International Personal Banking - Banking Mandate Form
Standard Bank Isle of Man Limited
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Section 1: Existing client details on your account
1.1 Your details
Client 1
Client 2 (if applicable)
Name
Client number
Please tick which of the following are relevant to you and complete the appropriate section(s) in full using BLOCK CAPITALS.
Please also read and sign Section 7 (Page 4). This will enable us to update the details we hold on your account.
Personal details (Page 2)
Residential address details (Page 2)
Employment details (Page 3)
Operating your account (Page 3)
Security details (Page 3)
Section 2: Personal details
2.1Name
Client 1
Mr
Title
Mrs
Ms
Client 2 (if applicable)
Miss
Other (specify):
Mr
Mrs
Ms
Miss
Other (specify):
Family name / surname
First name
Middle / other names
Former names such as maiden name or
names previously used, please state if none
Gender
Male Female
Reason for name change
Marriage
Divorce
Other (specify):
Legal
Male Female
Marriage
Divorce
Legal
Other (specify):
Section 3: Residential address details
3.1 Address
Client 1
Client 2 (if applicable)
Line 1
Line 2
Line 3
Line 4
Post code / Zip code
Country
Home telephone number1
1
Include your country and local regional dialling codes.
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Tick here if Client 2 resides at the same address
as Client 1
Page 2 of 6
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Section 4: Employment details
Please provide details of your current, main employment. Or, if you are retired or unemployed, please provide details of your last employment before retirement
or unemployment commenced.
4.1
Employment status
Client 1
Client 2 (if applicable)
Employed
Contracting
Employed
Contracting
House person In education
House person In education
Retired Unemployed
Retired Unemployed
Self employed
Self employed
Occupation (e.g. lawyer, engineer)
Position currently held (where applicable)
Nature of business (e.g. engineering)
Gross annual salary
currency
amount
currency
amount
Name of employer
Length of time with employer
4.2
Employer’s address
years
months
years
Client 1
Client 2 (if applicable)
Client 1
Client 2 (if applicable)
months
Line 1
Line 2
Line 3
Line 4
Post code / Zip code
Country
Employer’s website (if any)
4.3
Contact details
Email address
Telephone number1
1
Include your country and local regional dialling codes.
Section 5: Operating your account
5.1
Instructing the Bank by telephone, fax and / or scan
If you wish to instruct the bank by phone, fax or scan, please tick this box.
5.2
Operation of your account - joint accounts
Any one account holder can sign to operate the account. Please note Visa debit cards and Internet Banking payments are not permitted if all account holders are to sign.
If you require all account holders to sign, please tick this box.
Section 6: Security details
6.1
Security details
Please provide the following details in full, memorise them and do not share them with anyone. This is how we will identify you in the event that we need to speak with
you on the phone.
Client 1
Client 2 (if applicable)
Password1
Name of your first school
Mother’s former name, such as maiden name
or name previously used
Favourite sport or colour
1
Choose a memorable word with letters and numbers only.
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Section 7: Your agreement with Standard Bank Isle of Man Limited
Applicant(s) who wish to instruct the Bank by telephone, facsimile or as a signed instruction attached to an email (“scan”) are asked to read and sign the
telephone, facsimile and scan indemnity below:
Please consider the clauses that follow carefully as they limit the Bank’s liability and constitute an assumption of risk by you. If you are in any doubt about the risks
related to telephone, facsimile or scanned instructions or the effect of the indemnity you should seek independent legal advice.
To: Standard Bank Isle of Man Limited (the “Bank”)
I / We (the “Account Holder(s)”), request and authorise the Bank to accept and act upon the Account Holder(s)’ (i) telephone, (ii) facsimile, and (iii) scan instructions
(“Instruction(s)”) in respect of any Instruction which the Bank would normally accept if the Instruction were presented in an original written format in accordance with the
terms of the mandate.
This release and indemnity is supplemental to (and forms part of) the Bank’s General Terms and Conditions. Should there be any conflict between this indemnity and the
Bank’s General Terms and Conditions the provisions of this indemnity shall have precedence.
By signing this release and indemnity the Account Holder(s) acknowledge and agree that:
1. The Bank may, but is not obliged, to act on any Instruction that claims to come from the Account Holder(s);
2. It is not possible for the Bank to check the authenticity of all facsimile transmissions or scans that claim to come from the Account Holder(s);
3. All facsimile transmissions, scans, mandates, consents, commitments, and any other documents, which claim to come from the Account Holder(s) (claimed
Instructions) will be treated as having been given by the Account Holder(s) in the form actually received by the Bank. The claimed Instructions may, as a result of the
malfunction of equipment, the distortion of communication links and the like, be different to that intended or sent - and the Account Holder(s) will be bound by them;
4. The Bank will not be liable for any loss (consequential or otherwise) incurred by the Account Holder(s) as a result of the Bank acting or declining to act (wholly or in
part) on Instructions which the Bank believes to have been given in conformity with the above, whether or not such Instructions have been so given. The fact that any
Instruction may later be shown to be in any way false, incomplete, inaccurate, delayed, erroneous, unauthorised or otherwise not authentic, should not be an
impediment to the rights of the Bank hereunder. This does not exclude losses arising from the proven unlawful or fraudulent acts of the Bank’s employees;
5. No scan can be considered received by the Bank until the Account Holder(s) have either received a reply or read receipt from the Bank;
6. The Bank may, notwithstanding this release and indemnity, require that any Instruction given by any party to the account(s) be given in accordance with the signing
arrangements of the account(s), and the Bank may at its discretion request written or any other form of confirmation of any Instruction;
7. The Account Holder(s) will carry out and keep to any procedures or restrictions or both, imposed on the Account Holder(s) by the Bank about the sending of facsimile
transmissions or scans to the Bank;
8. This release and indemnity will not be affected by any failure by the Bank to impose any or sufficient procedures or restrictions or to ensure that any, or all of them
are complied with; and
9. The Bank may at any time on written notice sent to the Account Holder(s) withdraw from these arrangements regarding accepting Instructions.
The Account Holder(s) will (if more than one person, jointly and severally) release and indemnify the Bank against any claims, demands or actions made against the Bank
or any loss or liability or expense incurred by the Bank as a result of the Bank entering into and performing this agreement and / or acting or declining to act on any
Instruction.
The Account Holder(s) waive any rights the Account Holder(s) may have now or in the future against the Bank for direct or indirect losses or damages the Account
Holder(s) may suffer because the Bank acted on any Instructions.
7.1 Signatures
Client 1
Client 2 (if applicable)
Printed name
Signature
Date (dd/mm/yyyy)
/
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/
/
/
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Appendix A: Identification verification document template (for Clients who have changed their name)
For certifier use only
Photocopy this document with your identification in the space provided for each client. The certifier must complete the details as directed below.
Use this form to submit a certified copy of your identification documentation.
Suitable identifications are:
Step 1: Place your identification document face up within this space, ready to
photocopy
Step 2: Photocopy the whole page so that the identification documentation and
declaration are clearly visible
Step 3: Take your original identification document and the photocopied page to a
suitable certifier, as detailed below
Step 4: The acceptable certifier must complete all sections of the declaration on
the photocopied sheet which displays your identification documentation,
not on this page
Step 5: Remember to include the signed photocopied page displaying your
identification document when you return your application form
Passport
Government issued identification card
Full UK, Channel Island or Isle of Man driving licence
Marriage certificate
Deed Poll document
Important:
1) Identifications must be valid, in issue and show the client’s signature
2) If your name has changed (e.g. from marriage) please provide appropriate
documentation (e.g. marriage certficate or name change form)
3) The copy must be of good quality and show the details / photograph clearly
PLACE IDENTIFICATION HERE READY TO PHOTOCOPY
Declaration and signature of certifier. The certifier must be independent of the account holder.
Certified as a true copy of the original and the photograph bears a true likeness of
Name
(Client name)
Position
Date (dd/mm/yyyy)
/
/
Certifier signature
Telephone number/email address, if not included in
the Company stamp
Certifier Company stamp
Certifier (please tick)
Lawyer* Accountant* Senior Civil Servant
Notary Public*
Member of Judiciary
Customs Officer
Actuary* Police Officer
Standard Bank approved certifier**
Director, Manager, or Company Secretary of a regulated financial services business
* Must be a member of a recognised professional body
** Must be approved by Standard Bank Isle of Man Limited to certify documents
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Appendix B: Residence verification document instructions (for Clients who have changed their address)
It is essential that you provide proof of your residential address, either as an original or certified copy. Address confirmation is required for one person
if the account is for a married couple living at the same address. A certified copy must state “Certified as a true copy of the original” and include a date,
the Certifier’s name, signature, position held and contact details (telephone number or email address). A certified translation must be submitted where the
document is not in English.
Please note we are unable to return original copies to you.
• A utility bill (electricity, gas, water) that is no more than six months old (excluding mobile phone bills)
• A Bank, Building Society or Credit Card statement from a recognised financial institution (excluding store cards) that is no more than six months old
• A valid, full, UK or Isle of Man driving licence (if not used for confirmation of your identity)
Please return the completed form to:
All applicants, unless otherwise stated
South African resident applicants
Standard Bank Isle of Man Limited
Standard Bank House, One Circular Road
Douglas, Isle of Man IM1 1SB
Telephone: +44 (0)1624 643643
Email: [email protected]
Gauteng, Pretoria, Mpumalanga and Bloemfontein
The Standard Bank of South Africa Limited
7th Floor, West Wing
30 Baker Street, Rosebank, 2196
Telephone: +27 (0) 860 333 383
Email: [email protected]
For Independent Financial Advisors (IFAs) only
Standard Bank Isle of Man Limited
Standard Bank House, One Circular Road
Douglas, Isle of Man IM1 1SB
Telephone: +44 (0) 1624 643821
Email: [email protected]
African resident applicants
The Standard Bank of South Africa Limited
7th Floor, West Wing
30 Baker Street, Rosebank, 2196
Telephone: +27 (0) 11 344 5730
Email: [email protected]
KwaZulu-Natal and Eastern Cape
The Standard Bank of South Africa Limited
Standard Bank Centre, One Kingsmead Way
Kingsmead, Durban, 4000
Telephone: +27 (0) 31 374 1862
Email: [email protected]
Western Cape
The Standard Bank of South Africa Limited
3rd Floor, Protea Place, Cnr Protea & Dreyer Road
Claremont, Cape Town, 7708
Telephone: +27 (0) 21 670 6432
Email: [email protected]
www.standardbank.com/international
Important information
This document is issued by Standard Bank Isle of Man Limited. Standard Bank Isle of Man Limited is licensed by the Isle of Man Financial Supervision Commission. Registered in the Isle of Man
No. 4713.
Standard Bank Offshore Services (RSA), operates under the license of The Standard Bank of South Africa Limited (“SBSA”), an authorised Financial Services Provider (“FSP”) number 11287. We
are authorised to provide financial services for the following products: Long-Term Insurance A, B1, B2 and C; Short-Term Insurance: Personal Lines and Commercial Lines; Retail Pension Benefits;
Securities and Instruments: shares, money market, debentures and securitised debt, warrants, bonds, and derivative instruments; Collective Investment Schemes; Foreign currency denominated
investments; and long and short term deposits. The compliance department can be contacted on (011) 636 1781 or by email at [email protected]. SBSA holds
professional indemnity insurance cover.
SBSA is authorised by Standard Bank Isle of Man Limited to sell its products in South Africa and other African countries. Other local Standard Bank Group entities are similarly authorised within their
own countries.
All transactions to the account must be in line with current Exchange Control legislative requirements applicable to the country in which you are resident or working.
Telephone calls may be recorded.
RMC2013.287
SB01/2015-05/114207
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