WITHDRAWAL/CLOSURE FORM

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1 *SFCIBWC01F* WITHDRAWALCLOSURE FORM for use with the Collective Investment Bond (CIB) WITH THIS FORM YOU CAN: close an entire CIB... section 3 make a withdrawal by selling individual policies... section 4Ai) make a withdrawal by selling sufficient individual policies to raise a specific amount of money... section 4Aii) withdraw a specific amount of money proportionally across all funds and all policies... section 4Bi) withdraw a specific amount of money from named funds across all policies*... section 4Bii) * This option is not available if you invest using our WealthSelect Managed Portfolio Service (MPS). This form cannot be used for the following, for which there are separate forms: the offshore Collective Investment Bond (OCIB) or any other Old Mutual Wealth products. NOTE The accompanying document contains notes to help you when completing each section of this form. The notes also clarify whether any additional documents are needed (for example proof of identification). It is important that you read these notes because, although we normally pay proceeds five working days after we carry out your instruction, an incorrectly completed form or missing documents could cause delays. Complete the details in each applicable section carefully; we cannot be held responsible for any consequences if they are incorrect. Errors or omissions by you or your financial adviser will not be corrected retrospectively. If, in our view, your instruction is not clear, we will be unable to proceed until we have contacted you for clarification and this could delay your withdrawalclosure. Whatever the reason for selling your investment(s), we recommend that you consult your financial adviser before you do so. Your adviser will be able to explain your options, help you decide the most suitable route and advise you about any tax implications.! Withdrawals There are two ways to make a withdrawal from your bond: FULL surrender of individual policies PARTIAL surrender across all policies and there are different tax implications depending on the method you choose. The following websites contain guidance from HMRC: WE CANNOT ADVISE YOU WHICH METHOD IS BEST FOR YOUR PERSONAL CIRCUMSTANCES. HMRC rules do not permit us to amend the basis on which a withdrawal was completed if the tax consequences were not what you expected. We strongly recommend that you consult your financial adviser before making a withdrawal from your bond. 1 of 8

2 Please use BLOCK CAPITALS and blue or black ink. 1 BOND DETAILS Bond number u please complete this carefully because we cannot be held responsible for any consequences if it is incorrect Full names of investor 1. Permanent residentialregistered address of investor Postcode If your address has changed within the last 12 months, we will need proof of the new address, for instance a recent original bill showing the new address, eg phone, electricity, gas, water, etc but not a mobile phone bill. Full names of joint investor u if applicable 2. State below whom we should contact if we have any queries about your instruction: Please contact my financial adviser (tick) OR Please contact me using the details below: Telephone 2 DETAILS OF ASSIGNEE u IF APPLICABLE Please give the details of the assignee; the authority in section 7 must then be completed by the assignee. Assignee s full name and address Postcode 3 TO CLOSE YOUR BOND (FULL SURRENDER) Tick here to surrender (sell) your entire bond u there may be tax consequences if the bond is closed Now go to section 5 4 TO MAKE A WITHDRAWAL FROM YOUR BOND SELECT ONE METHOD FOR WITHDRAWAL There are different tax implications depending on the method you choose A) FULL SURRENDER OF INDIVIDUAL POLICIES B) PARTIAL SURRENDER ACROSS ALL POLICIES Complete ONE of the following two options: Complete ONE of the following two options: Ai) I wish to sell policies from my bond Bi) I wish to withdraw Now go to section 5 u state how many you wish to sell by selling proportionally from ALL funds in my bond Now go to section 5 OR Aii) I wish to withdraw OR Bii), which is on the next page by selling sufficient individual policies from my bond u We will calculate the number of policies to sell to raise at least the amount of money you have requested, based on the last known prices for your funds. If the sale prices are higher on the day we sell the policies, it could mean that you will receive more than requested; however, if the prices are lower on that day it could mean that you receive less than requested. Now go to section 5 2 of 8 PDF March 2016 (CIB withdrawalclosure)

3 4 TO MAKE A WITHDRAWAL FROM YOUR BOND (CONTINUED) Bii) I wish to make a withdrawal from my bond by selling from the following funds: u this option is not available if you use our Managed Portfolio Service Full fund name* Unitshare type i.e. IncAcc Amount to sell from fund* (show as or % not a mixture of both) ** % TOTAL NOTE * If you do not name the funds to sell, or do not specify the amount to sell in or %, we will contact you for clarification, which will delay your withdrawal. If you ask for one or more entire funds to be sold, and the balance to be taken from another fund(s), we will sell the first fund then, when we know the amount raised, we will carry out a second sale and so on, until the amount requested has been raised. We will confirm details and release the proceeds of each transaction separately. This means you will receive more than one payment to make up the amount requested. ** If you wish to keep your investment in a fund open, the monetary amount you enter to be sold from the fund must not equate to more than 90% of the value of that fund. If you wish to sell the fund in its entirety, please indicate this by writing 100% in the percentage box. Now go to section 5 Please tickcomplete this section to tell us whom to pay (see the accompanying notes for guidance). We will assume option (i) if you do not state otherwise. (i) 5 PAYEE S DETAILS Pay the investor(s) (tick) u this includes payment to trustees and pension scheme trustees (ii) Pay the following beneficiary u enclose proof of hisher identification Beneficiary s name Beneficiary s address Beneficiary s date of birth (ddmmyyyy) u heshe must be at least 18 years old Postcode If payment is to be made to more than one beneficiary, please provide the same information for each beneficiary on a separate sheet of paper or by using a copy of this page. (iii) Pay the client account of the following financial institution, financial adviser, accountant or solicitor (iv) Invest the proceeds in the following Old Mutual Wealth product Product name u you must submit your application for the product at the same time as this instruction Product number or application reference u if known For options (i), (ii) and (iii) you must also complete section 6 with bank details for the payee. PDF March 2016 (CIB withdrawalclosure) 3 of 8

4 6 PAYEE S BANK DETAILS Please complete the details below carefully because we cannot be held responsible for any consequences if they are incorrect. NOTE If you selected option (i) or (ii) in section 5, please send proof of the bank account ownership with this form, if not previously provided; the notes at the end of the form explain what we can accept as proof of ownership. Bank or building society name and address u must be in the UK Postcode BankBuilding society account number Name of bankbuilding society account holder Branch sort code Building society roll number u if applicable Payment will be made direct to the bank using BACS five working days after we carry out your instruction. 7 DECLARATION AND AUTHORITY The declaration below is made by each person authorising the withdrawalclosure. I hereby: a) authorise and request Old Mutual Wealth to carry out the instructions detailed on this form b) confirm that you have brought to my attention the importance of reading the accompanying notes before completing the form c) (if not a trustee) confirm that I am entitled to the legal and beneficial interest in the investments to be sold (if a trustee) confirm that no notice of assignment or mortgage affecting any beneficial interest has been received by the trustees d) confirm that there is no bankruptcy order against the investor, or beneficiary (if applicable) e) confirm that the investor, or beneficiary (if applicable), is not an undischarged bankrupt andor not deemed to be insolvent in accordance with the meaning of the Insolvency Act 1986 or Enterprise Act f) (if payment is being made to a beneficiary) confirm that the beneficiary is entitled to receive payment under the terms of the trust g) confirm that payment to the payee in section 5 will discharge Old Mutual Wealth from all liabilities and claims arising from this transaction h) accept that the instructions in this form will be carried out under the Terms and Conditions of the CIB. i) confirm that I understand the tax consequences of the instruction given in this form. All investors including trustees andor assignees (where applicable) MUST SIGN THIS AUTHORITY. NOTE For trust investments, if the trustees signing this form differ from those we have on our records, we will need to see all trust documents showing the trustee changes before we can carry out the request. The documents can be the originals, or copies certified as true copies, for example by your financial adviser or a solicitor. 1. Signature Date (ddmmyyyy) 2 0 Print full name Capacity u eg investor, trustee, signatory, attorney, assignee 2. Signature Date (ddmmyyyy) 2 0 Print full name Capacity u eg investor, trustee, signatory, attorney, assignee 3. Signature Date (ddmmyyyy) 2 0 Print full name Capacity u eg investor, trustee, signatory, attorney, assignee 4. Signature Date (ddmmyyyy) 2 0 Print full name Capacity u eg investor, trustee, signatory, attorney, assignee 4 of 8 PDF March 2016 (CIB withdrawalclosure) *SFCIBWC01X*

5 REASONS FOR SELLING u COMPLETION OF THIS SECTION IS OPTIONAL At Old Mutual Wealth, we are keen to improve our products and services and we value your feedback. Please take a few moments to answer the questions below to help us understand your decision to sell your Old Mutual Wealth investment. (Please tick as applicable) Q1 Did you seek advice from a financial adviser before deciding to sell? Yes No Q2 What is the main reason for deciding to sell your investment? Poor fund performance Paymentscharges too high or not as expected Money required for another purpose Customer service experience To invest in a different product No specific reason Q3 If you are going to use the money from this sale to invest in another product, is it: an Old Mutual Wealth product? another company s product? u It would help us if you state the name of the company here Once completed, please send the form (pages 1-5) and any necessary documents to us at the address below when we have carried out your instructions, we will send you details of the transactions including the value of the proceeds. Old Mutual Wealth Head Office Old Mutual House Portland Terrace Southampton SO14 7AY Calls may be monitored and recorded for training purposes and to avoid misunderstandings. Old Mutual Wealth is the trading name of Old Mutual Wealth Limited which provides an Individual Savings Account (ISA) and Collective Investment Account (CIA) and Old Mutual Wealth Life & Pensions Limited which provides a Collective Retirement Account (CRA) and Collective Investment Bond (CIB). Old Mutual Wealth Limited and Old Mutual Wealth Life & Pensions Limited are registered in England and Wales under numbers and respectively. Registered Office at Old Mutual House, Portland Terrace, Southampton SO14 7EJ, United Kingdom. Old Mutual Wealth Limited is authorised and regulated by the Financial Conduct Authority. Old Mutual Wealth Life & Pensions Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Their Financial Services register numbers are and respectively. VAT number When printed by Old Mutual this item is produced on a mixed grade material, which uses a combination of recycled wood or paper fibre from controlled sources and virgin fibre sourced from well managed, sustainable forests. PDF March 2016 (CIB withdrawalclosure) 5 of 8

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7 NOTES TO HELP YOU COMPLETE THE CIB WITHDRAWALCLOSURE FORM These notes are for you to keep; please read them before completing and sending your instruction to us.! There are different tax implications depending on the method you choose if you are making a withdrawal from your bond. WE CANNOT ADVISE YOU WHICH METHOD IS BEST FOR YOUR PERSONAL CIRCUMSTANCES. HMRC rules do not permit us to amend the basis on which a withdrawal was completed if the tax consequences were not what you expected. The following websites contain guidance from HMRC: In addition to the tax implications referred to above, a sale of individual policies (whether you are closing your bond or making a withdrawal) may result in Old Mutual Wealth Life & Pensions Limited levying a tax charge on any gains resulting from the transaction and deducting any outstanding Phased Initial Charge. If so, the charges will be deducted from the sale proceeds before the balance is sent to you. We strongly recommend that you consult your financial adviser before making a decision to close or withdraw money from your bond. GENERAL NOTES Ensure that all applicable sections are completed clearly as missing or unclear information will delay the instruction being carried out or could mean that we have to return the form. Unless we need any additional information from you, payment will be sent or invested in line with your instructions, five working days after we carry out your instruction. This is because it can take five working days for the sale proceeds to reach our bank account from the fund managers, before we can complete the process for releasing the proceeds to you in line with your instructions. SECTION 1 BOND DETAILS This is for details of the investment you want to close or from which you want to make a withdrawal. SECTION 2 ASSIGNEE DETAILS Complete this section with the details of anyone to whom the investment has been assigned or with whom the policy schedules have been deposited or otherwise charged as security. The assignee must sign the authority in section 7. SECTION 3 TO CLOSE YOUR BOND Complete this section to request a full surrender and close your bond there may be tax consequences, so we recommend that you consult your financial adviser before sending us your request. SECTION 4 TO MAKE A WITHDRAWAL FROM YOUR BOND Part A gives two options for withdrawal by FULL surrender of individual policies. Part B gives two options for withdrawal by PARTIAL surrender across all policies. The minimum withdrawal payment is 50. The minimum balance to keep a bond open after a withdrawal is 1,000 (+ 1.5 times any outstanding Phased Initial Charge, if applicable). Automatic Rebalancing selling specific funds could cancel any automatic rebalancing instruction currently in place for your CIB if it changes the original fund selection and proportions chosen for rebalancing. If rebalancing is cancelled as a result of your withdrawal, we will need a new rebalancing instruction to start it again. Your financial adviser can obtain an Automatic Rebalancing form from our website; alternatively you can request one from us by calling or by sending us an to SECTION 5 PAYEE DETAILS Select option (i) for: Payment to the investor The payee will ordinarily be you, the investor, this is therefore the first option shown. Payment to pension schemes Payment must be made to the pension scheme trustees (eg The Trustees of the ABC Pension Scheme). Payment to trustees Payments can be made to a trustee(s) into a UK bank account held in their capacity as trustee(s) (eg The Trustee(s) of the John Smith Will Trust). If there is no trustee bank account, we can pay to a client money account (see option iii). Select option (ii) for: Payment to a beneficiary of a trust Beneficiaries must be at least 18 years old. Payments will only be made to an account of a UK financial institution held in the name of the beneficiary. Payments to a beneficiary will only be made if we have received proof of the beneficiary s identity. 7 of 8

8 SECTION 5 PAYEE DETAILS (CONTINUED) Select option (iii) for: Payment to a Client Money Account We can make payment to the client money account of a financial institution, a financial adviser, an accountant or a solicitor provided they are authorised to handle client money. Select option (iv) for: Payment to another Old Mutual Wealth product If you want to transfer the surrender proceeds to invest in another of our products, you must submit your application for that product at the same time as this form. There could be restrictions concerning the name in which the new product is held; you should therefore check with your financial adviser before choosing this option. Please note that we will refer to the name of the investor or beneficiary on any payments we make. SECTION 6 PAYEE S BANK DETAILS Payments will be made by direct, electronic payment to a UK bank account using BACS (Bankers Automated Clearing System), whereby the money reaches the bank account five working days after we carry out your instruction. We will only send a cheque if the bank cannot accept such a payment or if details provided are invalid (cheques will be sent to the latest address we have on our records for you). If you selected option (i) or (ii) in section 5, we will need to see proof of the bank account ownership, if you have not previously provided it. The proof can be a cancelled cheque or a copy of your bank account statement dated within the last six months (certified as a true copy by your financial adviser). If you have online bank account statements, a printed copy certified by your adviser will suffice. SECTION 7 DECLARATION AND AUTHORITY All investors, including trustees andor assignees if applicable, MUST SIGN THE AUTHORITY and state the capacity in which they are acting. For trust investments, if the trustees signing this form differ from those we have on our records, we will need to see all trust documents showing the trustee changes before we can carry out the request. The documents can be the originals, or copies certified as true copies, for example by your financial adviser or solicitor. GLOSSARYDEFINITION OF TERMS Some of the terms we use in this form are explained below: Assignee BACS Beneficial interest Beneficiary Client Money Account Financial institution Full surrender Investor Partial surrender PolicyPolicies Trustees This is anyone to whom the ownership of the investment has been transferred (assigned) or with whom the policy schedules have been placed or are otherwise regarded as security (eg a bank). Bankers Automated Clearing System. This is the method we ordinarily use to make direct, electronic payments to banks. It usually takes five working days for a payment to get to the bank account after we carry out your instruction. The right to benefit from a contract or trust. A beneficiary will have beneficial interest, unlike a trustee who has responsibility to hold the property in trust, but does not benefit from it. Anyone who is entitled to receive assets or profits from property, for example an estate, a trust, or an insurance policy. An account in which a company is authorised by the Financial Conduct Authority (FCA) to receive or hold money on behalf of a client. The money is then governed by specific rules issued by the FCA. An organisation such as a bank. A full surrender will close the individual policy(ies) selected and sell all units in the policy(ies) concerned. References to investor in this form mean the CIB bond holder. (Also known as a partial withdrawal) This means that units will be sold across all policy(ies) in your bond. The bond is made up of 1,000 identical policies, sometimes also known as segments, with the value of your bond and its benefits divided equally across all policies. Those who are holding property in trust on behalf of someone else. When you send the completed form to us, please include the following documents as applicable: Proof of your residential address if it has changed within the last 12 months, for example an original household bill dated within the last six months (mobile phone bills are not acceptable). If not already provided, proof of identification for ALL bond holders and any parties linked to the investment (eg attorneys, trustees or trust beneficiaries who are receiving payment). Please enclose a copy of either a passport or a photo driving licence certified as a true copy by your solicitor, financial adviser or your bank (including the bank s stamp). Proof of bank account ownership, if applicable (see the accompanying notes for section 6). Trust documents (if applicable, see the accompanying notes for section 7). Calls may be monitored and recorded for training purposes and to avoid misunderstandings. Old Mutual Wealth is the trading name of Old Mutual Wealth Limited which provides an Individual Savings Account (ISA) and Collective Investment Account (CIA) and Old Mutual Wealth Life & Pensions Limited which provides a Collective Retirement Account (CRA) and Collective Investment Bond (CIB). Old Mutual Wealth Limited and Old Mutual Wealth Life & Pensions Limited are registered in England and Wales under numbers and respectively. Registered Office at Old Mutual House, Portland Terrace, Southampton SO14 7EJ, United Kingdom. Old Mutual Wealth Limited is authorised and regulated by the Financial Conduct Authority. Old Mutual Wealth Life & Pensions Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Their Financial Services register numbers are and respectively. VAT number When printed by Old Mutual this item is produced on a mixed grade material, which uses a combination of recycled wood or paper fibre from controlled sources and virgin fibre sourced from well managed, sustainable forests. PDF March of 8

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