certain purposes.

2.2 We will collect, process and use personal data relating to you, including your PPSN and the information referred to in Note 1 (Evidence of Identity):

(a) as necessary for the performance of the Agreement (including any Transaction);

(b) for the administration of your Product(s) and any other State Savings Product(s) that you may hold now or in the future, and

(c) for associated legal purposes, including compliance with statutory anti-money laundering obligations and account security and fraud prevention,

2.3 You acknowledge the collection, processing and use of your personal data (including your PPSN) for the purposes as outlined in 3.2.

2.4 Personal data may be processed by us, our Agents, and any third party service providers acting on our behalf for the purposes of the Agreement and for associated legal purposes and for any other purpose required for or reasonably incidental to the performance of the Agreement.

2.5 We will retain your personal data for as long as you have a holding with State Savings and otherwise in accordance with applicable data protection law and statutory obligations (including under anti-money laundering legislation).

2.6 Subject to your consent, your personal data may be used by us, or our Agents, for the purpose of marketing State Savings Products. Where you hold more than one Product, the preferences indicated most recently by you will apply to all Products held by you to which the General Terms and Conditions apply.

2.7 You have the right to request access to and a copy of your personal data held by us in accordance with the GDPR, to have your personal data corrected where it is inaccurate or misleading, to have your personal data erased, to object to the processing of your personal data by us, to request data portability in relation to your personal data. Should you wish to avail of any of these rights, please contact the Data Protection Officer, State Savings, GPO, FREEPOST, Dublin 1, D01 F5P2.

You also have the right to lodge a complaint with the Office of the Data Protection Commissioner. See www.dataprotection.ie for more information.

3. Registers3.1 Once your application to purchase a Product has been accepted and evidence of your identity has been provided to our satisfaction under Note 1 (Evidence of Identity),

we will record your name(s) and the Principal Amount of the Product in the Register applicable to that Product, which Register shall be the official record of the Holder(s) and the Principal Amount of that Product.

3.2 We will not be responsible for any delay that may arise in the processing of your application to purchase due to you submitting an incomplete application or you failing to provide evidence of identity to our satisfaction under condition 2 (Evidence of Identity). In particular, you should note any such delay caused by you may mean that by the time the process referred to in condition 5.1 has been completed, the Product that you applied to purchase may no longer be available. In this event, we will contact you to request your new instructions.

3.3 The Registers may be in paper form or electronic form or partly in one form and partly in the other form, in each case, at the absolute discretion of the NTMA.

SAFE

ARE

AB

roch

ure

and

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pplic

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n F

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epos

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ccou

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e Sa

ving

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oduc

ts a

re:

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mor

e in

form

atio

n o

n S

tate

Sav

ings

Web

: St

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avin

gs.ie

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lep

hon

e:

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ngs

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turn

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3 ye

ar S

avin

gs B

onds

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1.

00%

2.00

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4

year

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iona

l Sol

idar

ity

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20.

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%

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5 ye

ar S

avin

gs C

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cate

s20.

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%

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0%1.

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ear N

atio

nal S

olid

arit

y Bo

nd2

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6 ye

ar In

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(ALS

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ENEF

IT)

1 A

ER =

“Ann

ual E

quiv

alen

t Rat

e”.

2 Not

subj

ect t

o ta

x in

Irel

and

but p

leas

e se

e Co

ndit

ion

4 Ta

xati

on in

Spe

cific

Con

diti

ons.

3 S

ave

in 1

2 m

onth

ly in

stal

men

ts a

nd le

ave

for 5

yea

rs.

AER

cal

cula

tion

ass

umes

a 5

½ y

ear a

vera

ge li

fe.

4 Sub

ject

to D

IRT

(Dep

osit

Inte

rest

Ret

enti

on T

ax) a

t the

pre

vaili

ng ra

te.

5 Priz

e Bo

nds –

The

var

iabl

e ra

te u

sed

to c

alcu

late

priz

e fu

nd is

0.5

0%. T

here

are

two

€1

mill

ion

priz

es p

er a

nnum

and

thou

sand

s of w

eekl

y pr

izes

. No

inte

rest

is p

aid

to P

rize

Bond

hol

ders

. Ins

tead

the

inte

rest

is p

aid

into

the

mon

thly

priz

e fu

nd, t

o be

dis

trib

uted

to

win

ners

in th

e w

eekl

y dr

aw.

6 Var

iabl

e Ra

te m

eans

that

the

inte

rest

rate

pai

d on

this

Pro

duct

may

be

chan

ged

by th

e N

TMA

from

tim

e to

tim

e. S

uch

chan

ges w

ill b

e no

tifie

d by

at l

east

one

of t

he fo

llow

ing

met

hods

: dire

ct n

otifi

cati

on to

you

by

post

, pub

licat

ion

in a

nat

iona

l new

spap

er,

publ

icat

ion

on StateSavings.ie

or n

otifi

cati

on b

y an

y ot

her m

eans

.

Bro

chu

res

and

App

licat

ion

For

ms

for

Stat

e Sa

vin

gs P

rodu

cts

lis

ted

abov

e ar

e av

aila

ble

in a

ny

Post

Offi

ce o

r on

line

at

Stat

eSav

ings

.ie. S

tate

Sav

ings

pro

duct

s ar

e su

bjec

t to

Ter

ms

and

Con

diti

ons

and

rele

van

t le

gisl

atio

n. Y

ou m

ay fi

nd

our

Term

s an

d

Con

diti

ons

boo

klet

on

line

and

in P

ost

Offi

ces.

Important –Before completing this Application Form and in particular Section 6 “Declaration and Signature” you must read the Notes 1, 2 and 3 below.

NATIONAL TREASURY MANAGEMENT AGENCY

Mail this form to – State Savings, GPO, Freepost, Dublin 1, D01 F5P2

Dated 16 April 2018

BR1C

341

8 [5

p].in

dd

106

/04/

2018

15

:21