ISA Application Form

Please download and print the application form below. After you have completed and signed the form post it to Halifax Share Dealing Ltd. Please note that accounts will not be activated until the signed documents have been received.

Halifax Share Dealing Ltd
PO Box 93
1 Lovell Park Road
LS1 1NS

If you have any problems please contact us.

isa application form

PERSONAL DETAILS

Title *

Forename(s) *

Surname *

Occupation *

Address Line 1 (Permanent Residence) *

Address Line 2 *

Postcode *

Country *

Years at address

Telephone *

Email *

Previous Address Line 1 (If less than 3 years at the current address)

Previous Address Line 2

Postcode

Date of birth (DD/MM/YYYY) *

Country of birth *

Town / City of birth *

Nationalities (up to 6 allowed) *

Country of residence *

Which countries are you tax resident in or have you been a resident of in the past 2 years? (You must provide at least one country) *

Please note: tax resident relates to countries where you have the obligation to file a tax return or where you are subject to income tax in the UK or in another country.

Do you have a National Insurance Number? *
yesno

National Insurance No. (9 digits)

Taxpayer Identification Number (TIN) (if applicable)

Mother's Maiden Name

Father's Initials

First job/Employ

MONEY LAUNDERING

Source of Funds *

Savings Income Sale of Property InheritanceFamily GiftSale of Shares
We will attempt to verify your identity electronically. If we require further documentation we will contact you directly.

What timescales are you looking to invest over? *

One-off 0–1 years 1–5 years 5 years +

INVESTMENT DETAILS

(Please complete all that apply)

Initial Investment (min £1,000)

Monthly Investment

Lump Sum (Min £1,000)

Total Amount

Initial charge £30 plus VAT. If this is not included, it will be Signature(s) deducted from the initial subscription.
Monthly: Please enclose a personal cheque for your first Date contribution made payable to Halifax Share Dealing Limited and complete the Direct Debit instruction opposite. (Please note that regular subscriptions will continue until we are otherwise notified.)
Lump Sum: Please enclose a personal cheque made payable to Halifax Share Dealing Limited. (Minimum investment £1,000).

INCOME OPTIONS

Please tick one box only *
Dividends automatically reinvestedDividends paid automatically to your bank

DIRECT DEBIT INSTRUCTION

Name(s) of Bank Account Holder(s) *

Bank or Building Society Account No. (8 digits) *

Branch Sort Code (XX-XX-XX) *

Name of your Bank or Building Society branch *

Address Line 1*

Address Line 2*

Postcode *