TTOG10065 - Appendix 13: Bank mandate (individual)

Specimen Mandate Form

(Customer’s Name) …………………………………………………………………………………………

(Customer’s Address) ………………………………………………………………………………………

…………………………………………………………………………………………………………………………… 

To ……………………………………………………………… (Name of Bank)* 

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. 

Signed …………………………………………

Date ……………………………………………… 

*Mandates to the Ulster Bank should specify the branch.