APPLICATION FORM NATIONAL SOLIDARITY BOND ISSUE 6

NATIONAL TREASURY MANAGEMENT AGENCY

Section 1 – Savings Term (Please select one option)

Individual Amounts: Minimum Maximum

Individual Amounts: Minimum Maximum

€50 €120,000 €50 €120,000

4 year National Solidarity Bonds (Issue 6)

10 year National Solidarity Bonds (Issue 6)

Fill in Purchase Amount Fill in Purchase AmountPayment Methods Payment Methods

Cash Personal Cheque

Total

€ €

€

Section 4 – Method of Payment (Cheques to be made payable to NTMA State Savings)

Source of Funds (Please tick appropriate option below)

Personal Savings

Inherited Funds

Other (Please specify)

Please tick Account type required above (Tick one box only)

Consent Signature of nominated Parent/Guardian for a Minor (aged less than 18)Sole MinorJoint

Complete Section 5 Panel 1

Complete Section 5 Panels 1, 2

Name

Signature

(Block Letters)

Section 3 – Type of Holder Note-For application forms for Charities, Trusts, Clubs, other unincorporated bodies or Friendly Societies telephone State Savings at 1850 30 50 60/+353 1 705 7200

FOR OFFICIAL USE ONLY

RECEIPT NO. GROF

Office Name

PLEASE ENDORSE ALL CHEQUES WITH THE RECEIPT NUMBER

Signature of Officer:

Date:

DATE STAMP

(A) (B)

If you are an existing State Savings customer please enter any one of your existing account references and the product type below.

Existing Account Number

Existing Product Type

Section 2 – Other Products you may hold

(i.e. Savings Certificates/Savings Bonds/National Solidarity Bond/Deposit Account/Prize Bonds)

N S B 0 1 4 3 1 1

Section 6 – Declaration and Signature I/We have read and accept the General Terms and Conditions and the Specific Conditions dated Monday 16 April 2018 including the use of my/our PPSN. Please sign and date.

Debit Card

€

€

First Named Holder Second Named Holder

Signature of 1st Named Holder Date Signature of 2nd Named Holder Date

* PPSN

* First name(s)

* Surname

* Date of birth

* Address line 1

* Address line 2

Address line 3

Eircode

* Country of residence

* Nationality

* Place of birth

Gender

Contact Phone no.

E-mail address

DD MM YYYY

Male Female

DD MM YYYY

Male Female

Unless otherwise agreed with you all Correspondence will be sent to the address in Panel 1 –

Panel 1 First named holder Panel 2 Second named holder

Section 5 – Holder(s) Details

23

Min

imu

m Pu

rchase - €50

Maxim

um

Purch

ase - €120,00

0 per in

dividual, p

er Issue.

1 Annual Equivalent Rate.

1 Annual Equivalent Rate.

Your Savin

gs w

ill growas follow

s:

Cum

ulative

Bon

us

percen

tage

Encashment

value of €1,000 at end period:

AER

1

TAX

FREE

Year 10.05%

€1,00

0.500.05%

Year 20.25%

€1,002.50

0.12%

Year 30.50%

€1,005.0

00.17%

Year 41.0

0%€1,010.0

00.25%

Year 53.0

0%€1,030.0

00.59%

Year 65.0

0%€1,050.0

00.82%

Year 77.0

0%€1,070.0

00.97%

Year 810.0

0%€1,10

0.00

1.20%

Year 913.0

0%€1,130.0

01.37%

Year 1016.0

0%€1

,160.00

1.50%

Min

imu

m Pu

rchase - €50

Maxim

um

Purch

ase - €120,00

0 per in

dividual, p

er Issue.

Earn 16%

TAX

FREE Total Return

after 10 years (AER

1 1.50%

)W

here N

ational Solidarity Bon

ds are encash

ed before th

e elapse of 10 years, th

e AER w

ill be low

er.

Wh

at are State Savings?

• State Savings form

part of the N

ational Deb

t of Ireland

which

is managed by th

e National Treasury M

anagemen

t A

gency.

• Wh

en you

save with

State Savings you

are placing your

mon

ey directly with

the Irish

Governm

ent.

• The repaym

ent of all State Savin

gs mon

ey is a direct, un

conditional obligation

of the Irish

Governm

ent.

• Repaym

ent

of your

mon

ey in

cludes

principal,

interest

and b

onus paym

ents if du

e.

How

can I buy State Savings Products?

• Call in

to any Post Offi

ce.

• Onlin

e at StateSavings.ie

The com

plete range of State Savin

gs products are listed on

our w

ebsite StateSavings.ie. Cu

stomers can

buy Fixed Term

Produ

cts and Prize B

onds onlin

e.

To buy, online or by mail, you m

ust be an existing State Savings custom

er for whom

we already have the necessary

evidence of identity. Please contact us for further information

– contact details are on page 4.

If you are n

ot an existin

g custom

er or if your last purchase of State Savin

gs products w

as prior 05 Octob

er 2014 you

mu

st first register by com

pleting a purchase at a Post O

ffice

or by postal application

to State Savings, G

PO Freep

ost, D

ublin 1, D

01 F5P2.

Your Savin

gs w

ill growas follow

s:

Cum

ulative

Bon

us

percen

tage

Encashment

value of €1,000 at end period:

AER

1

TAX

FREE

Year 10.05%

€1,00

0.500.05%

Year 20.55%

€1,005.50

0.27%

Year 30.90%

€1,009.0

00.30%

Year 42

.00%

€1,020.0

00.50%

1. Nation

al Solidarity Bon

d 4 year (Issu

e 6)

Earn 2%

TAX

FREE Total Return

after 4 years (AER

1 0.50%)

Wh

ere National Solidarity B

onds are en

cashed b

efore the

elapse of 4 years, the A

ER will b

e lower.

for purchases after 16 April 2018

All Panels marked with an asterisk must be completed in order to purchase State Savings Products.

2. Nation

al Solidarity Bon

d 10 year (Issue 6)

BR1B 3418 [5p].indd 2

06/04/2018 15:23

NATIONAL TREASURY MANAGEMENT AGENCY

Mail this form to – State Savings, GPO, Freepost, Dublin 1, D01 F5P2

IMPORTANT – Before completing this Application Form and in particular Section 6 “Declaration and Signature” you must read the General Terms and Conditions and the Specific Conditions issued on Monday 16 April 2018. Copies are available on StateSavings.ie and in every Post Office.

The following extract quotes three of the Conditions from the “General Terms and Conditions and the Specific Conditions” dated 16 April 2018. (Note: rather than being numbered as 1,2,3 these 3 conditions carry their original reference numbers (2,3,5) as published within the General Terms & Conditions)

2. Evidence of Identity2.1 You are required to confirm your identity to us (including your surname, first name, date of birth and address) for the purposes of:

(a) the Agreement (including any Transaction);

(b) the administration of your Product(s) and any other State Savings Product(s) that you may hold now or in the future, and

(c) associated legal purposes, including compliance with statutory anti-money laundering obligations and account security and fraud prevention,

2.2 We may verify your identity:

(a) electronically (by reference to information supplied by you, including your Personal Public Service Number (PPSN)); or

(b) manually (by reference to acceptable original or certified copy documentation supplied by you, which may include documents such as your current passport, current EU driving licence, recent utility bill, recent account statement from a bank, building society or credit union, and/or your Public Services Card or other official documentation issued to you by the Revenue Commissioners or the Department of Employment Affairs and Social Protection).

2.3 Where you have not provided evidence of your identity to our satisfaction, we will advise you and we will not proceed with your application to purchase the Product until evidence of your identity has been verified to our satisfaction. For the avoidance of doubt, no interest, bonus or other amount shall accrue in respect of a Product during the period when evidence of identity is being verified under this condition.

3. Personal Data 3.1 The NTMA is the Data Controller (for the purpose of the General Data Protection Regulation (GDPR)) for all personal data supplied by you. The Minister for Finance

and the NTMA are each a ‘specified body’ for the purposes of sections 262 to 270 and schedule 5 of the Social Welfare Consolidation Act 2005, as amended, under which the NTMA and the Minister for Finance are both authorised to process personal data including PPSNs for certain purposes.

3.2 We will collect, process and use personal data relating to you, including your PPSN and the information referred to in condition 2 (Evidence of Identity):

(a) as necessary for the performance of the Agreement (including any Transaction);

(b) for the administration of your Product(s) and any other State Savings Product(s) that you may hold now or in the future, and

(c) for associated legal purposes, including compliance with statutory anti-money laundering obligations and account security and fraud prevention,

3.3 You acknowledge the collection, processing and use of your personal data (including your PPSN) for the purposes as outlined in 3.2.

3.4 Personal data may be processed by us, our Agents, and any third party service providers acting on our behalf for the purposes of the Agreement and for associated legal purposes and for any other purpose required for or reasonably incidental to the performance of the Agreement.

3.5 We will retain your personal data for as long as you have a holding with State Savings and otherwise in accordance with applicable data protection law and statutory obligations (including under anti-money laundering legislation).

3.6 Subject to your consent, your personal data may be used by us, or our Agents, for the purpose of marketing State Savings Products. Where you hold more than one Product, the preferences indicated most recently by you will apply to all Products held by you to which the General Terms and Conditions apply.

3.7 You have the right to request access to and a copy of your personal data held by us in accordance with the GDPR, to have your personal data corrected where it is inaccurate or misleading, to have your personal data erased, to object to the processing of your personal data by us, to request data portability in relation to your personal data. Should you wish to avail of any of these rights, please contact the Data Protection Officer, State Savings, GPO, FREEPOST, Dublin 1, D01 F5P2.

You also have the right to lodge a complaint with the Office of the Data Protection Commissioner. See www.dataprotection.ie for more information.

5. Registers5.1 Once your application to purchase a Product has been accepted and evidence of your identity has been provided to our satisfaction under condition 2 (Evidence of

Identity), we will record your name(s) and the Principal Amount of the Product in the Register applicable to that Product, which Register shall be the official record of the Holder(s) and the Principal Amount of that Product.

5.2 We will not be responsible for any delay that may arise in the processing of your application to purchase due to you submitting an incomplete application or you failing to provide evidence of identity to our satisfaction under condition 2 (Evidence of Identity). In particular, you should note any such delay caused by you may mean that by the time the process referred to in condition 5.1 has been completed, the Product that you applied to purchase may no longer be available. In this event, we will contact you to request your new instructions.

5.3 The Registers may be in paper form or electronic form or partly in one form and partly in the other form, in each case, at the absolute discretion of the NTMA.

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rs.

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to D

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(Dep

osit

Inte

rest

Ret

enti

on T

ax) a

t the

pre

vaili

ng ra

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5 Priz

e Bo

nds –

The

var

iabl

e ra

te u

sed

to c

alcu

late

priz

e fu

nd is

0.5

0%. T

here

are

two

€1

mill

ion

priz

es p

er a

nnum

and

thou

sand

s of w

eekl

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izes

. No

inte

rest

is p

aid

to P

rize

Bond

hol

ders

. Ins

tead

the

inte

rest

is p

aid

into

the

mon

thly

priz

e fu

nd, t

o be

dis

trib

uted

to

win

ners

in th

e w

eekl

y dr

aw.

6 Var

iabl

e Ra

te m

eans

that

the

inte

rest

rate

pai

d on

this

Pro

duct

may

be

chan

ged

by th

e N

TMA

from

tim

e to

tim

e. S

uch

chan

ges w

ill b

e no

tifie

d by

at l

east

one

of t

he fo

llow

ing

met

hods

: dire

ct n

otifi

cati

on to

you

by

post

, pub

licat

ion

in a

nat

iona

l new

spap

er,

publ

icat

ion

on StateSavings.ie

or n

otifi

cati

on b

y an

y ot

her m

eans

.

Bro

chu

res

and

App

licat

ion

For

ms

for

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e Sa

vin

gs P

rodu

cts

lis

ted

abov

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e av

aila

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in a

ny

Post

Offi

ce o

r on

line

at

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eSav

ings

.ie. S

tate

Sav

ings

pro

duct

s ar

e su

bjec

t to

Ter

ms

and

Con

diti

ons

and

rele

van

t le

gisl

atio

n. Y

ou m

ay fi

nd

our

Term

s an

d

Con

diti

ons

boo

klet

on

line

and

in P

ost

Offi

ces.

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anag

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and

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s fo

r 4 &

10

year

s

103

103

BR1B

341

8 [5

p].in

dd

106

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2018

15

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