PERF

SSCN

* Title

* First name(s)

Middle name

* Surname

* PPSN

* Date of birth

* Address line 1

* Address line 2

Address line 3

* County

Eircode

Contact Phone no.

E-mail address

All Correspondence will be sent to the address in Panel 1 Panel 1 First named holder Panel 2 Second named holder

Section 4 – Holder(s) Details All fields marked with an asterisk must be completed in order to purchase State Savings Products.

Section 3 – Type of Holder Note – this form is for sole and joint applications only. For other application forms telephone 1850 30 50 60 / +3537057200

Section 2 – Other Products you may hold

Application form

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

Section 1 – Product Options (Please tick one) Individual amounts: Minimum - €50 | Maximum - €120,000

Completed Application Form Proof(s) of Name Proof(s) of Address Proof(s) of PPSN

(A) 10 Year National Solidarity Bonds (Issue 6)

(B)Savings Bonds (Issue 17) 3 Year

(C) Savings Certificates (Issue 22) 5 Year

(D)

DATE STAMPOffice Name

Signature of Officer:

Date:

Receipt No. GROF

FOR OFFICIAL USE ONLY

PLEASE ENDORSE ALL CHEQUES WITH THE RECEIPT NUMBER

(Cheques to be made payable to NTMA State Savings)

Payment Methods Fill in Purchase Amount Payment Methods Fill in Purchase Amount

Cash € Personal Cheque €

Debit Card € Total €

*Source of Funds (Please tick appropriate option below)

Personal Savings Other – Please specify

Inherited Funds

Please refer to StateSavings.ie for further details or contact 1850 30 50 60 Monday to Friday.

Please tick type of holding required above

Consent Signature of nominated Parent/Guardian for a Minor (aged less than 18)Name (Block Letters)

Signature

Sole Complete Section 4 Panel 1

Minor aged less than 18 yrs Joint Complete Section 4Panels 1, 2

Mr Mrs Ms OtherMiss Mr Mrs Ms OtherMiss

See Note 3, Page 2. See Note 3, Page 2.

Section 7 – 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.

Section 6 – Checklist for Documentation required for First Time Purchases Please see note 2.2 (b) overleaf

Section 5 – Method of Payment and Source of Funds All fields marked with an asterisk must be completed in order to purchase State Savings Products.

(C) Savings Certificates Issue 22 (5 Year) (D) National Solidarity Bond Issue 6 (10 Year)

for purchases after 13 July 2019

(A) Savings Bonds Issue 17 (3 Year)(B) National Solidarity Bond Issue 6 (4 Year)

4 Year National Solidarity Bonds (Issue 6)

DD DDMM MMYYYY YYYY

SAFE AREA

2

How

can I buy State Savings Products?

• Call in

to any Post Offi

ce.• O

nline at StateSavin

gs.ieTh

e complete ran

ge of State Savings produ

cts are listed on our

website StateSavin

gs.ie.

1. Existin

g Custom

ersExisting State Savings custom

ers for wh

om w

e already have the

necessary Eviden

ce of Identity docum

entation

may purchase

online, by m

ail or at any Post Offi

ce.

2. N

ew Cu

stomers or last pu

rchase w

as completed b

efore O

ctober 2014

a. Please provide Original or Certifi

ed copies of each of the following:

• Proof of name (C

urrent Passp

ort or EU D

riving Licence).

• Proof of address issued w

ithin last six m

onths (H

ousehold Bill,

Bank Statem

ent, Letter from

Revenue C

omm

issioners).

• Proof of PPSN (Public Services C

ard, Letter from Revenu

e C

omm

issioners or D

EASP).

b. Com

plete Application

Form.

c. Bring all documen

tation to your local Post O

ffice or forw

ard to th

e address detailed on page 4.

d. For Joint A

pplications, both

customers n

eed to attend at th

e Post O

ffice for ID

Verifi

cation.

3. S tate Savings Cu

stomer N

um

ber (SSC

N)

The State Savings Customer N

umber (SSC

N) is a uniqu

e customer

number that iden

tifies you and enables you to transact w

ith us easily. Your SSC

N m

ay be printed on correspondence you receive

from us. See w

ww

.Statesavings.ie/SSCN

for more details.

4. Terms an

d Conditions

State Savings Products are subject to M

aximum

Holding Lim

its, other Term

s and Conditions and relevan

t legislation. You m

ay find our Term

s and Conditions booklet online and in Post O

ffices.

5. Con

tact Us

Please contact us for furth

er inform

ation at 1850 30 50 60,

(Mon

day to Friday). Additional con

tact details are on Page 4.

• State Savings form part of the N

ational Debt of Ireland w

hich is m

anaged by the National Treasury M

anagemen

t Agency (N

TMA

)

• Wh

en you

save with

State Savings you

are placing your m

oney

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.

• Repaymen

t of your mon

ey inclu

des principal, in

terest and

bonu

s paymen

ts if due.

Wh

at are State Savings?

A. Savin

gs Bon

d - 3 Year - Issue 17

1% Tax Free Total Retu

rn after 3 Years - A

ER 0.33%

Cu

mu

lative Bon

us

Percentage % Tax Free

Encash

men t valu

e of €1,000 at en

d period:A

ER1

Year 1 0.05%

€1,000.500.05%

Year 2 0.60%

€1,006.500.30%

Year 3 1.00%

€1,010.000.33%

B. Nation

al Solidarity Bon

d - 4 Year - Issue 6

2% Tax Free Total Retu

rn after 4 Years - A

ER 0.50%

Cu

mu

lative Bon

us

Percentage % Tax Free

Encash

men t valu

e of €1,000 at en

d period:A

ER1

Year 1 0.05%

€1,000.500.05%

Year 2 0.55%

€1,005.500.27%

Year 3 0.90%

€1,009.000.30%

Year 4 2.00%

€1,020.000.50%

C. Savings Certifi

cate - 5 Year - Issue 22

5% Tax Free Total Retu

rn after 5 Years - A

ER 0.98%

Cu

mu

lative Bon

us

Percentage % Tax Free

Encash

men t valu

e of €1,000 at en

d period:A

ER1

Year 0.5 0.00%

€1,000.000.00%

Year 1 0.05%

€1,000.500.05%

Year 1.5 0.20%

€1,002.000.13%

Year 2 0.50%

€1,005.000.25%

Year 2.5 0.65%

€1,006.500.26%

Year 3 0.85%

€1,008.500.28%

Year 3.5 1.20%

€1,012.000.34%

Year 4 1.90%

€1,019.000.47%

Year 4.5 3.00%

€1,030.000.66%

Year 5 5.00%

€1,050.000.98%

D. N

ational Solidarity B

ond - 10 Year - Issu

e 616%

Tax Free Total Return

after 10 Years - AER 1.50%

Cu

mu

lative Bon

us

Percentage % Tax Free

Encash

men t valu

e of €1,000 at en

d period:A

ER1

Year 1 0.05%

€1,000.500.05%

Year 2 0.25%

€1,002.500.12%

Year 3 0.50%

€1,005.000.17%

Year 4 1.00%

€1,010.000.25%

Year 5 3.00%

€1,030.000.59%

Y ear 6 5.00%

€1,050.000.82%

Y ear 7 7.00%

€1,070.000.97%

Y ear 8 10.00%

€1,100.001.20%

Year 9 13.00%

€1,130.001.37%

Year 10 16.00%

€1,160.001.50%

For Fixed Term Produ

cts A, B, C

and D

please note:

a) Min

imu

m Pu

rchase €50, M

aximu

m Pu

rchase € 120,000 per in

dividual, per issu

e

b) Wh

ere any Fixed Term produ

ct is encash

ed before the elapse of en

d period, the A

ER will be low

er

1 Annual Equivalent Rate.

Reference number for First Named Holder Reference number for Second Named Holder

Existing Account Number

Existing Product Type

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

3

SAFE

ARE

AB

roch

ure

and

A

pplic

atio

n F

orm

Fixe

d Ra

te P

rodu

cts

fo

r 3,

4, 5

& 1

0 ye

ars

4A

n Po

st is

an

agen

t of

th

eN

atio

nal T

reas

ury

Man

agem

ent

Age

ncy

NATIONAL TREASURY MANAGEMENT AGENCY

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

NTM

A B

roch

ure

213

July

201

9N

TMA

Bro

chu

re 1

E13

July

201

9

IMPORTANT – Before completing this Application Form and in particular Section 7 “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 Privacy Office, 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.

SAFE

ARE

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OR

CHIL

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Stat

e Sa

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form

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n S

tate

Sav

ings

Web

: St

ateS

avin

gs.ie

Te

lep

hon

e:

1850

30

50 6

0 /

+353

1 7

05 7

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ail:

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ings

.ie

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(ALS

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IT)

1 A

ER =

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quiv

alen

t Rat

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2 Not

subj

ect t

o ta

x in

Irel

and

but p

leas

e se

e Co

ndit

ion

4 Ta

xati

on in

Spe

cific

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diti

ons.

3 S

ave

in 1

2 m

onth

ly in

stal

men

ts a

nd le

ave

for 5

yea

rs.

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cal

cula

tion

ass

umes

a 5

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ear a

vera

ge li

fe.

4 Sub

ject

to D

IRT

(Dep

osit

Inte

rest

Ret

enti

on T

ax) a

t the

pre

vaili

ng ra

te.

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

y pr

izes

. No

inte

rest

is p

aid

to P

rize

B ond

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

Stat

e Sa

vin

gs P

rodu

cts

lis

ted

abov

e ar

e av

aila

ble

in a

ny

Post

Offi

ce o

r on

line

at

Stat

eSav

ings

.ie. S

tate

Sav

ings

pro

duct

s ar

e su

bjec

t to

Te

rms

and

Con

diti

ons

and

rele

van

t le

gisl

atio

n. Y

ou m

ay fi

nd

ou

r Te

rms

and

Con

diti

ons

boo

klet

on

line

and

in P

ost

Offi

ces.

100

103

103

102

PERF

91