Payment Application Form

NI
To help avoid processing delays please complete clearly in BLOCK CAPITALS and black ink

1. Applicant’s signal no: Signature (for bank use only)

Payment reference (for bank use only) UBNPAYO

Applicant’s name:

Applicant’s address:

Please debit my/our:

(i) Sterling account OR (ii) Currency account: Sort code: Account number:

Repetitive payment reference (if any):

In Foreign currency: In GBP equivalent:

2. Amount of payment:
OR
Currency that payment
Value date:
is to be sent in:
Amount and currency
in words:
Only complete the section below if the payment is subject to a foreign exchange contract or pre-booked exchange rate:
Deal or contract number:

3. Beneficiary details: person or organisation to be paid: if information is unknown, please request the beneficiary to obtain this information from their
Bankers. You must ensure the correct account number or IBAN is recorded to avoid the RISK TO YOU of payment loss. Complete all mandatory (*) fields:
Beneficiary’s account
number or IBAN: *
Beneficiary’s name: *

Beneficiary’s address:

Beneficary’s bank BIC: National clearing code:

(BIC not required for SEPA
payments)
Beneficiary’s bank name:

Beneficiary’s bank address:

Reference to appear on
(Max. 16 characters)
your statement:
Message to Beneficiary:
(Maximum 140 characters
including spaces)
Bank to Bank Info: Bank use only:
Charge(s): if none of the boxes are crossed, option A will apply. Mark one box only. Option A is mandatory for all payments across Europe.
A. I/We will pay Ulster Bank charges only B. Beneficiary pays all charges C. I/We pay all charges**

4. Authorisation: signed in accordance with my/our customer Account Opening Form/Bank Account Mandate/Joint Account Mandate. I/We have read and
agreed to be bound by the Terms and Conditions and consent to the use of my/our personal data for the purpose of carrying out the instruction. I/We
acknowledge that in order to make this payment my/our personal information such as my/our name and address may be transmitted with the payment.
For and on behalf of: Date:

Signature: Signature:

FOR BANK USE ONLY: Signature indicates validation of Fax Header Branch Signal Number: Brand:
BRANCH AUTHORISATION: ISV Number:
1st
Signature (For Bank Use Only):
2nd

** Note if option C is ticked the charges you may incur are outside the control of Ulster Bank Limited.

ULS96153NI (13/01/2018) Ulster Bank Limited. Registered in Northern Ireland. Registration Number R733

Page 1 of 1
Registered Office: 11-16 Donegall Square East, Belfast BT1 5UB.
Calls may be recorded.
 Payment instruction will be submitted into the CHAPS system. This will happen
Terms and Conditions either within 90 minutes of Step 1 or 60 minutes of Step 2 depending on which is
shorter (unless it is a future dated payment). If you give us your instruction in
Please read these Terms and Conditions carefully. They explain the Account branch by a Payment Application Form, it may take longer than 90 minutes as your
Holder’s rights and responsibilities and those of the Bank in respect of the Bank instruction will be faxed to our processing centre.
sending a CHAPS or foreign payment on your behalf. Nothing in these Terms and Step 3: Funds are debited from your account: Your account will be debited on
Conditions affects the agreement governing the operation of your account(s) with the same business day. You’ll notice that your available funds will be reduced by
us. If your Account Agreement is inconsistent with these Terms and Conditions, the amount of the Payment immediately.
these Terms and Conditions will apply. Step 4: The Payment is sent to the Beneficiary’s bank or provider: The
Payment will then be sent to the Beneficiary’s bank or provider for payment and
1. In these Terms and Conditions, the following words and expressions shall have the settlement in accordance with that bank or provider’s terms of business.
following meanings:
‘Account’ means any account held by the Account Holder with the Bank; The steps above may not happen in the times stated if:
‘Account Agreement’ means the agreement governing the operation of your • Your Payment instruction hasn’t been given to us using the Payment
account(s) with us. Application Form provided by us
‘Account Holder’, ‘you’ or ‘your’ means the individual (this includes a sole trader, • Your Payment instruction doesn’t contain the information we need to enable
a partnership, an incorporated company or an unincorporated association such as the Payment to be made, or it’s illegible
a club or society) requesting a Payment to be made by the Bank indicated by the • Your Payment instruction isn’t signed in accordance with your account
account holder and any reference to the Applicant shall be taken to have the same mandate
meaning as Account Holder; • You don’t have sufficient funds available in your account to allow the Payment
‘Agent’s Charges’ are the charges levied by the other financial institutions to be made
involved in the Payment. Ulster Bank Limited has no control over these; • You aren’t able to make CHAPS payments from your account
‘Bank’, ‘we’, ’us’ or ’our’ means Ulster Bank Limited; • We suspect that your instruction may be fraudulent and we need to carry out
‘Beneficiary’ means the intended payee of, and as stated on, the Payment; additional checks
‘BIC’ means the international recognised Business Identifier Code; • We can’t process your Payment instruction for legal or regulatory reasons.
‘Business Day’ means a day (other than a Saturday or Sunday or a bank or public
holiday) on which the Bank is open for business for the purpose of processing the 6. Unless otherwise agreed between the Account Holder and the Bank, the Account
Payment; Holder cannot cancel a Payment after the Bank has processed the Payment. In the
‘CHAPS’ means the Clearing House Automated Payment System – this service case of future dated Payments, the Account Holder may cancel a Payment by
allows you to send same day value payments within the UK; contacting the Bank at least one Business Day before the Payment is due to be
‘CHAPS Unique Identifier’ is the combination of the Beneficiary’s sort code and processed. The Account Holder should have their Chip & PIN enabled card (or chip
account number which you give to us and we then use when your Payment and signature where permitted by the branch) with them in order to cancel a future
instruction is submitted to CHAPS; dated Payment in the branch. The Account Holder will provide the name of the
‘Europe’ means all European Union members (and associated territories) and Beneficiary, Beneficiary’s account number and bank details (IBAN and SWIFT
from time to time European Economic Area (EEA) Member States (Iceland, BIC), Payment amount and Payment date. For SEPA Payments, only IBAN is
Liechtenstein and Norway), as well as Monaco, San Marino and Switzerland; required, rather than BIC and IBAN.
‘IBAN’ is the International Bank Account Number that is used to identify the
Beneficiary’s account; 7 The Bank does not accept liability for any delay in transit or for any failure in the
‘Payment’ means the payment to be made on behalf of the Account Holder as Payment reaching the intended Beneficiary’s account, unless such delay or failure
indicated by the Account Holder’s instructions; is caused by the negligence of the Bank. The liability of the Bank under this Clause
‘SEPA’ means the Single Euro Payments Area in which you can make and receive 7 shall be limited to that provided for in Clause 2. Notwithstanding any other
non-urgent euro payments under the same basic conditions, rights and obligations provision of these Terms and Conditions, the Bank shall have no liability for, and
regardless of your location in the European Union (EU) or European Economic may delay or refuse to process or proceed with processing any payment, without
Area (EEA); giving notice or reason to the sender or the beneficiary if
‘SWIFT’ means the Society for Worldwide Interbank Financial Telecommunications; (i) in its opinion it is prudent to do so in the interest of crime prevention or following
advice from any governmental or regulatory (in each case either domestic or
2. Reasonable care will be exercised by the Bank. Should such care not be exercised international) authority; or
then, subject and without prejudice to the limits on the liability of the Bank under (ii) such delay or refusal is a consequence of the checks
the Account Agreement and these Terms and Conditions, the Bank will be carried out as part of the proper operation of the Bank’s payment processing
responsible to the Account Holder only (not the Beneficiary or their banker) for any systems.
loss of a kind that would ordinarily be expected to occur. This includes interest but
not loss of contracts or profits or other indirect or consequential loss. 8. If the Bank refuses to process a Payment, unless there is a security or legal reason
not to, the Bank will notify the Account Holder by email or by phone or by writing
3. The Account Holder is responsible for the accuracy of the Payment instructions to it and, if possible give the Bank’s reason for doing so.
given and must ensure that all Payment instructions given contain, as appropriate,
the Beneficiary’s account number/IBAN, full name and address and Beneficiary’s 9. Unless otherwise agreed, where a Payment is to be made in a different currency
bank’s BIC. For CHAPS Payments, if you don’t give us the Beneficiary’s CHAPS to that in the Account, the rate of exchange applied to the Payment will be that
Unique Identifier then we may have to refuse your Payment instruction. You must used by the Bank on the date of processing the Payment. Therefore, unless a
also give us the correct name for the Beneficiary and that name must match the specific pre-agreed rate and reference are quoted, foreign currency transfers will
name associated with the CHAPS Unique Identifier you’ve also given us. For be converted at the Bank’s prevailing rate at the time the transaction is processed
SEPA Payments, only the IBAN is required, rather than IBAN and BIC. If this by the Bank. The Account Holder can obtain details of the exchange rate on that
information is not provided, or is incorrect or incomplete, the Bank reserves the day from the foreign exchange board in the Bank’s branches and on the Bank’s
right to return the Payment. Payments in euro in favour of beneficiaries in the website.
EU/EEA countries plus Switzerland which do not contain the IBAN of the
Beneficiary and the BIC of the Beneficiary’s bank or which contain an incorrect or 10. Unless otherwise agreed, the charges to be paid by the Account Holder will be
incomplete IBAN and BIC will not be processed and will be returned. The Bank debited to the account from which the Payment is being made. Please refer to
shall not be liable for any loss occasioned by the Account Holder as a result of this Clause 12.
failure to provide accurate Payment instructions.
11. In order to make this Payment through the banking payments system, the Bank
In the event that a currency payment is returned to us by the receiving bank, the may require to transfer relevant personal information to third parties. This may
funds will be credited to the account from which the Payment was made. If this is mean that such personal information will be transferred to countries which do not
in a different currency to the currency of the Payment, the returned funds will be provide the same level of protection for your personal information as Northern
converted at the exchange rate applicable on the day they are credited to the Ireland. By giving this instruction and confirming payment, you agree to this and
Account. This may mean that the credit to the Account is of greater or lesser value you are authorised to instruct the Bank to transfer personal information relating to
than the original debit. If this information is not provided, or incomplete, the Bank other individuals named. Information transferred to these third parties may
reserves the right to refuse to make the Payment and will notify the Account Holder subsequently be accessed and used by law enforcement agencies and other
of this in the manner set out in Clause 8. authorities to prevent and detect crime and comply with legal obligations.
4. The Bank undertakes to process the Payment on the date requested provided that 12. For details of amounts we will charge you for sending payments on your behalf,
it is received on a Business Day by the cut-off time specified in the ‘Schedule of please refer to ‘Schedule of Services – Payment & International Banking Charges’
Services – Payments & International Banking Charges’ and otherwise subject to available from branches, your Private Banking Manager or from
these Terms and Conditions. Payment instructions received on a non-Business www.ulsterbank.co.uk. If there are any changes to these charges, we will give you
Day or after the cut-off time on a Business Day will be processed on the next at least 60 days notice.
Business Day. If the date requested has already passed when received by the
Bank, the Payment will be processed on that Business Day if received before the 13. If you are not satisfied with any of Ulster Bank’s products or services we have a
cut-off time, or on the next Business Day if received after the cut-off time or on a complaint handling procedure that you can use to resolve such matters. A leaflet
non-Business Day. A Payment instruction in respect of a future dated Payment will giving details of the procedure can be obtained from any of our branches or by
be treated as received on the date for payment as specified by the Account Holder telephoning the Bank. If you wish to dispute a payment transaction your dispute
in the Payment instruction or, if this is not a Business Day, on the following will be handled in line with the complaints procedure outlined in your Account
Business Day. Agreement.
The Bank is a member of The Financial Ombudsman Service. If you are still not
5. Specific conditions regarding the CHAPS Payments process satisfied after following the Bank’s procedures, you can ask the Ombudsman to
review the complaint. You can find out more about The Financial Ombudsman
We’ll treat receipt of your completed Payment Application Form as your consent for Service in a leaflet available from any branch. Alternatively you can write to The
us to carry out this payment process on your behalf. Your Payment instruction will Financial Ombudsman Service, Exchange Tower, London E14 9SR or telephone
be processed as follows: 0800 015 4422.
Step 1: Receipt of your Payment instruction: This is the point at which we 14. The laws of Northern Ireland apply to these Terms and Conditions. If there’s a
receive your Payment instruction, rather than at the point when it is sent by you. dispute between us, you can take legal action against us in any Northern Irish
court.
payment: Once we’ve carried out the necessary checks and we’re satisfied that
Step 2: We accept your Payment instruction and it’s sent to CHAPS for

you have sufficient funds in your account to allow the payment to made, your

ULS96153NI (13/01/2018)