CH225170 - How to do a compliance check: Information Powers: Third Party Notice: Bank mandates: Specimen mandate form

(Customer’s Name)………………………………………………………………………………………

(Customer’s Address)….………………………………………………………………………………..

……………………………………………………………………………………………………………

To …………………………………………………………………………………. (Name of Bank)*

I hereby authorise you through any of your Branch Managers to give [your name] …………………….

or any other authorised officer of HM Revenue and Customs such information and documents as he/she may request concerning my bank accounts and financial affairs and any transactions or business whatsoever I have had with your Bank at any time.

Signed ……………………………………….

Date…………………………………………..

*Mandates to the Ulster Bank should specify the branch.