Read the instructions in this form carefully and complete your details in BLOCK CAPITALS using BLACK INK. Hand the form to your employer.

It may take up to 2 working days from when your employer initiates each wages payment for the funds to reach your account.

If you have any questions about when your wages payment will reach your account, please contact your employer first when the payment was initiated.

If the payment has not reached your account after 4 workingdays, please call our Customer Services team, providing full details of the payment, such as the date it was initiated by your employer, the exact value and the name of the person/company who made it.

Note to Cardholder Note to Employer

2

3

1

Cardholder’s details / Informations du titulaire

Details of Bank Account to be credited / Details du compte à crediter

Instruction to Employer / Instructions

First name / Prenom

Adress / Adresse

Postcode / Code PostalPhone number / Numéro de téléphone

Surname / Nom de famille

Cardholder employee’s signature / Signature du titulaire de la carte

Date/ /

BIC: PFSRIE21XXX

Your IBAN

Please keep a copy of this form for your records

(This is your 22 digit Intenational Bank account number in your client area

The VERITAS Prepaid MasterCard is issued by Prepaid Financial Services Ltd pursuant to license by MasterCard International Incorporated.

VERITAS Prepaid Card Account MasterCard Wages Transfer Request / Demande de Virement de Salaires

For your wages to be paid directly by your employer to your VERITAS Prepaid Card Account please complete this form and give it to your employer. Your wages will then be credited your VERITAS Prepaid Card instead of receiving them by cash or check. To proceed, please date and sign Section 1 “ Instruction to Employer” and complete Section 2 “Cardholder’s Details”. You will also need to complete Section 3 “Details of Bank Account to be credited ” with the 16 digit of your IBAN starting with IE which is found on the first page of your customer area.Please then give the form to your employer to complete the instruction.

Please note that it may take up to 2 working days from the day the employer initiates each payment for the funds to reach your VERITAS Prepaid Card account.

Always keep the payslip provided by your employer as proof of your wages payment. Should you wish at any time to stop your wages being paid to your VERITAS Prepaid Card account please inform your employer immediately who will then cancel the instruction.

Your employee is a prepaid VERITAS card account holder. This form is an instruction from your employee to pay his wages directly to his prepaid VERITAS card account Please ensure that all sections of the form are completed. In particular, Please make sure that the full 22 digits IBAN is correctly indicated each time a payment is made

Once the form is complete, you will need to amend your payroll processing so that the employee's wages are paid direct to the nominated Veritas bank account, as detailed in Section 3 "Details of Bank Account to be credited"

Please pay my wages directly to my Prepaid Veritas Card account. Please find below details of my account in sections 2 and 3.

I understand that this instruction means that my wages will be credited to my prepaid Veritas Card account and I will no longer receive my wages by cash, check or other means. I also understand that this instruction may constitute a variation to my employment Contract.

I E