SME Business LendingApplication Form

Contents

Part 1 BusinessDetails

Part 2 PersonalDetails

Part 3 ApplicationDetails

Part 4 (i) DataProtectionNotice

Part 4 (ii) CreditReferencesSearchingandReporting

Part 4 (iii) SignatureandDeclaration

Three easy steps to applying for business lending with permanent tsb.

1.ArrangeameetingwithyourRelationshipManageratthebranch.

2.CompletethisApplicationForminfull.

3.GatheranyadditionalsupportingdocumentationorinformationthatmayberequiredbytheBank(YourRelationshipManagerwillinformyouiftheBankhasanyadditionalrequirements).

SME–Enterpriseswhichemployfewerthan250personsandwhichhaveanannualturnovernotexceedingEUR50million,and/orannualbalancesheettotalnotexceedingEUR43million.

1

BusinessType SoleTrader Ltd.Co. Other

IfOtherSpecify

CompanyRegistrationNumber

CompanyIncorporatedin(Country)

No.ofOutlets

PrimaryBusinessActivity

InBusinessSince / month/year

CustomerSince / month/year

NumberofEmployees asat / /

BusinessPremisesStatus: Owned Leased Other

SME Business Lending Application Form:Thankyouforyourrecentenquiryinrelationtocreditfacilities.Inordertoprogressyourapplicationyoushouldarrangeameetingwithyourpermanent tsbRelationshipManagerandcompletethisBusinessLendingApplicationForm.YoucancompletethisformwiththeassistanceofyourRelationshipManagerduringthismeetingorwiththehelpofaBusinessProfessional.

YourRelationshipManagerwillinformyouofanyfurtherdocumentationthatmayberequiredtosupportyourapplication.Yourrequestfor creditwill beprogressedwhen yourRelationshipManager has received thesedocuments alongwith your signedBusinessLendingApplicationForm.

Part 1 Business Details: Pleasetellusaboutyourbusiness.Thisinformationwillassistusinprovidingaprofessionaltimelyresponse.

Business Details:

BusinessName/TradingName

BusinessAddress

ContactPerson

Email

Telephone/Mobile

Fax

BestContactTime

MainBankAccountDetails

SortCode

Business Ownership Details: Listthenamesofallindividualswhoultimatelyownorcontrol25%ormoreofthesharesorvotingrightsintheCompanyorotherwiseexercisecontroloverthemanagementoftheCompany.

1. Owner’sname Director:Yes No

Address

Occupation

2. Owner’sName Director:Yes No

Address

Occupation

3. Owner’sName Director:Yes No

Address

Occupation

Listbelowanycorporateshareholderthatultimatelyownsorcontrols10%ormoreofthesharesorvotingrightsinthisCompanyorotherwiseexercisescontroloverthemanagementoftheCompany.

1. CompanyName

RegisteredNo.

2. CompanyName

RegisteredNo.

Ifmorefieldsrequired,pleasephotocopythispageoruseaseparateform.

Irishresident: Yes No

DateofBirth / /PercentageShareholding:

Irishresident: Yes No

DateofBirth / /PercentageShareholding:

Irishresident: Yes No

DateofBirth / /PercentageShareholding:

%ofsharesownedintheCompany

%ofsharesownedintheCompany

%

%

YYMMDD

YYMMDD

YYMMDD

YYMM

YYMM

%

%

%

Y Y

Y Y

YYMMDD

2

Business Borrowing & Savings Details

Borrowings FinancialInstitution

AmountOutstanding

MonthlyRepayments

Overdraft

BusinessCards

Loans(CreditUnionetc.)

Leasing/HirePurchase

CommercialMortgage

OtherFinancialCommitments(e.g.Forwardcontracts,BankGuaranteesetc)

Savings & Investments FinancialInstitution AmountHeld

Deposits

InvestmentAccounts

Shares

Property(pleasealsoindicatecurrentpropertyvalue) Value

Other

Business Financial Details

Periodending //

FullYearAccounts YesNo

AccountType AuditedAuditor’sName

Certified

Management

Other

Value(000’s)

Sales/Turnover

NetProfit

Drawings

Interest

Depreciation

Tax

YYMMDDAssets Value Liabilities Amount

Land&Buildings Creditors

MachineryandEquipment VAT/PAYE/PRSI

FurnitureandFittings DirectorsLoans

Stock CorporateTax

Debtors BankDebt

Cash Leasing

Deposits Other

Other

TotalAssets TotalLiabilities

Current Values

TaxStatus(Taxuptodate)

IsaRevenueAgreementinplace?

MonthlyAmountofRevenueAgreement

YesNo

YesNo

Other

Part 2 Personal Details

Personal Details Principal Business Owner

Name

Address

DateofBirth

Accountnumber

SortCode

TimewithBank

Contact Details

Email

Telephone/Mobile

BestContactTime

Yourpersonaldetailsarealsoimportanttousandwhileitiscriticaltounderstandyourbusiness,itisalsoimportanttounderstandowners.Thesedetailswillhelpusmeetyourcurrentneeds.

YYMMDD / /

NoofDependants

AgeRange from to

ResidentialStatus Owner Tenant

LivingwithParents Other

Numberofyearsataddress

Estimatedvalueofhome

Previousaddress(iflessthan3yearsatcurrentaddress)

AnnualSalary

Salarypaymentfrequency

3

Personal Financial Details Principal Business Owner

Borrowings FinancialInstitution

AmountOutstanding

MonthlyRepayments

Mortgage

PersonalLoan

MotorLoan

Overdraft

Credit&othercards

TaxLiability

Other

Savings&Investments FinancialInstitution AmountHeld

Deposits

InvestmentAccounts

LifeAssurance

Shares

Pension

Propertyotherthanfamilyhome(pleasealsoindicateCurrentpropertyvalue) Value

Other

Personal Details Second Business Owner (if applicable)

Name

Address

DateofBirth

Accountnumber

SortCode

Contact Details

Email

Telephone/Mobile

BestContactTime

YYMMDD / /

No.ofDependants

AgeRange from to

ResidentialStatus Owner Tenant

LivingwithParents Other

Numberofyearsataddress

Estimatedvalueofhome

Previousaddress(iflessthan3yearsatcurrentaddress)

AnnualSalary

Salarypaymentfrequency

Personal Financial Details Second Business Owner

Borrowings FinancialInstitution

AmountOutstanding

MonthlyRepayments

Mortgage

PersonalLoan

MotorLoan

Overdraft

Credit&othercards

TaxLiability

Other

Savings&Investments FinancialInstitution AmountHeld

Deposits

InvestmentAccounts

LifeAssurance

Shares

Pension

Propertyotherthanfamilyhome(pleasealsoindicatecurrentpropertyvalue) Value

Other

Ifmorethan2,pleaseuseseparateformorphotocopythispage

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Part 3 Application Details

Application Details

Facility 1 Overdraft Loan

Other

Amountrequired

RepaymentPeriod Years Months

PurposeofFacility(e.gWorkingCapital)

LoanRepaymentFrequency(e.gMonthly)

LoanFirstRepaymentDate:

Doyouseeanyadditionalrequirementsoverthecoming12months?

Ifyes,pleaseprovidedetails:

YYMMDD / /

Pleasetellusaboutyourcurrentfinancialrequirements.Ifyouareunsure,pleasediscusswithyourRelationshipManager,whowillbehappytogothroughthevariousoptions.

YY

Facility 2 Overdraft Loan

Other

Amountrequired

RepaymentPeriod Years Months

PurposeofFacility(e.gWorkingCapital)

LoanRepaymentFrequency(e.gMonthly)

LoanFirstRepaymentDate:

Yes No

YYMMDD / / YY

DescribebrieflythepurposeofFacility1and/orFacility2andwhatfinancialinputisbeingprovidedbyyouandthesourceofthesefunds.PleaseletusknowifyourbusinessissupportedbyEnterpriseIreland,City&CountyEnterpriseBoards,BusinessAngelsetc.and/orotherspecialistfunds.

Additional InformationDependingonthepurposeofyourborrowingfurtherdetailsmayberequired.Forexample,ifyouarepurchasinganewbusinesspremisestheaddress,propertyvaluationetc.willberequired.Foramachinerypurchasethemachineryvalue,expectedfit-outcosts,expectedlifeetc.willberequired.Pleaseprovideanyadditionalinformationwhichisrelevanttoyourapplication.

Attachments

Thesedetailsmaynotberequiredforallapplications.YourRelationshipManagerwilladviseyouwhatfurtherinformationisrequiredtoensureaspeedydecision. Yes No Date Received

Completedapplicationform

ManagementAccounts

Certified/AuditedAccounts

Cashflowstatement/projections

BusinessPlan

AgedDebtorsListing

AgedCreditorsListing

ConfirmationofTaxAffairs

Other

Security/Collateral proposed

YourRelationshipManagerwillinformyouifsecurityisrequired.

Lendingcriteria,termsandconditionsapply.permanent tsbp.l.c.isregulatedbytheCentralBankofIreland.

FOR BANK USE ONLY:

Branch ApplicationNo.

CIFNo.1 CIFNo.2

ReceivedBy Date: YYMMDD / / YY

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Part 4 (i) Data Protection Notice

Youhavetherightatanytimetorequestacopyofany“personaldata”withinthemeaningoftheDataProtectionActs1988and2003(asamendedorre-enactedfromtimetotime)thatpermanent tsbholdsaboutyou(forwhichpermanent tsbmaychargeasmallfee)andtohaveinaccuraciesinthatinformationcorrected,bywritingtoDataAccessRequest,DocumentManagementControl,permanent tsb,56-59St.Stephen’sGreen,Dublin2.

permanent tsbwillretainandusetheinformationprovidedbyyou(whetherinthisapplicationformorotherwise)andanyinformationrelatingtothe

conductofthecreditfacility(includinganypersonaldata)forthepurposesofprocessingthisapplication,managingandadministeringthecreditfacility,creditchecks(whichmayinvolveautomatedcreditscoring),debtcollection,groupreportingandanalysis,andcompliancewithpermanent tsb’slegalandregulatoryobligations,aswellasforanyotherpurposetowhichyouhaveconsented.permanent tsbmayalsopassthisinformationtoothercompanieswithinthepermanent tsbGroup,andtoitsagentsanddelegates,inconnectionwiththesepurposes.

Part 4 (ii) Credit References Searching and Reporting

Signatureoffirstapplicant* Signatureofjointapplicant*(ifany)

*AuthorisedrepresentativeoftheBusiness

Date: Date:

Part 4 (iii) Signature and Declaration To be completed by the individuals listed in part 2-Personal Details.

I/WedeclarethatI/Weam/areoffullageandI/WeherebymakeapplicationforBusinessLendingwithpermanent tsbasdescribedabove.I/Wedeclarethattheforegoingstatementsandparticularsandotherinformationwehavegiventopermanent tsbtobestrictlytrue,tothebestofmy/ourknowledgeandbelief.TheinformationI/Wearesupplyingonthefollowingformwillbeusedforthepurposeofprovidingme/uswiththeserviceIhaverequested.Bysupplyingmyhomeorworkaddress,telephonenumberoremailaddressIamgivingmyconsentforpermanent tsbtocontactmeinanyofthosewaysinconnectionwiththisrequest.

Signatureoffirstapplicant* Signatureofjointapplicant*(ifany)

*AuthorisedrepresentativeoftheBusiness

Date: Date: YYMMDD / / YYYYMMDD / / YY

YYMMDD / / YYYYMMDD / / YY

permanent tsbmayfromtimetotimemakesearchesagainstyouandanyindividualnamedonthisformontherecordsheldbycreditreferenceagencies.Whensuchasearchismadethecreditreferenceagencieswillkeeparecordforaperiod(usuallyayear)thatthesearchhasbeenmade.

permanent tsbmayalsoprovideinformationtocreditreferenceagenciesconcerningthisapplicationandthemannerinwhichthecreditfacilitywasconducted.

Individualshavetherightatanytimetorequestfromanycreditreferenceagencyacopyofany“personaldata”withinthemeaningoftheDataProtection

Acts1988and2003(asamendedorre-enactedfromtimetotime)thatsuchacreditreferenceagencyholdaboutthatindividual(forwhichtheymaychargeasmallfee)andtohaveinaccuraciesinthatinformationcorrected.

I/Weacknowledgethatpermanent tsbwillcarryoutcreditreferencesearchesagainstme/us.I/Weacknowledgethatsuchcreditreferenceagencieswillrecordthatsuchasearchhasbeenmadeanddisclosethatfacttotheirmembersforaperiodofatleastoneyear.I/Wealsoacknowledgethatpermanent tsbwillprovideinformationconcerningthisapplicationandtheconductoftheAccounttocreditreferenceagencies.

Keeping you informed (Direct Marketing)

Tokeepyouinformedofanybenefits,productsorservicesthatweofferandforthatpurposeandthepurposesmentionedbelow,pleasechecktheboxesbelowtoindicatethewaysyouwishtobecontacted:

Applicant1 Applicant2

Y N Y N

Post n n n nOnline n n n nMobilephone n n n nEmail n n n nHomephone n n n nTextmessage n n n n

Information provided by you (whether in the application for an Account orotherwise)andanyinformationrelatingtotheconductofyourAccount(s)maybe used by us to: (i) transmit to you information relating to other products,services,specialoffers,promotions,competitionsrunbyusorothercompaniesin thepermanent tsbGroup(“Group”meansthepermanent tsbGroup,afinancial services group principally comprised of banking companies) or (ii)provide such information to other companies in permanent tsb Group sothattheycantransmittoyoudetailsoftheirproducts,services,specialoffers,promotionsandcompetitions.

If at any time you change your mind and you wish to amend your contactpreferences,youmaycontactusbywritingtoFREEPOSTF4940,CustomerDataQuality (DirectMarketing),permanent tsbp.l.c.,56-59StStephen’sGreen,Dublin2.

WARNING: If you do not meet the repayments on your credit agreement, your account will go into arrears. This may affect your credit rating, which may limit your ability to access credit in the future.

Lendingcriteria,termsandconditionsapply.permanent tsbplcisregulatedbytheCentralBankofIreland.

6

Contact UsDrop in to

Any of the 77 Local Branches Nationwide

Call us on 1890 818 729

Visit www.permanenttsb.ie/business

permanent tsb p.l.c.isregulatedbytheCentralBankofIreland.

BMK3311(10/15)