PREMIER ISA APPLICATION FORM

PREMIER ISA APPLICATION FORM
OFFICE USE ONLY
PLEASE COMPLETE USING
BLOCK CAPITALS AND BLACK INK
Account number
PERSONAL DETAILS
Title
Mr / Mrs / Miss / Ms etc
Surname
Forename
Other forenames
Date of birth
Address
Postcode
Nationality
Occupation
Daytime number
Evening number
Mobile number
Email address
Fax number
Preferred contact method
Do you have a National Insurance (NI) number?
Yes
No
If Yes you must enter it here
You should be able to find your NI number on a payslip, form P45 or P60, a letter from the HM Revenue & Customs, a letter from the DWP, or pension order book.
Please tick to confirm that you have received the Deposit Guarantee
Scheme Information Sheet
YOUR DECLARATION
For your own benefit and protection, you should read carefully the information and terms contained in this application form, including the declaration below, and the conditions
relating to this account referred to below before signing this form. If you do not understand any point, please ask for further information.
I apply to subscribe for a cash ISA for the tax year 2016/2017 and each subsequent year until further notice.
I declare that
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all subscriptions made, and to be made belong to me;
I am 16 years of age or over;
I have not subscribed and will not subscribe more than the overall subscription limit in total to a cash ISA and a stocks and shares ISA in the same tax year;
I have not subscribed and will not subscribe more than the cash ISA subscription limit to one cash ISA;
I have not subscribed and will not subscribe to another cash ISA in the same tax year that I subscribe to this cash ISA; and
I am resident in the United Kingdom for tax purposes or, if not so resident, either perform duties which, by virtue of Section 28 of Income Tax (Earnings & Pensions) Act 2003 (Crown
employees serving overseas), are treated as being performed in the United Kingdom, or I am married to, or in a civil partnership with, a person who performs such duties. I will
inform Tipton & Coseley Building Society if I cease to be so resident or to perform such duties or be married to, or in a civil partnership with, a person who performs such duties.
I authorise Tipton & Coseley Building Society
 to hold my cash subscription, ISA investments, interest, dividends and any other rights or proceeds in respect of those investments and any other cash;
 to make on my behalf any claims to relief from tax in respect of ISA investments; and
 to use information held about me in the manner specified in the section overleaf headed ‘Data Protection Act 1998’ which I have read.
I agree to the ISA terms and conditions and I declare that this application form has been completed to the best of my knowledge and belief.
I agree to be bound by the Rules of the Society, the assignment to charity conditions (overleaf), the conditions relating to the account opened and the Society’s Terms &
Conditions for Savings Accounts, a copy of which I have received.
Unless you have indicated otherwise below, we may pass your information to other companies within the Society's Group and to other organisations selected by the Society for the
purpose of sending to you details of other products and services that the Society thinks may be of interest to you.
I/We do not wish to receive information about the Society's products and services and do not wish the Society to share my/our information with other organisations for their
marketing.
Signed
Dated
IMPORTANT: Please see over for identification and address requirements
OFFICE USE ONLY
Date Opened
First Check
Customer Number
Identity
(PIDE List 1)
Identity
(PIDE List 1)
Customer Number
Sample Check
Second Check
Identity
(PIDE List 2)
Identity
(PIDE List 2)
V2.002 6 April 2016
IMPORTANT - USE OF YOUR INFORMATION
Data Protection Act 1998
Any information you provide, including information you give us in the future, may be held on record by the Society. The record may be held as a computer record. The Society may use this information
for purposes of customer administration, research and statistical analysis, and for fraud prevention for the benefit of the Society and its customers. This information will be held during the life of the
account and may be kept for six years after the account is closed.
Under current Data Protection legislation, you have the right to ask us to send you a copy of your records (on payment of an administration fee) and the right to change any of your information that is
incorrect. You also have the right of access to your personal records held by credit and fraud agencies. We will supply their names and addresses upon request.
Marketing of other Products and Services
We would like to tell you about our financial products, services, promotions, offers, events and competitions such as mortgages, savings, personal loans and insurances which may be of interest to you,
and to introduce you to or pass your contact details and details of the types of products we have provided you with to our associated companies in the Tipton & Coseley Group ("the Group") and to other
organisations for them to use in the same way.
We would like to be able to contact you by telephone (including mobile), fax, post, or email using the contact details which you provide in this form, or which you provide or we obtain in our dealings
with you. Some of these contact methods may involve you being automatically selected to receive a pre-recorded message, or may involve a SMS/text on your mobile phone.
You can choose whether to be contacted for marketing purposes, so if you do not wish this, please indicate your preferences by ticking the relevant boxes in the declaration section of this form. If you
decide not to tick the box now, but later decide that you wish us to stop this use, you can at any time ask us to do so by writing to us at Tipton & Coseley Building Society, 70 Owen Street, Tipton, West
Midlands, DY4 8HG. You can also contact us here if you would like a list of companies within the Tipton & Coseley Group.
Credit Reference Agencies for verification of identity
We may make searches about you at credit reference agencies who will supply us with information, including information from the Electoral Register, for the purpose of verifying your identity. The
agencies will record details of the search, whether or not this application proceeds. The searches will not be seen or used by lenders to assess your ability to obtain credit. Credit searches and other
information which is provided to us and/or the credit reference agencies about you and those with whom you are linked financially may be used by the Society and other companies if you, or other
members of your household, apply for other facilities including insurance applications and claims. This information may also be used for debt tracing and the prevention of money laundering as well as
the management of your account. Alternatively, we may also ask you to provide physical forms of identification.
Fraud Prevention Agencies
To prevent or detect fraud, or to assist in verifying your identity, we may make searches of records held by other companies within our Group and at fraud prevention agencies who will supply us with
information. We also pass information to government departments and to financial and other organisations involved in fraud prevention to protect ourselves and our customers from theft or fraud. If you
give us false or inaccurate information and we suspect fraud, we will record this. We, and other companies, may use this information if decisions are made about you or others at your address on credit
or credit related services or motor, household, credit, life or any other insurance facilities. It may also be used for tracing and claims assessment.
Joint Applications
An "association" between any joint applicants and/or any individual identified as a financial partner, will be created at credit reference agencies, which will link your financial records. You and anyone
else with whom you have a financial link understand that each other's information will be taken into account in all future applications by either or both of you. This linking will continue until one of you
successfully files a "disassociation" at the credit reference agencies.
Proving your identity
In order to comply with money laundering regulations and to protect our customers from fraud, we are required by law to confirm the identity and address of every applicant. Further details are
available on request or from any of our branch offices.
Agreement to Assign Windfalls to Charity
Words printed in italics in this section of the application form are explained in the notes at the end.
1. Paragraphs 2 to 6, below, will apply to me unless I am an exempt customer at the time when the account is opened.
2. I agree with the Society that, if the right to any windfall benefits is granted to me after the account is opened, I will assign those windfall benefits to the selected charity.
3. I authorise the Society and the successor to pass any windfall benefits direct to the selected charity (or to any other charity which the selected charity may nominate to receive those benefits),
without notice to me.
4. I understand that:
 the Society has promised to transfer to the selected charity the benefit of the agreement which I have given under paragraph 2, above;
 neither the Society nor the selected charity will release me from that agreement; and
 any power of the Society to change the terms of its contract with me will not apply to any of the terms set out in this section of the application form.
5. I authorise the Society to give the selected charity any information about me or any account which I have with the Society (now or in the future) - but only if the selected charity reasonably needs
it regarding the agreement I have given under paragraph 2, above.
6. I understand that the Society will require anyone who opens a share account (who is not then an exempt customer) to agree to assign to charity the right to any windfall benefits to which that
person may become entitled. The terms of the agreement will be decided by the Society and may be different from the current terms. This paragraph will no longer apply if the Society publishes a
termination notice.
Notes
These notes apply to paragraphs 1 to 6, above:
(a) The ‘account’ is the share account which you are applying to open by completing this form.
(b) The ‘current terms’ means terms which are the same as, or similar to, the terms set out in paragraphs 2 to 5, above.
(c) You are an ‘exempt customer’ when you open the account if:
 you have held shares in the Society on, and at all times since, 31 October 1999; or
 you belong to one of the groups of other people who, in the Society’s opinion, do not need to be asked to agree to the current terms. A list of these groups is available from the Society at any
time. The Society may alter the number and composition of the groups from time to time, but no alteration will apply retrospectively.
(d) A ‘fixed-term scheme notice’ means a notice in the press publicising a decision by the Society that, though it will require new shareholding members to enter into agreements as described in
paragraph 6 above, the member’s agreement will only require him or her to assign any windfall benefits to charity if an event relating to a transfer of the Society’s business to a successor occurs
during a fixed term specified in the agreement.
(e) A person ‘opens’ an account either by opening a new account or by having an existing account transferred into his or her name (whether as sole or joint holder).
(f) A ‘public announcement’ is a public announcement by the Society of a proposal to transfer its business to a successor.
(g) The ‘selected charity’ means Tipton & Coseley Building Society Charitable Foundation or, if it is at any time no longer a registered charity, any other charity or charities selected by it to receive
assignments of windfall benefits.
(h) The ‘successor’ is any company or other corporate body to which the Society transfers its business under Section 97 of the Building Societies Act 1986 (or under any provision which amends or
replaces it).
(i) A ‘termination notice’ means a notice in the press publicising a decision by the Society that it will no longer require new shareholding members to enter into agreements as described in paragraph
6, above.
(j) A ‘windfall benefit’ is a benefit which a person has the right to receive as a shareholding member of the Society, under the terms of any future transfer of the Society’s business to a successor (i.e.
on a conversion or take-over), other than: the replacement of savings in a share account with the Society with savings in a deposit account with the successor; or
 any benefit conferred under the terms of a transfer which is the subject of a public announcement made more than five years after the Society has published a termination notice or a fixed
term-scheme notice; or
 any benefit which the Society has decided may be kept by a person who has a number of accounts and was an exempt customer when opening one or more (but not all) of them. A list setting out
the conditions which determine whether, and to what extent, such a person may keep a benefit is available from the Society at any time. These conditions may be altered by the Society from
time to time, but no alteration will apply retrospectively.
(k) Where more than one of you is signing this form, paragraph 1 and (if applicable) paragraphs 2 to 6, above, apply to each of you separately.
(l) If the Society no longer exists following a merger with another building society, paragraphs 2 to 6, above, will still apply between you and the other society.