APPLICATION FORM SELF INVESTED PERSONAL PENSION (SIPP)

Transcription

1 APPLICATION FORM DISCRETIONARY PORTFOLIO SERVICE/ADVISORY PORTFOLIO SERVICE This form should be used for a Self Invested Personal Pension (SIPP) to be managed by Quilter Cheviot. We are required to obtain the following information from you. It is important that all the questions are answered as incomplete forms may need to be returned. Please inform us immediately if your circumstances change as this might affect the suitability of any investment decision or recommendation we make. The member (and pension adviser where applicable) should complete pages 1 to 6 of this form and sign page 8. The scheme administrator and trustee should complete page 7. SIPP PROVIDER Member s Personal Details Title Surname Forename(s) MEMBER S NAME Title Surname Number of dependants Forename(s) Date of birth (DD/MM/YYYY) PROVIDER REFERENCE Nationality Country of birth SERVICE CATEGORY Please tick the category of service required Country of tax residence, if not UK Discretionary Portfolio Service (DPS) Our principal bespoke investment management service where your manager is directly responsible for every aspect of your portfolio and can undertake transactions without prior reference to you. Taking into account your investment objective, attitude to risk and any other relevant information, your investments are individually tailored to best match your requirements. Advisory Portfolio Service (APS) Our investment management service for accounts where it is not possible to delegate the day to day decisionmaking process. When appropriate, we will contact you with recommendations and comments on the portfolio but we will not undertake transactions without your prior agreement. Country of domicile, if not UK National Insurance Number l / l l l l l / Or local tax number for overseas residents Are you, or have you ever been, a US citizen, the holder of a US passport, Green Card or US bank account: or have you ever resided in or owned property in the US? If you have ticked yes, please provide details 01

2 CONTACT DETAILS Permanent residential address * If inheritance, please state the full name of the deceased or donor (as applicable), their relationship to you and their primary source of wealth. If this source of wealth derives from any activities abroad, please state which country(ies). Preferred correspondence address (if this is not the permanent residential address) *If other, please specify. Preferred telephone number EMPLOYMENT/OUTSIDE BUSINESS INTERESTS Are you a director or significant senior manager of a Plc? * *If yes, which company(ies)? Fax number SOURCE OF OVERALL WEALTH Please tick all applicable sources of wealth. Please note that we may ask for evidence of source(s) of wealth in some cases; Do you have a shareholding of 5% or more in any Plc? * *If yes, which company(ies)? Employment* Investment or savings Inheritance* Family trust Business ownership or sale Property Other* * If employment, please state the nature of the business or occupation from which your wealth derives. 02

3 Are you or have you ever been employed in the financial services industry? Are you a politically exposed person or associated with one now or at any time in the past? * *If yes, please state your position and/or association INVESTMENT EXPERIENCE Your answers to these questions will enable us to determine your familiarity with particular types of services and investment. We would draw your attention to the risk warnings outlined in Annex 1 of our Terms and Conditions booklet in respect of some of these types of investment. Have you been an investor in financial markets for more than 5 years? Do you have experience of managing your own investments and directing deals? What is your current occupation, or your previous job if you have retired? Please state if you have not had a job previously. Do you have experience of using derivatives (including options), warrants, leveraged or unregulated products? YOUR PENSION ADVISER Contact name Name of company Does your employer need to receive contract notes? * *If yes, please provide details FCA reference number (if applicable) Address Telephone Can we take investment instructions from your pension adviser? 03

4 SOURCE OF FUNDS Please tick the applicable sources of how you fund your pensions; Surplus earned income Employee share (or share option) sales or sale of business Transfer from/consolidation of other schemes Savings previously held outside of the pension scheme Inherited capital Other source(s) Existing fund If other, please provide details; Additional contributions What is the approximate asset allocation of your pension funds not managed by Quilter Cheviot? Cash and bonds UK equities % % Overseas equities Alternatives % % What percentage of your Quilter Cheviot fund is available as a tax-free lump sum? % What percentage of your overall retirement income do you expect this SIPP to provide? % Do you or will you have a secured annual pension income of over 20,000 and qualify for the Minimum Income Requirement? If known, what is the anticipated annual pension withdrawal from this SIPP? or % Existing fund Are there any other considerations we should be aware of in respect of managing this SIPP? Additional contributions DETAILS OF YOUR PENSION FUND(S) This section can be answered by your pension adviser. Please indicate the amount being invested into this SIPP If in pension withdrawal, when is the next formal review of pension? (DD/MM/YYYY) Does Quilter Cheviot manage any of your other investments? other investments Are you making or do you plan to make additional contributions into this fund? If yes, how much each year What is the approximate value of your invested pension funds? 04

5 INVESTMENT STRATEGY Your answers to the following questions will determine the most appropriate investment objective for your SIPP. We will confirm this and the most suitable benchmark before undertaking any activity on your account. It is important that you keep us informed of any changes to your circumstances so we can review the strategy. TIME HORIZON Are you already retired? If not, what is your anticipated retirement date? (DD/MM/YYYY) When do you intend to start taking income from this fund? (DD/MM/YYYY) How do you anticipate taking income from this fund? (please tick all that apply) Buying an annuity/secured income Income drawdown/unsecured income Phased retirement MAIN PURPOSE OF THE FUND Before retirement Accumulate wealth - the emphasis is on maximising the capital value of the fund Preserve wealth - the emphasis is on maintaining the capital value of the fund After retirement Accumulate wealth - the emphasis is on maximising the capital value of the fund Preserve wealth - the emphasis is on maintaining the capital value of the fund Supplementing income - the emphasis is on providing a return to maintain your pension income over the longer term Regular income - the emphasis is on maintaining the long term security of your pension income RISK Investment is the purchase of an asset with the hope that it will generate income or appreciate in the future. All investments involve risk and while we will help you to understand what these are you should be aware that your capital is at risk and you may not receive the amount you originally invested. Risk capacity - Your overall financial circumstances will principally determine your capacity for risk and ability to absorb a loss of capital. Risk tolerance - You may have to accept more risk than you initially anticipate in order to achieve your long-term objective. Please show the extent to which you are able to tolerate short-term fluctuations in capital and income by ticking one of the following boxes: I/we can tolerate significant fluctuations in the capital value in order to generate potentially higher investment returns. In normal market conditions, I/we can tolerate fluctuations in both the capital value and income. I/we can tolerate some fluctuation in capital value providing current income is maintained in normal market conditions. Regardless of market conditions, my/our tolerance of fluctuations in the capital value and income is very limited. INVESTMENT RESTRICTIONS Do you wish to exclude certain investments and/or asset classes for tax or ethical reasons from your portfolio? If yes, please contact us for our Investment Restrictions supplement. te - investment restrictions set by the trustee/provider are notified separately. 05

6 REPORTING Our half yearly summaries, annual tax summary and valuations as requested will be sent to the SIPP administrator. Please enter what you and/or your adviser would like to receive. Correspondence Copy contract notes Comprehensive half yearly summary Member Adviser INTERNET ACCESS Do you want to access and download valuations and transactions from our website? ANTI-MONEY LAUNDERING VERIFICATION REQUIREMENTS We are required to verify the identity of all potential clients and their beneficial owners (where applicable). We cannot conduct business with you until this process is complete. For UK and Jersey resident individuals, we will use the following information to perform electronic identification checks. For overseas residents, or where the electronic identification check fails, we will ask you for certified copies of identity documentation. Previous surname if changed in the last 5 years Previous residential address, if less than 1 year at current address (a care of or post box is not acceptable) If yes and you already have an internet account with us, please enter your user ID. Member Adviser Either Passport number (this is at the very bottom of the photo page) l l l l l l l l l / l l / l l l l l l / / l l l l l l / l Date of expiry (DD/MM/YYYY) Or Driving licence number l l l l / l l l l l / l l / l Date of expiry photocard (DD/MM/YYYY) Please sign the Declaration page 8. 06

7 The following should be completed by the scheme administrator and trustee. TRUSTEES DETAILS Pension trustee(s) name SCHEME ADMINISTRATOR Full name of pension administrator Contact name Contact name Full postal address Full postal address Telephone Telephone Fax Fax Member trustee name (where applicable) SIPP BANK ACCOUNT AND INCOME INSTRUCTIONS Account name HMRC approval number Sort code l / l / l Account number Reference For accounts not in drawdown, the portfolio income is transferred to the capital account for re-investment on a monthly basis. Where income is to be paid to the above bank or building society account, please confirm amount of standing order. Monthly standing order of or quarterly standing order of 07

8 DECLARATION (to be signed by the trustee) We acknowledge receipt of and confirm our agreement to Quilter Cheviot s Terms and Conditions. (If you do not understand any point, please ask for further information.) In addition, we consent to your Order Execution Policy and to Quilter Cheviot (or any affiliate, as the case may be) effecting transactions on our behalf outside a regulated market or multilateral trading facility. Where there is more than one contributor to the scheme, we confirm that the identity and source of funds of each contributor have been verified by us. Furthermore, we hereby delegate authority to the member (as our agent in respect of this account) to: (a) provide you on an ongoing basis with information regarding his/her personal details and relevant outside interests; (b) agree the investment objective, risk preference and any investment restrictions applicable to the management of the investments; (c) give instructions provided that these instructions are consistent with the investment guidelines that we have prescribed in relation to the SIPP ; and (d) elect to receive internet access and various reports for either him or herself and/or his/her adviser, as noted on page 5. Subject to the above, we specifically agree that in the event of any inconsistency between the information or instructions provided by us and by the member, the information or instructions provided by the member shall prevail. To the best of our knowledge the information provided in this form by the member and his/her adviser is true and accurate in all respects. DECLARATION ON BEHALF OF TRUSTEE(S)/ INSURANCE COMPANY Signatory 1 Date (DD/MM/YYYY) Name capacity/position Signatory 2 Date (DD/MM/YYYY) Name capacity/position Signatory 3 Date (DD/MM/YYYY) Name capacity/position MEMBER S DECLARATION (to be signed by the member) The below confirmations are, what we call in legal terminology, representations and warranties. This means that we are entitled to rely on these confirmations without the need to check whether they are correct, and will have legal rights against you if the confirmation is not correct. I confirm that all the information in this form is accurate, complete, can be relied upon, and that my investment objectives are as set out in this application form. I confirm my acceptance of the Quilter Cheviot fee arrangement. If the Quilter Cheviot fee cannot be paid from the SIPP, I will be personally liable for such fees. I acknowledge receipt of a copy of the Quilter Cheviot Terms and Conditions and risk disclosures. I agree to the terms for online access as detailed in the Quilter Cheviot Terms and Conditions I authorise Quilter Cheviot to obtain relevant financial details from my pension adviser. If you are a trustee of this fund, please also sign the trustee declaration. Signed Date (DD/MM/YYYY) QUILTER CHEVIOT Print name One Kingsway London WC2B 6AN t: +44 (0) w: quiltercheviot.com Quilter Cheviot Limited is registered in England with number , registered office at One Kingsway, London WC2B 6AN. Quilter Cheviot is a member of the London Stock Exchange and authorised and regulated by the UK Financial Conduct Authority. 08