- 2 - How Does the Company Get Paid for the Services Provided to You? Method One

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2 Developing and presenting financial adviser services recommendations and/or alternatives. 2. Implementing the recommendations, as mutually agreed with the client. 3. Monitoring and reviewing the client s insurance programme as implemented by the brokerage. Services and Products I Provide The company provides advice on the following insurance issues; medical insurance, life insurance, partnership insurance, mortgage repayment insurance, personal guarantee insurance, income protection insurance, trauma insurance, group insurance and redundancy insurance. Product providers used For risk management products, Phil Jones Insurance Services Ltd needs to have a contractual agreement with the product provider in order to place business with that provider. The company has contractual agreements for the sale of these products with the following suppliers; AMP, AIA, Asteron, Cigna, Fidelity, OnePath, Partners Life, Pinnacle Life and Sovereign. How Does the Company Get Paid for the Services Provided to You? Method One Fees received from client By mutual consent the company may charge a fee for the advice provided. The fee would either be a fixed sum plus GST, or at an hourly rate of up to $500/hour + GST. Method Two Remuneration received other than from a client Remuneration is also received in the form of commissions from suppliers, according to their current rates. These commissions comprise an initial payment on acceptance of the business and an annual servicing fee thereafter. These rates of commission may vary from time to time, and are totally at the discretion of the financial institution. The company may also be eligible to receive additional benefits as incentives, depending on the total amount of business placed with the various companies. These incentives are usually production based, for a designated period of time. Other These benefits can include; travel and accommodation, as well as a variety of consumer goods, such as wine, Christmas presents, Christmas hampers, Easter eggs, diaries, ball point pens, umbrellas, bags, mouse pads, jotter pads, event tickets for films, concerts, sports events, wine and food festivals, meals, Valentines Day flowers, subsidised professional development, discounted training courses, etc. These gifts are at the discretion of the initiating company and we are unable to provide further details of those gifts until such gifts are received. Neither the company nor its employees are able to influence the financial institutions to make such gifts. The company does not use any financial planning software, report writers, or other analytical tools, etc provided by any company, nor is it the recipient of any loans, advances, subsidised office accommodation, subsidised office expenses, business development grants, etc, from any company with which it places business. The database software currently in use is not supported by any insurance company, and conversion to a new system also not provided by any insurance company, is currently being undertaken. I may receive a referral fee from my strategic alliance partners, if my clients are referred to them or vice versa.

3 - 3 - Other Interests and Relationships The company has no arrangements whereby it is required to place any minimum percentage of business with any supplier or financial organisation, nor does it have production quotas with any supplier or financial organisation. The company has never had such a relationship with any other party and steadfastly refuses to enter into any such covenants which would place restrictions on its own integrity and financial and managerial independence. Professional Indemnity (PI) Insurance Cover I and my company, Phil Jones Insurance Services Ltd, are covered under a professional indemnity insurance policy. This policy includes the following covers; professional indemnity, public liability, employers liability, dispute resolution liability, statutory liability, trustees liability, internet liability, directors and officers liability. This policy applies when I act in my professional capacity as an adviser providing financial adviser services. As with all insurances, these covers have limitations and are subject to certain exclusions, terms and conditions. What Else Should You Know About Me? Disclosure of Criminal Convictions Current legislation requires the following disclosures to be made, but limited only to the previous five years. As additional disclosure, in excess of legal requirements: Neither the company nor any principal officer has ever been; Convicted of an offence under the Securities Market Act 1988; the Investment Advisers (Disclosure) Act 1996 or the Securities Act 1978 or for a crime involving dishonesty. A director or principal officer of a body corporate that has committed an offence against the Securities Market Act 1988, the investment Advisers (Disclosure Act) 1996 or the Securities Act 1978 or for a crime involving dishonesty. Adjudged bankrupt. Prohibited by an Act, or by a court from taking part in the management of a company or business. The subject of an adverse finding by a court in any proceeding taken against me in my professional capacity; or Expelled from, or prohibited from being a member of a professional body. What are My Obligations: As a registered financial adviser I have obligations under the Financial Advisers Act 2008 (including Regulations made under that Act) and under general law. Your Obligations Any advice provided as a result of the fact find process can only be as good as the information received from you so I ask that you provide me with the information I request. Without relevant and correct information about your personal and financial situation I run the risk of giving advice that is not appropriate for your needs. If you are unsure as to why I need certain information, please ask so that I can explain.

4 - 4 - Privacy Act 1. It is understood that any information gathered for this needs analysis is personal and I undertake to keep this information confidential and secure. 2. The Privacy Act 1993 gives you the right to request access to and correction of, your personal information. 3. Information provided by you and or any authorised agent will be used by me and any members of my staff for the purpose of providing advice to you and may also be used by any: (a) Product or service provider when implementing any of my/our recommendations or variations thereof; (b) Compliance advisers, assessors or by any claims investigators who may need access to such information; and (c) Other professionals such as solicitors, accountants, finance brokers, financial planners when such services are required to complement this advice and as requested by you. 4. The information will be held by me at: 3B/77 The Strand, Parnell Auckland. If you need to know more, where can you get more information? If you have a question about anything in this disclosure statement or you would like to know anything more about me, please ask me. If you have a question about financial advisers generally, you can contact the Financial Markets Authority. You can check that I am a registered financial services provider at Declaration I, Phillip Owen Jones, declare that, to the best of my knowledge and belief, the information contained in this disclosure statement is true and complete. Signed:. Date : Appendix A: Client Acknowledgement I,. acknowledge receipt of the Supplementary Disclosure Statement Version 4 Dated 1 July 2014 for: Phillip Owen Jones and Phil Jones Insurance services Ltd. Signed:.. Date: Signed:. Date:.

5 SCOPE OF SERVICE AND ENGAGEMENT 1. I understand from current legislation that I am entitled to be given comprehensive insurance advice. 2. I understand that Phil Jones, and Phil Jones Insurance Services Ltd, provide advice on life cover, accidental death cover, disability income protection, trauma, business overheads cover, mortgage protection insurance, key person insurance, medical insurance, group insurance, redundancy insurance. 3. I have either received advice on all the above insurance categories, or I consider myself to be sufficiently well informed on the above products, and accordingly I / we are only implementing insurance contracts at this time, as indicated below and as per the implementation schedule attached. untimely death paying mortgage commitments in the event of illness/injury suffering a serious illness or disability suffering a permanent disability loss of income through sickness or disability loss of income through redundancy, insolvency of employer, etc reimbursement of medical expenses requiring timely hospital or specialist treatment (Life Insurance) (Mortgage Repayment Insurance) (Trauma Insurance) (Permanent Disability Insurance) (Income Protection Insurance) (Redundancy Insurance) (Medical Insurance) (Health Insurance) a personal risk analysis a business risk analysis compensation for the illness, injury or death of a senior employee or business partner (Key Person, Co-Shareholder Insurance) other (please specify below) Acknowledgments Compliance or regulatory bodies may require evidence that I have explained specific requirements or obligations and provided certain information to you. Can you please acknowledge by signing below that these requirements have taken place? Disclosure Statement I / We acknowledge that I / we have received a Disclosure Statement from the adviser named in this document. This document was current and dated: / /.. Version (if applicable)

6 - 2 - Provision of Information I / We understand the services being provided are restricted to the scope of service or subject to specific limitations indicated on the previous page. Scope of Service I / We understand the services being provided are restricted to the scope of service or subject to specific limitations indicated on the previous page. Privacy Act I / We acknowledge I / we have read and understood the information relating to the Privacy Act 1993 and how this information may be used. Adviser Remuneration I / We acknowledge I / we have had the basis of adviser remuneration explained. Client name:.. Client name:.. Signature : Signature :

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