PMS ??? Personal details PMS ??? COLOUR - Barclays

1 Section 1 The Business details *1. Business Name ( the legal entity):For existing customers only*2. Sort code: *3. Account number: *4. Position held (Owner/Partner/Director/or Official):5. Unique Taxpayer Reference (UTR): Section 2 Your Personal details *Title: Mr Mrs Miss Ms Other: *Forenames: *Surname: *Date of birth: *National Insurance Number: *Mother s maiden name: (please complete for security purposes)*Country of residence: *Nationality: *Country of birth: *Do you have dual/multi nationalities: Yes No If yes, please state countries of dual/multi nationality:*Permanent Residential Address: *Postcode: *When did you move in: (MM/YYYY)*If you have lived there less than three years, please enterprevious address: *Postcode: *When did you move into your previous address: (MM/YYYY)Note: If the combined occupied time for both addresses is lessthan three years, please detail previous addresses on a separatepiece of paper.

2 *Telephone numbers Home:Work: Mobile: Personal email address:If you are an existing Barclays Account Holder pleasecomplete the following:Name of your branch:Name on your account:Your sort code: Your account number: Type of Controlling PersonPlease enter the legal name of the relevant entity AccountHolder(s) of which you are a Controlling PersonEntity 1:Entity 2:Entity 3: Barclays Business is a trading name of Barclays Bank UK PLC. Barclays Bank UK PLC is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority (Financial Services Register No. 759676). Barclays Bank UK PLC adheres to The Standards of Lending Practice which is monitored and enforced by The Lending Standards Board. Further details can be found at in England. Registered No. 9740322. Registered Office: 1 Churchill Place, London E14 5HP.

3 Item Ref No: 9903923A_UK. Revised: 05/18 Please complete this form in BLOCK CAPITALS using a BLACK ballpoint pen and SIGN it. EVERY authorised person of the businessmust complete a form each. Fields highlighted in BLUEand with an asterisk must be completed to enable us to process the refer to your guide to completing this form sectionfor help in completing the detailsBusiness BankingCMYPMS ???PMS ???PMS ???PMS ???COLOURCOLOURKNon-printingColoursJOB LOCATION:PRINERGY 08/05/2018 10:36 Page 1 Please pr ovide the Con tr olling Person s Sta tus by ticking theappr opriate bo Residency Citizenship Inf ormation(Continue on a separate sheet if necessary)For the purposes of taxation, I am a resident in, or a citiz enof the follo wing countries and my Tax Identification Number(TIN)/functional equiv alent in each additional country is setout belo w or I ha ve indicated that a TIN/functional equiv alentis una vailable: Please no te tha t it is mandatory to supply a TIN or func tionalequivalent if the country in which you ar e tax resident issuessuch iden tifiers.

4 If no TIN is available or has no t ye t beenissued, please pr ovide an explanation for this in the rele van tbo x below The TIN is a combination of le tters and/ or numbers assignedto the individual by their country of residence (or its taxauthorities) to iden tify the individual in the course ofcollecting tax esEn tity 1En tity 2En tity 3a. Con tr olling Person of an en tityor other legal person con tr olby ownershipb. Con tr olling Person of an en tityor other legal person con tr olby other meansc. Con tr olling Person of an en tityor other legal person seniormanaging officiald. Con tr olling Person of atrust se ttlore. Con tr olling Person of atrust trust eef. Con tr olling Person of atrust pr otec torg. Con tr olling Person of atrust beneficiaryh.

5 Con tr olling Person of atrust otheri. Con tr olling Person of a legalarr angement (non-trust) se ttlor-equivalen tj. Con tr olling Person of a legalarr angement (non-trust) trust ee-equivalen tk. Con tr olling Person of a legalarr angement (non-trust) pr otec tor-equivalen tl. Con tr olling Person of a legalarr angement (non-trust) beneficiary-equivalen tm. Con tr olling Person of a legalarr angement (non-trust) other-equivalen t In some coun tries this ma y be a number tha t is spe cific allyreferr ed to as a TIN while other coun trie s ma y use othernumbers ( Na tional Insurance Number or So cial SecurityNumber) to iden tify their residents for tax pu Per son:Country: Tax Identification Number (TIN) ortick the box if TIN is unavailable:If no TIN available?

6 Please pr ovide explanatio n belo wCountry: Tax Identification Number (TIN) ortick the box if TIN is unavailable:If no TIN available? Please pr ovide explanatio n belo wCountry: Tax Identification Number (TIN) ortick the box if TIN is unavailable:If no TIN available? Please pr ovide explanatio n belo wIf you ar e a US Person you will need to tell us your US TIN inaddition to an y other coun tries, including your TIN for eac hcoun try , where you ar e tax tick this box and provide your US details below ifyou are a US resident alien, or currently hold US includes if you were born in the US or are a US PassportHolder, or you hold dual citizenship with the US and anothercountry. If you are a US citizen living permanently or temporarilyoutside the US, you will still be a US citizen unless you haveofficially renounced your US : Tax Identification Number (TIN) ortick the box if TIN is unavailable:If no TIN available?

7 Please pr ovide explanatio n belo 08/05/2018 10:36 Page 2 Section 3 Your Inf ormation I con firm tha t the in formation I ha ve pr ovided ma y be usedby [Bar cla ys] and its associated en tities, for example[Bar cla ys] ma y be required to shar e it with an y rele van t taxauthorities where I am tax resident. If my tax residency changes I will pr ovide [Bar cla ys] with anupda ted self-certification and declaration within 30 da ys. I certify tha t I am the con tr olling person (or am authorised tosign for the con tr olling person) for all of the acc oun ts rela tingto this self certification. If I am signing on behalf of the con tr olling person, I amauthorised to sign for them and will no tify them tha t I ha vecompleted this declaration and tha t their de tails ma y bereported to the tax authorities of the coun tries in which the yar e resident for tax purposes.

8 I declare tha t all sta tements made in this declaration ar e, tothe best of my kno wledge and belie f, true, corr ec t see sec tion 4 for mor e de tails about ho w we use yourin you ha ve signed this on behalf of the Con tr olling Personplease indicate the cap acity in which you ha ve ac ted andpr ovide your name and addr ess her e:Cap acity Full Name Addr ess *Name: *Signatur e: *Da te: (DD/MM/YYYY)Please note:We will send you a le tter con firming we v ecompleted our checks and sear ches on you, and tha t your ne w mandate is in place. Un til you receive this le tter , we won tbe able to complete an y payment instructions or an y otherchanges to the business instructed by Barclays we believe that part of providing an excellent serviceis to occasionally make you aware of our Group s products andservices (and those of specially selected partners).

9 Please tell usif you would prefer we did NOT contact you via:Mail:SMS:Telephone:Email:Your guide to completing this form Please complete this form in BL OCK CAPITALS (ifhandwritten) using a BLA CK ballpoint pen and sign in BL UE and with an ast erisk mu st becompleted to enable us to pr ocess the formPlease note tha t: All ne w authorised persons need to complete this form. This applies to all ne w Bar cla ys cust omers and anyone ne w to the Business, including the owner, Dir ec tor , the Chairmanor Secr etary Mak e sur e you keep a cop y of the Using in formation abo utyou shee t fr om within the Changing acc ou nt de tails pac k The Bank ma y be unable to accept an y instructions fr om youun til we ha ve completed our 1 The Business details1.

10 Name of the Business: Please insert the name of theBusiness2. Sort code: Please insert the Business sort code as it appearson your bank sta tement3. Acc oun t number: Please insert the Business ac coun t num ber(if you ar e an existing cust omer) as it appears on yourbank sta tement4. Position held: Please insert your position in the Business, Owner, Partner, Dir ec tor , Compan y Sec reta ry , etc5. Please en ter your 10-digit Unique Taxp ayer Refer enc e (UT R).You will receive a UTR when you regist er for Self Asse ss men tor se t up a limit ed comp an ySection 2 Your per sonal details Please insert your title, for ename, su rname, da te of birth,coun try of residence, na tionality, and pla ce of birth Please insert your mo ther s maiden name, which will be us edfor security purposes Please insert your addr ess(es) de tails and the length of tim eyou v e liv ed at each addr ess Please insert your br anch and acc oun t de tails if you ar e anexisting Bar cla ys Acc oun t no te.