PLEASE COMPLETE THIS FORM IN BLOCK CAPITALS …

1 Proposal Ref. person (print name )TelephoneFaxThis form when completed will be sent to one or more financial institutions whoare members of the Irish Finance Houses signing this proposal form, I certify that all information provided on this form is COMPLETE and accurate, and I consent to the use and disclosure of this information for the purposes set outabove. I acknowledge that the recipients of this information are authorised to contact me and to disclose any material misstatements of fact on this proposal to their members and other by Applicant or on behalf of Applicant ( PLEASE tick as appropriate)SignatureDateMotor Finance Proposal FormData Protection and Consents The information that you provide on this proposal form will be forwarded to one or more financial institutions, being members of the Irish Finance Houses Association,and will be used by them for the purposes of assessing the suitability for you of their motor finance products, and potentially offering you aproduct or quote.

2 As part of this process, credit searches will be made with one or more credit reference agencies, including the Irish Credit Bureau (lCB), which will make a record of the search. Details ofany agreement you enter into, and your conduct of that agreement, may be shared with credit reference agencies, ICB and their members. Searches may also be carried out to verify your identity, and youmay be contacted directly (including by telephone) for the purposes of verifying the information on this form. Credit scoring and other automated decision-making processes may be this application has been completed by a motor dealer or other third party on behalf of the applicant for finance, the motor dealer or other third party, by submitting this form, iscertifying that: all information provided on this form is COMPLETE and accurate and has been provided to it and confirmed by the applicant for finance; it has informed the applicant of, and obtained theapplicant's consent to, the disclosure of the applicant's information to one or more financial institutions, as set out above, and forthe purposes set out above, including making direct contact with the applicant.

3 And it has been authorised to COMPLETE and submit this application form on the applicant's behalf and as the applicant's The applicant will be required to provide the financial institution with evidence of identity and current permanent address in compliance with the provisions of the CriminalJustice Act, COMPLETE THIS FORM IN BLOCK CAPITALS IN BLACK INKFOR INDIVIDUALJ oint Proposal (where applicable)SurnameFirst namePlease provide Joint Applicant details on separate Proposal Form,which must be signed by the Joint Mr Mrs MsSurnameFirst nameAddressTime at addressyrsmthsMother's maiden namePrevious address (if less than 3 years at current address)Time at previous addressyrs mthsResidential status Home owner Tenant Living with parentsDate of birthGenderMaleFemalePlace of birth(as per driving licence/passport)Telephone WorkHomeMobileEmailMarital statusNo.

4 Of dependent childrenOccupationEmployment status ( PLEASE fill both A and B)A) Full timePart timeSelf-employedB) Permanent Temporary ContractWork Permit Permit expiry dateEmployer nameEmployer addressEmployer tel. with employer yrs mthsPrevious employer name (if less than 3 years with current employer)Time with previous employer yrs mthsNet salary per mth Other income per mthMortgage / Rent payment per mth Other borrowings per mth name of bankBank sort code--Bank account numberBranch Time with branch yrs mths Irish Finance Houses Association September 2007 Form for INDIVIDUAL VEHICLE MakeModelSpecificationRegistration UsedDemoCurrent mileageorCurrent kilometresCash priceLess customer depositLess trade-inRegistration no.

5 Of trade-inPlus settlement figureFinance amountTerm mthsNo. in advanceCustomer final paymentDealer buybackcontact you in relation to otherproducts and tick the box if you donot wish to be : If you do not meet the repayments on your agreement, your account will go into arrears. This may affect your credit you miss a repayment, you will be charged interest on arrears and your agreement may be terminated.