TTOG10065 - Appendix 13: Bank mandate (individual)
Specimen Mandate Form
(Customer鈥檚 Name) 鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹��
(Customer鈥檚 Address) 鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹��
鈥︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌︹赌β�
To 鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�� (Name of Bank)*聽
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 they may request concerning my bank accounts and financial affairs and any transactions or business whatsoever I have had with your Bank at any time.聽
Signed 鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹��
Date 鈥︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�︹�β�
*Mandates to the Ulster Bank should specify the branch.