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If you have difficulties signing or making a mark please phone the Helpline. First name s Declaration Date of birth DD MM YYYY Full address Do not use a PO Box number or care of address I declare that my income or the saver s income if this form is completed on their behalf is below my annual tax-free income limit and if it increases above the annual limit I will tell the bank or I understand that HM Revenue Customs may check the information given on this form. Signature Postcode National Insurance number You may find this on a P60 P45 pension book or payslip. For a saver under 16 leave blank Date DD MM YYYY Please give or send your completed form to your bank or building society. Getting your interest without tax taken off Before you fill in this form please read these notes carefully To check whether you are entitled to receive interest without tax being taken off you must read R85 Helpsheet 2007 first. Account details Name of bank or building society Is your income below your annual tax-free income limit If completing this form on behalf of the saver refer to their income Yes No If Yes please complete this form* If No please do not complete this form as you are not eligible to receive interest in this way. If you are not sure please read the Helpsheet again or phone the Helpline on 0845 980 0645. building society that you do not have to pay tax on the interest paid to you. If your income goes up above your annual tax-free income limit you must tell your bank or building society. It is not their responsibility to check that the information you have given on this form is true or up to date. Please note that we may check the information you have given* You must complete a separate form for each bank or building society with whom you have an account. If you open a new account you will need to complete another form R85. Saver s details Title Surname Branch name Sort code Account number 1 Tick box if a joint account You can make this declaration on behalf of the saver if you are the parent or guardian of the saver who is a child under 16 or you look after the account of someone who lacks the mental capacity to do so or you hold power of attorney for the saver or you have been appointed by the Department for Work and Pensions to claim and receive benefits for the saver. Getting your interest without tax taken off Before you fill in this form please read these notes carefully To check whether you are entitled to receive interest without tax being taken off you must read R85 Helpsheet 2007 first. Account details Name of bank or building society Is your income below your annual tax-free income limit If completing this form on behalf of the saver refer to their income Yes No If Yes please complete this form* If No please do not complete this form as you are not eligible to receive interest in this way. Account details Name of bank or building society Is your income below your annual tax-free income limit If completing this form on behalf of the saver refer to their income Yes No If Yes please complete this form* If No please do not complete this form as you are not eligible to receive interest in this way. If you are not sure please read the Helpsheet again or phone the Helpline on 0845 980 0645. building society that you do not have to pay tax on the interest paid to you.

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