MetLife Investment Bond Portfolio (UK) Application Form for Companies

Transcription

1 MetLife Investment Bond Portfolio (UK) Application Form for Companies Beacon House, 27 Clarendon Road, Belfast BT1 3BG You re on your way to a more certain future with the MetLife Investment Bond Portfolio (UK). It s important you complete all relevant sections of this form to apply. The checklist on this page will help guide you through the sections you need to complete. You should take time to answer the questions fully, clearly and accurately to prevent any delay to your application. If you are unsure about anything, your Financial Adviser is there to help you. The detail in this application must match your selected illustration. Please provide the MetLife illustration reference number which this application form relates to: How to complete this form Section Do I need to complete this section? Page 1. About the company Yes Principal beneficial owners of the company Yes About the Lives Assured Yes About your investment Yes About your choice of withdrawals Yes Adviser charging You must complete and sign this section if you want MetLife to make any payments to your Financial Adviser for advice they have given you Entity tax clarification Yes Financial Adviser information No - your Financial Adviser must complete this section Verifying corporate entities No - your Financial Adviser must complete this section Declarations Yes What to do next Yes Defined Terms used in section 7 No. Please read only. 28 Application Form for Companies VERSION APR 2016 Page 1 of 32

2 1 About the company 1.1 Details of the company Full registered name Trading name (if different) Company registration number Country of incorporation If the company is incorporated in the US, do not complete this form as the company is not eligible to take out this policy. Registered office address Full names of all directors Nature of business Company turnover per annum Source of funds being invested Application Form for Companies VERSION APR 2016 Page 2 of 32

3 About the company continued... Tax residency Is the company UK resident for tax purposes? Yes No If yes, please provide the company s unique tax payer reference number. To apply for this policy, the company must be resident in the UK for corporation tax purposes. In addition to the UK, is the company resident in any other country for tax purposes? Yes No If yes, please list which countries the company is tax resident in and provide the company s unique tax payer reference number for each country listed. 1.2 Contact details for correspondence relating to this application Position held at company Correspondence address (if different from registered address) Daytime telephone number Evening telephone number Contact address Application Form for Companies VERSION APR 2016 Page 3 of 32

4 About the company continued About the individuals authorised to sign for the company The authorised individual(s) must be authorised to complete the application for and on behalf of the company. First authorised individual Relationship to company (tick all that apply) Director/Company secretary Other - Please provide details Date of birth Sex Is the first authorised individual also a Life Assured? D D M M Y Y Y Y Male Female Yes No Second authorised individual (if applicable) Relationship to company (tick all that apply) Director/Company secretary Other - Please provide details Date of birth Sex Is the second authorised individual also a Life Assured? D D M M Y Y Y Y Male Female Yes No MetLife normally requires two authorised individuals, who are either a registered Director of the Company or a Company Secretary to complete and sign the form. If additional officers of the company are likely to be dealing with MetLife in the future, please attach an authorised signatories list with this application form. Application Form for Companies VERSION APR 2016 Page 4 of 32

5 2 Principal beneficial owners of the company Please provide details of all individuals that have a share holding of more than 25. First principal beneficial owner Date of birth Sex D D M M Y Y Y Y Male Female Permanent residential address Daytime telephone number Evening telephone number Second principal beneficial owner Date of birth Sex D D M M Y Y Y Y Male Female Permanent residential address Daytime telephone number Evening telephone number Application Form for Companies VERSION APR 2016 Page 5 of 32

6 Principal beneficial owners of the company continued... Third principal beneficial owner Date of birth Sex D D M M Y Y Y Y Male Female Permanent residential address Daytime telephone number Evening telephone number Fourth principal beneficial owner Date of birth Sex D D M M Y Y Y Y Male Female Permanent residential address Daytime telephone number Evening telephone number Where principal beneficial owner is itself, a company Full registered name Trading name (if different) Company registration number Country of incorporation Application Form for Companies VERSION APR 2016 Page 6 of 32

7 Principal beneficial owners of the company continued... Registered office address Contact details for correspondence relating to this application Correspondence address Telephone number address Full names of all directors Nature of business Company turnover per annum Application Form for Companies VERSION APR 2016 Page 7 of 32

8 3 About the Lives Assured Please give details of all the Lives Assured under this Bond. If details already provided in section 1, just complete first name and surname boxes. First Life Assured Date of birth Sex D D M M Y Y Y Y Male Female Permanent residential address Relationship to company (Director or employee) Second Life Assured Date of birth Sex D D M M Y Y Y Y Male Female Permanent residential address Relationship to company (Director or employee) Application Form for Companies VERSION APR 2016 Page 8 of 32

9 About the Lives Assured continued... Third Life Assured Date of birth Sex D D M M Y Y Y Y Male Female Permanent residential address Relationship to company (Director or employee) Fourth Life Assured Date of birth Sex D D M M Y Y Y Y Male Female Permanent residential address Relationship to company (Director or employee) Application Form for Companies VERSION APR 2016 Page 9 of 32

10 4 About your investment 4.1 How will you invest? How much do you want to invest? The minimum is 10,000. Initial investments exceeding 1.5m must be approved by MetLife in advance. How will you be paying into the Bond? Company cheque Company cheques should be made payable to MetLife and sent with our application. We can only accept a Bank or Building Society draft if it is endorsed with the appropriate company name. Direct Credit Telegraphic Transfer If you are paying by Direct Credit or Telegraphic Transfer please attach the Direct Credit or Telegraphic Transfer form to this application, and use these bank details: Bank name and address: HSBC, Canary Wharf, London Account name: MetLife Europe Limited Sort code: Account number: Would you like to use phased investment? This option is only available when investing in Non-Guaranteed or Protected Growth Funds. Yes No Application Form for Companies VERSION APR 2016 Page 10 of 32

11 About your investment continued Where you want to invest Please indicate below the investments you have selected for your MetLife Investment Bond Portfolio (UK). All investments must be in whole percentages. If you have selected the Secure Capital Option (SCO) or Secure Income Option (SIO) the minimum investment is 5,000. The Secure Income Option and Secure Capital Option are only available with MetLife s Active Asset Allocation. Guaranteed investments Secure Capital Option - through Active Asset Allocation SCO maturity date/term Percentage Indicate the maximum Growth Asset Secure Income Option - through Active Asset Allocation Percentage Indicate the maximum Growth Asset Other investments Protected Growth Funds MetLife Protected Growth Fund 80 MetLife Protected Growth Fund 70 Other Portfolios (non guaranteed) MetLife Managed Wealth Portfolio - Foundation MetLife Managed Wealth Portfolio - Min MetLife Managed Wealth Portfolio - Mid MetLife Managed Wealth Portfolio - Max MetLife Defensive Managed Portfolio MetLife Conservative Managed Portfolio MetLife Cautious Managed Portfolio MetLife Balanced Managed Portfolio MetLife Aggressive Managed Portfolio MetLife Defensive Index Portfolio MetLife Conservative Index Portfolio MetLife Cautious Index Portfolio MetLife Balanced Index Portfolio MetLife Aggressive Index Portfolio MetLife BlackRock Sterling Liquidity Fund Pecrentage Percentage TOTAL (Must add up to 100) 100 Application Form for Companies VERSION APR 2016 Page 11 of 32

12 About your investment continued... Please give the names of the applicants or lives (up to two) on which you would like the Secure Income Option to be based (Secure Income Lives). The Secure Income will be payable for as long as the Secure Income Lives are still alive and the policy is in place. The minimum age for a Secure Income Life is 50. For a sole life the maximum age, at the time of investment, is 75. If there are two Secure Income Lives one of them must be 75 or younger. Any Secure Income death benefit will be payable on the death of the last surviving Secure Income Life. If you elect two Secure Income Lives, your Secure Income Option will be on a joint life second death basis. First Secure Income Life Second Secure Income Life Date of birth D D M M Y Y Y Y Date of birth D D M M Y Y Y Y 4.3 Fund-specific options Please answer the questions below which relate to the funds you have chosen to invest in on the previous page section 4.2. Secure Capital Option If you have chosen the Secure Capital Option and there are two Lives Assured, the death benefit should be paid after the: First death - Both must be 75 or younger at the time of investment for this option Second death - Younger Life Assured must be 75 or younger at the time of investment If there are more than two Lives Assured, the death benefit will be paid on the last death. Protected Growth Funds / Non-Guaranteed Investments If there are two Lives Assured, the death benefit should be paid after the: First death - Both must be 90 or younger at the time of investment for this option Second death - Younger Life Assured must be 90 or younger at the time of investment If there are more than two Lives Assured, the death benefit will be paid on the last death. Application Form for Companies VERSION APR 2016 Page 12 of 32

13 5 About your choice of withdrawals Your Protected Growth Funds / Non-Guaranteed Investment withdrawals How much would you like to withdraw each time? or What is the percentage based on the original investment you would like to withdraw? or What is the percentage based on the fund value at the time of the withdrawal you would like to withdraw? Secure Capital Option How much would you like to withdraw each time? Secure Income Option Do you want your withdrawals to be the maximum allowed for your age at commencement of withdrawals? Yes No If no, how much would you like to withdraw each time? What percentage of the maximum guaranteed withdrawal would you like? or 5.1 Your withdrawal details Please give a start date for your withdrawals. D D M M Y Y Y Y Regular withdrawals will usually reach your account within five to seven working days of the date you have chosen. How often would you like withdrawals made? Monthly Quarterly Every four months Every six months Annually If you are selecting the Secure Income Option, you can defer receiving withdrawals until a later date. For payment to commence, you must confirm in writing to MetLife at least one month prior to your desired initial payment date. From which funds would you like to make your withdrawals? All funds SCO funds SIO funds Non SIO or SCO funds If you make non-guaranteed withdrawals from your Secure Income Option portfolio, this will reduce your guaranteed withdrawals. 5.2 Your account details Please provide details of the account you would like us to pay into from your Bond. Name of bank or building society Branch address Name of account holder(s) Sort code Account number Building society roll number (if applicable) Application Form for Companies VERSION APR 2016 Page 13 of 32

14 6 Adviser charging Do you want MetLife to make any payments to your Financial Adviser for advice they have given to you in relation to this application? Yes - please read the important information in section 6.1, complete section 6.2 and sign the confirmation in section 6.3 No - please proceed to section Important information about adviser charging MetLife will facilitate Adviser Charges on your behalf in accordance with its terms and conditions, details of which can be found in our current Charges Booklet, copies of which are available from MetLife using the contact details on the back page of this form. MetLife monitors the level of Adviser Charges paid from its policies, and reserves the right not to facilitate an Adviser Charge if it considers that the payment requested would have a detrimental effect upon your investment, such that the MetLife product that you are invested in would no longer perform in accordance with its design. The amounts in section 6.2 below must match the selected illustration indicated on the front page of this application form. 6.2 Adviser charging If you do not provide full details here, MetLife will not be able to make any payments to your Financial Adviser. Please note that MetLife cannot take payment details from your illustration. Initial Adviser Charge or of investment. Ongoing Adviser Charges Please indicate the amount of the payment you wish us to make, how often you would like us to make this payment and from which investments you would like the payment to be made. or of full fund value, to be taken: Monthly Quarterly Every four Months Every six Months Annually from the following investments: One option must be ticked If you don t tick an option we ll assume you are going with option A and want to pay Adviser Charges from all investments. A. Please pay Ongoing Adviser Charges from all investments. This will include any new funds invested into my Investment Bond in future. Payments from Secure Income or Secure Capital Investments will proportionately reduce the guaranteed benefits. B. Please pay Ongoing Adviser Charges from my Protected Growth Funds and Non-Guaranteed Investments. If there is not enough money in these funds, or I have initially decided not to invest in them, the payments will be made from my Secure Income and/or Secure Capital Investments proportionately reducing the guaranteed benefits they provide, until additional monies are paid into the Protected Growth Funds and/or Non-Guaranteed Investments. When you pay your Ongoing Adviser Charges You can choose to start your Ongoing Adviser Charges immediately or some time in the future. Please give us a start date in the field below. If you leave the start date blank we will pay Ongoing Adviser Charges monthly in arrears. You can stop or change this arrangement at any time. Starting on: D D M M Y Y Y Y Application Form for Companies VERSION APR 2016 Page 14 of 32

15 Adviser charging continued Confirmation Please sign below to confirm you have read and understood the important information in this section 6, agreed the amounts stated in section 6.2 with your Financial Adviser and to confirm your instruction to MetLife to facilitate such amounts on your behalf. By signing below you also agree that: a. MetLife may set off any Adviser Charges that you instruct MetLife to facilitate against any amount that your Financial Adviser owes to MetLife provided that your Financial Adviser has agreed that you will no longer be obliged to pay the amount of Adviser Charges set off; and b. Unless you instruct MetLife in writing to the contrary, if your Financial Adviser transfers some or all of their business to another Financial Adviser (the New Adviser), including the business they do with you, MetLife will pay any facilitated Adviser Charges to the New Adviser. c. MetLife will not reclaim any payments you have asked it to pay to your Financial Adviser on your behalf. First authorised individual name Signature Date D D M M Y Y Y Y The authorised signatory must sign here Second authorised individual name Signature Date D D M M Y Y Y Y The authorised signatory must sign here All alterations must be made by crossing out the part you want to change, writing your amend and signing against it. Application Form for Companies VERSION APR 2016 Page 15 of 32

16 7 Entity tax classification For the purposes of the International Tax Compliance Regulations 2015 we are required to classify our customers as one of the types of entity listed below. It is important that you read this section 7 carefully and accurately complete the relevant questions below and provide any requested information. Terms appearing in bold are defined in section 12. If you are unsure about any aspect of this section, please speak to your Financial Adviser. 7.1 Financial Institutions Is the company a Financial Institution (if no, please proceed to question 7.2) Yes No If yes, please indicate which type of Financial Institution and indicate which one of the following classifications applies: Type: Investment Entity* (see 7.2 below and complete page 17 if applicable) Other Financial Institution Classification: Deemed-Compliant Financial Institution Exempt Beneficial Owner Registered Deemed-Compliant Financial Institution* Participating Financial Institution* (United Kingdom Financial Institutions will be Participating Financial Institutions if they are Reporting United Kingdom Financial Institutions with a Global Intermediary Identification Number ( GIIN )) *Please provide the company s GIIN: 7.2 Non-Financial Institutions If the company is not a Financial Institution, please specify which type of Non-Financial Entity ( NFE ) it is: Active Non-Financial Entity (Active NFE) Passive Non-Financial Entity (Passive NFE) If the company is a Passive NFE or if it is an Investment Entity located in a Non-Participating Jurisdiction and managed by another Financial Institution, please complete page Other Entities If the company is neither a United Kingdom Financial Institution nor an NFE, please contact the MetLife Technical Services Team before completing the remainder of this form. If the company is a Passive NFE, you will need to complete the information on the following pages for each controlling person. If any controlling person of the Passive NFE is a US citizen or is resident in the US for tax purposes, the company is not eligible to take out this policy. Please copy these pages and complete further sections if necessary (where the company has more than four controlling persons). Application Form for Companies VERSION APR 2016 Page 16 of 32

17 Entity tax classification continued... Controlling person 1 - director or principal beneficial owner (please circle as appropriate) Please state your city / town and country of birth Citizenship Are you a US citizen? Yes No If you are a US citizen, the company is not eligible to take out this policy. If you have indicated a US place of birth but have answered no to the question above, please provide a certified copy of your Certificate of Loss of Nationality. Tax residency Are you a UK resident for tax purposes? Yes No If yes, please provide your National Insurance number You must be UK resident for tax purposes, for the company to apply for this policy. Are you resident in any other country for tax purposes? Yes No If yes, please list which countries you are tax resident in and provide your tax identification number for each country listed. If you are resident in the US for tax purposes, the company is not eligible to take out this policy. Date of birth D D M M Y Y Y Y Permanent residential address Daytime telephone number Evening telephone number Controlling Person status Please provide the Controlling Person's status by ticking the appropriate box: Controlling Person of a legal person - control by ownership Controlling Person of a legal person - control by other means Controlling Person of a legal person - senior managing official Controlling Person of a trust - settlor Controlling Person of a trust - trustee Controlling Person of a trust - protector Controlling Person of a trust - beneficiary Controlling Person of a trust - other settlor-equivalent trustee-equivalent protector equivalent beneficiary-equivalent other-equivalent Application Form for Companies VERSION APR 2016 Page 17 of 32

18 Entity tax classification continued... Controlling person 2 - director or principal beneficial owner (please circle as appropriate) Please state your city / town and country of birth Citizenship Are you a US citizen? Yes No If you are a US citizen, the company is not eligible to take out this policy. If you have indicated a US place of birth but have answered no to the question above, please provide a certified copy of your Certificate of Loss of Nationality. Tax residency Are you a UK resident for tax purposes? Yes No If yes, please provide your National Insurance number You must be UK resident for tax purposes, for the company to apply for this policy. Are you resident in any other country for tax purposes? Yes No If yes, please list which countries you are tax resident in and provide your tax identification number for each country listed. If you are resident in the US for tax purposes, the company is not eligible to take out this policy. Date of birth D D M M Y Y Y Y Permanent residential address Daytime telephone number Evening telephone number Controlling Person status Please provide the Controlling Person's status by ticking the appropriate box: Controlling Person of a legal person - control by ownership Controlling Person of a legal person - control by other means Controlling Person of a legal person - senior managing official Controlling Person of a trust - settlor Controlling Person of a trust - trustee Controlling Person of a trust - protector Controlling Person of a trust - beneficiary Controlling Person of a trust - other settlor-equivalent trustee-equivalent protector equivalent beneficiary-equivalent other-equivalent Application Form for Companies VERSION APR 2016 Page 18 of 32

19 Entity tax classification continued... Controlling person 3 - director or principal beneficial owner (please circle as appropriate) Please state your city / town and country of birth Citizenship Are you a US citizen? Yes No If you are a US citizen, the company is not eligible to take out this policy. If you have indicated a US place of birth but have answered no to the question above, please provide a certified copy of your Certificate of Loss of Nationality. Tax residency Are you a UK resident for tax purposes? Yes No If yes, please provide your National Insurance number You must be UK resident for tax purposes, for the company to apply for this policy. Are you resident in any other country for tax purposes? Yes No If yes, please list which countries you are tax resident in and provide your tax identification number for each country listed. If you are resident in the US for tax purposes, the company is not eligible to take out this policy. Date of birth D D M M Y Y Y Y Permanent residential address Daytime telephone number Evening telephone number Controlling Person status Please provide the Controlling Person's status by ticking the appropriate box: Controlling Person of a legal person - control by ownership Controlling Person of a legal person - control by other means Controlling Person of a legal person - senior managing official Controlling Person of a trust - settlor Controlling Person of a trust - trustee Controlling Person of a trust - protector Controlling Person of a trust - beneficiary Controlling Person of a trust - other settlor-equivalent trustee-equivalent protector equivalent beneficiary-equivalent other-equivalent Application Form for Companies VERSION APR 2016 Page 19 of 32

20 Entity tax classification continued... Controlling person 4 - director or principal beneficial owner (please circle as appropriate) Please state your city / town and country of birth Citizenship Are you a US citizen? Yes No If you are a US citizen, the company is not eligible to take out this policy. If you have indicated a US place of birth but have answered no to the question above, please provide a certified copy of your Certificate of Loss of Nationality. Tax residency Are you a UK resident for tax purposes? Yes No If yes, please provide your National Insurance number You must be UK resident for tax purposes, for the company to apply for this policy. Are you resident in any other country for tax purposes? Yes No If yes, please list which countries you are tax resident in and provide your tax identification number for each country listed. If you are resident in the US for tax purposes, the company is not eligible to take out this policy. Date of birth D D M M Y Y Y Y Permanent residential address Daytime telephone number Evening telephone number Controlling Person status Please provide the Controlling Person's status by ticking the appropriate box: Controlling Person of a legal person - control by ownership Controlling Person of a legal person - control by other means Controlling Person of a legal person - senior managing official Controlling Person of a trust - settlor Controlling Person of a trust - trustee Controlling Person of a trust - protector Controlling Person of a trust - beneficiary Controlling Person of a trust - other settlor-equivalent trustee-equivalent protector equivalent beneficiary-equivalent other-equivalent Application Form for Companies VERSION APR 2016 Page 20 of 32

21 8 Financial Adviser information The Financial Adviser should complete this section. Name(s) Business name Business address Phone number address FCA Firm Reference Number FCA Individual Reference Number If you are part of a Financial Adviser network, please provide details below. Financial Adviser network FCA Network Firm Reference Number Business address Phone number address Application Form for Companies VERSION APR 2016 Page 21 of 32

22 9 Verifying corporate entities - To be completed by Financial Adviser This section must be completed by the Financial Adviser to confirm they have verified the identity of the private individual. 9.1 Details of company Full name of company Type of company - Such as a private limited company Business address - Full operating address Registered Office in country of incorporation Registration number - If any or appropriate Relevant company registry includes other registers, such as those maintained by charity commissions (or equivalent) or chambers of commerce Names of directors Names of principal beneficial owners - Over 25 share holding Application Form for Companies VERSION APR 2016 Page 22 of 32

23 Verifying corporate entities continued... Confirmation I confirm that: the information in section 9.1 of this application form was obtained by me/us in relation to the customer; I/We have seen and taken a copy of the evidence; the company is not incorporated in the US; and the company is resident in the UK for corporation tax purposes. Please complete in respect of the evidence you have seen - tick only one: Meets the standard evidence requirement set out within the guidance for the UK Financial Sector issued by Joint Money Laundering Steering Group (JMLSG); or Exceeds the standard evidence (written details of the further verification evidence taken are attached to this confirmation) Financial Adviser name Financial Adviser signature Date D D M M Y Y Y Y The Financial Adviser must sign here 9.2 Verifying identity of Controlling Persons of a Passive NFE. Only complete this section if the company is a Passive NFE. Confirmation I confirm that: the information in section 9.1 above was obtained by me/us in relation to the Controlling Persons; I/we have seen and taken a copy of the evidence; and nothing in the evidence seen indicates that any of the Controlling Persons are US citizen(s) or US resident(s) Please complete in respect of the evidence you have seen - tick only one: Meets the standard evidence requirement set out within the guidance for the UK Financial Sector issued by Joint Money Laundering Steering Group (JMLSG); or Exceeds the standard evidence (written details of the further verification evidence taken are attached to this confirmation) Financial Adviser name Financial Adviser signature Date D D M M Y Y Y Y The Financial Adviser must sign here Application Form for Companies VERSION APR 2016 Page 23 of 32

24 Verifying corporate entities continued... Please complete the details below in respect of each controlling person - Please copy this page and complete further sections if necessary (where the company has more than four controlling persons. Controlling person 1 Type of evidence seen - Must be a form of Government-issued identification Document identification number - If applicable Document expiry date D D M M Y Y Y Y Controlling person 2 Type of evidence seen - Must be a form of Government-issued identification Document identification number - If applicable Document expiry date D D M M Y Y Y Y Controlling person 3 Type of evidence seen - Must be a form of Government-issued identification Document identification number - If applicable Document expiry date D D M M Y Y Y Y Controlling person 4 Type of evidence seen - Must be a form of Government-issued identification Document identification number - If applicable Document expiry date D D M M Y Y Y Y Application Form for Companies VERSION APR 2016 Page 24 of 32

25 10 Declarations Authorised individuals must read these declarations carefully before they sign this form Data Protection Act I/We understand that MetLife values my/our privacy and complies with its privacy policy to hold in confidence information about me/us and my/our MetLife Investment Bond / Income for Life Bond / Guaranteed Investment Bond / Protected Growth Bond ( MetLife Bond ). However, in certain circumstances, MetLife may disclose or transfer this information, for example: a. If permitted by the Terms and Conditions of this Application Form and my/our MetLife Bond; b. If necessary to comply with the rules of any regulatory body whose rules or provisions apply to MetLife, such as the Financial Conduct Authority; c. To countries inside and outside the European Economic Area to administer and service my/our MetLife Bond. I/We understand that data protection laws may not be as comprehensive in other countries as in the European Union. However, where such a disclosure takes place MetLife will ensure that a contract is in place to ensure the level of protection for my/our data is maintained; or d. If it is in my/our own interests. MetLife may transfer my/our Personal Data and Sensitive Personal Data (as defined by the Data Protection Act 1988) to its parent company, MetLife Inc. (or any other parent as a result of merger or amalgamation or corporate restructure), any other organisation within the MetLife Group or to third-party service providers, inside or outside the European Economic Area, for processing for the purposes of providing MetLife services to me/us and for their confidential and internal use. Group means any subsidiary undertaking, parent undertaking, holding or associated company (as defined in s1162 of the Companies Act 2006 and s435 of the Insolvency Act 1986). MetLife may also disclose such details to other third parties where it is reasonably necessary to do so for their or MetLife s business analysis purposes or to administer and invest in the assets of my/our MetLife Bond or to enable them to provide services to me/us. MetLife, other companies within its Group and other reputable organisations chosen by MetLife will use, analyse and assess my/ our information to maintain and develop MetLife s and their relationships with me/us. The types of activity that this will include are: a. Administering and investing in the assets of my/our MetLife Bond and to deal with my/our enquiries; b. Operating and administering the product and services MetLife and/or they supply; c. Servicing my/our relationship with other companies within the MetLife Group and other organisations; d. Helping MetLife and them to identify products and services which may be of interest to me/us (unless I/we have asked MetLife not to); and e. Helping MetLife and them to understand and develop MetLife and their businesses, including new and innovative products and services. MetLife may search, share and use my/our information with any company within the MetLife Group and other appropriate thirdparty organisations, such as third-party verification service providers and financial crime and credit reference agencies, in order to verify my/our identity and prevent financial crime. This may mean that I/we may be asked to provide evidence to my identity. I /We understand that this is not a credit check and my/our credit rating should be unaffected. For operational reasons in order to carry out the activities listed above, MetLife may: a. Link information MetLife holds in relation to my/our MetLife Bond and other products and services I/we maintain with MetLife and other companies within its Group; and b. Link or use information MetLife receive from third parties about me/us. I/We understand that I/we have the legal right to make certain requests in respect of the information that MetLife holds about me/us: a. To stop MetLife from contacting me by post, fax, , SMS (text) messaging, or giving my details to others for these purposes I/we can send a written request to this effect to: The Data Protection Officer, MetLife, One Canada Square, London E14 5AA. b. To receive a copy of the information that MetLife holds about me/us, I/we can apply in writing to: The Data Protection Officer, MetLife, One Canada Square, London E14 5AA. If my/our MetLife Bond is terminated for any reason MetLife will hold my/our personal information about me/us and my/our MetLife Bond for no longer than is absolutely necessary. I/We declare that I/we have checked the details which I/we have provided in this Application Form. Application Form for Companies VERSION APR 2016 Page 25 of 32

26 Declarations continued Other declarations I/We, the authorised individual(s) specified in section 1.2 of this form declare: To the best of my/our knowledge and belief, all of the information provided on or with this form is accurate and complete. If I/we discover that any of the details are incorrect or incomplete, I/we will write to MetLife within 30 days with the correct information. The company has not been, and is not in the process of being dissolved, struck off or wound up. The Company is not insolvent nor has it ceased to trade and an administrator or administrative receiver has not been or is not in the process of being appointed. The Company has the capacity to enter into the contract applied for. The Company has an insurable interest in the life/lives of the person or persons whose lives are assured through this Bond (i.e. has an interest in the preservation of the Life/Lives Assured and/or it would suffer loss on their death(s)). The information I/we have given is true and complete and forms the basis of the contract. All changes in directors and other authorised signatories will be immediately notified to MetLife in writing including verification of identity. The Company applies for the Bond on the basis of this application form and the policy terms and conditions that have been provided to me/us. I/We understand that, subject to approval of this application by MetLife, the Bond will take effect on the date on which MetLife accepts this application and MetLife will confirm this by issuing and posting my/our policy document to the Company within five days after that date. I /We have checked the details provided on this application form. I /We enclose payment or payment instructions. If the company is a Passive NFE None of the Controlling Persons, are US citizen(s) or US resident(s) and I/we undertake to notify MetLife immediately if any of the Controlling Persons become US citizen(s) or US resident(s) after the date of this application. I/We understand that, if any of the Controlling Persons become US citizen(s) or US resident(s), MetLife may be required to share information about this MetLife Bond with the relevant UK tax authorities who may share such information with the relevant US tax authorities. If at any time MetLife has reason to believe that any of the Controlling Persons have become US citizen(s) or US resident(s) or subject to tax reporting requirements in any other country, I/we understand that it may request relevant documentation about their citizenship or residency and that I/we must provide such documentation to MetLife. I /We understand that failure to provide such information may result in information about this account being shared with the relevant UK tax authorities. I/We understand that, if any of the Controlling Persons are/or become subject to tax reporting requirements in any country other than the UK or if, at any time, I/we become subject to tax reporting requirements in any country other than the UK, I/we understand that MetLife may be required to share information about my/our MetLife Bond with the relevant UK tax authorities who may share such information with the relevant overseas tax authority. The nominated authorised individual(s) must sign the declaration. First authorised individual signature Second authorised individual signature (if applicable) Date Date D D M M Y Y Y Y D D M M Y Y Y Y Director / Company Secretary (please circle) For and on behalf of the company specified in section 1.1 of this form Director / Company Secretary (please circle) For and on behalf of the company specified in section 1.1 of this form Please note that: Making false statements can be a serious offence and carries severe penalties, including criminal prosecution. This Bond is a capital-only investment. If there is any conflict between the provisions of this application form and the policy terms and conditions, the provisions in the policy terms and conditions will apply. Application Form for Companies VERSION APR 2016 Page 26 of 32

27 11 What to do next Please check that all the answers on this application form have been completed fully and accurately. Make sure you have everything you need to include with this application form. Failure to attach or include all necessary paperwork and/or information may delay your application Attachment checklist Please tick which of these attachments apply to you and send them with your form. For the customer Any extra sheets you used to fill in the form, correctly labelled Your investment payment cheques For the Financial Adviser Written details of your extra verification evidence of the customer s identity if applicable. Ensure section 6.2 has been completed. Adviser charging details from quotes will not be accepted. Authorised signatories list (to include full name, position in company and specimen signature). A copy of the illustration for your investment. Please enclose copies of: Certificate of incorporation Certificate of change of name Copy of memorandum and articles of association Latest report and accounts 11.2 Where to send this application form Once you have checked the application form and the supporting documents, please send it with your attachments to: MetLife Beacon House 27 Clarendon Road Belfast BT1 3BG. Application Form for Companies VERSION APR 2016 Page 27 of 32

28 12 Defined terms used in section 7 Active NFE an entity will be classified as an Active NFE if it meets any of the following criteria: a. Less than 50 of the NFE s gross income for the preceding calendar year or other appropriate reporting period is passive income and less than 50 of the assets held by the NFE during the preceding calendar year or other appropriate reporting period are assets that produce or are held for the production of passive income; b. The stock of the NFE is regularly traded on an established securities market or the NFE is a Related Entity of an entity the stock of which is traded on an established securities market; c. The NFE is organised in a US Territory and all of the owners of the payee are bona fide residents of that US Territory; d. The NFE is a governmental entity, an international organisation, a central bank, or an entity wholly owned by one or more of the foregoing; e. Substantially all of the activities of the NFE consist of holding (in whole or in part) the outstanding stock of, and providing financing and services to, one or more subsidiaries that engage in trades or businesses other than the business of a Financial Institution, except that an NFE shall not qualify for this status if the NFE functions (or holds itself out) as an investment fund, such as a private equity fund, venture capital fund, leveraged buyout fund or any investment 35 vehicle whose purpose is to acquire or fund companies and then hold interests in those companies as capital assets for investment purposes; f. The NFE is not yet operating a business and has no prior operating history, but is investing capital into assets with the intent to operate a business other than that of a Financial Institution; provided, that the NFE shall not qualify for this exception after the date that is 24 months after the date of the initial organisation of the NFE; g. The NFE was not a Financial Institution in the past five years, and is in the process of liquidating its assets or is reorganizing with the intent to continue or recommence operations in a business other than that of a Financial Institution; h. The NFE primarily engages in financing and hedging transactions with or for Related Entities that are not Financial Institutions, and does not provide financing or hedging services to any Entity that is not a Related Entity, provided that the group of any such Related Entities is primarily engaged in a business other than that of a Financial Institution; or i. The NFE meets all of the following requirements: 1. It is established and maintained in its country of residence exclusively for religious, charitable, scientific, artistic, cultural, athletic or educational purposes or it is established and operated in its jurisdiction of residence and it is a professional organisation, business league, chamber of commerce, labour organisation, agricultural or horticultural organisation, civic league or an organisation operated exclusively for the promotion of social welfare; 2. It is exempt from income tax in its country of residence; 3. It has no shareholders or members who have a proprietary or beneficial interest in its income or assets; 4. The applicable laws of the entity s country of residence or the entity s formation documents do not permit any income or assets of the entity to be distributed to, or applied for the benefit of, a private person or non-charitable entity other than pursuant to the conduct of the entity s charitable activities, or as payment of reasonable compensation for services rendered, or as payment representing the fair market value of property which the entity has purchased; and 5. The applicable laws of the entity s country of residence or the entity s formation documents require that, upon the entity s liquidation or dissolution, all of its assets be distributed to a governmental entity or other non-profit organisation, or escheat to the government of the entity s country of residence or any political subdivision thereof; Annuity Contract a contract under which the issuer agrees to make payments for a period of time determined in whole or in part by reference to the life expectancy of one or more individuals. The term also includes a contract that is considered to be an Annuity Contract in accordance with the law, regulation, or practice of the jurisdiction in which the contract was issued, and under which the issuer agrees to make payments for a termof years; Cash Value Insurance Contract an Insurance Contract (other than an indemnity reinsurance contract between two insurance companies) that has a Cash Value greater than the sterling equivalent of $50,000; Controlling Persons each of the directors of the company and any principal beneficial owners identified in section 2 of this application. Application Form for Companies VERSION APR 2016 Page 28 of 32

29 Defined Terms used in Section 7 continued... Custodial Institution any entity that holds, as a substantial portion of its business, financial assets for the account of others. An entity holds financial assets for the account of others as a substantial portion of its business if the entity s gross income attributable to the holding of financial assets and related financial services equals or exceeds 20 of the entity s gross income during the shorter of: (i) the three-year period that ends on 31 December (or the final day of a non-calendar year accounting period) prior to the year in which the determination is being made; or (ii) the period during which the entity has been in existence; CRS the OECD common standard on reporting and due diligence for financial account information; Deemed-Compliant Financial Institution any of the categories of institutions identified as deemed-compliant financial institutions in Annex II to the IGA; Depositary Institution any entity that accepts deposits in the ordinary course of a banking or similar business; Exempt Beneficial Owner any of the categories of institutions identified as exempt beneficial owners in Annex II to the IGA; Financial Institution a Custodial Institution, a Depository Institution, an Investment Entity, or a Specified Insurance Company; Global Intermediary Identification Number or GIIN a number allocated to a financial institution by the Internal Revenue Service in the United States of America for FATCA purposes; IGA the intergovernmental agreement dated 12 September 2012 entered into between the United Kingdom of Great Britain and Northern Ireland and the Government of the United States of America to improve international tax compliance and to implement FATCA; Insurance Contract a contract (other than an Annuity Contract) under which the issuer agrees to pay an amount upon the occurrence of a specified contingency involving mortality, morbidity, accident, liability, or property risk; Investment Entity i. any entity that conducts as a business (or is managed by an entity that conducts as a business) one or more of the following activities or operations for or on behalf of a customer: 1. trading in money market instruments (cheques, bills, certificates of deposit, derivatives, etc.); foreign exchange; exchange, interest rate and index instruments; transferable securities; or commodity futures trading; 2. individual and collective portfolio management; or 3. otherwise investing, administering, or managing funds or money on behalf of other persons; to be interpreted in a manner consistent with similar language set forth in the definition of financial institution in the Financial Action Task Force Recommendations; ii. any entity the gross income of which is primarily attributable to investing, reinvesting, or trading in Financial Assets where the entity is managed by another entity that is a Depository Institution, a Custodial Institution, a Specified Insurance Company, or the first type of Investment Entity. Application Form for Companies VERSION APR 2016 Page 29 of 32

30 Defined Terms used in Section 7 continued... Investment Entity located in a Non-Participating Jurisdiction and managed by another Financial Institution. any entity the gross income of which is primarily attributable to investing, reinvesting, or trading in financial assets if the Entity is i. managed by another Institution; and ii. not a Participating Jurisdiction Financial Institution. Investment Entity managed by anopther Financial Institution an entity is managed by another entity if the managing entity performs, either directly or through another service provider on behalf of the managed entity, any of the activities or operations described in clause (i) above in the definition of Investment Entity. Any entity only manages another entity if it has discretionary authority to manage the other entity s assets (either in whole or part). Where an entity is managed by a mix of Financial Institutions, NFEs or individuals, the entity is considered to be managed by another entity that is a Depository Institution, a Custodial Institution, a Specified Insurance Company, or the first type of Investment Entity, if any of the managing entities is such another entity. Non-Financial Entity (NFE) any non-us entity that is not treated as a Financial Institution; Non-Reporting United Kingdom Financial Institution any United Kingdom Financial Institution, or other entity resident in the United Kingdom that is identified in Annex II to the IGA as a Non-Reporting United Kingdom Financial Institution or that otherwise qualifies as a deemed-compliant FFI, an exempt beneficial owner, or an excepted FFI under relevant US Treasury Regulations; Participating Jurisdiction a jurisdiction with which an agreement is in place pursuant to which it will provide the information set out in the CRS and that is identified in a published list. Passive NFE i. any NFE that is not an Active NFE; and ii. an Investment Entity located in a Non-Participating Jurisdiction and managed by another Finanicial Institution is also treated as a Passive NFE. Registered Deemed-Compliant Financial Institution a non-reporting United Kingdom Financial Institution to which a Global Intermediary Identification Number has been properly allocated; Related Entity of another entity if either entity controls the other entity, or the two entities are under common control. For this purpose control includes direct or indirect ownership of more than 50 of the vote or value in an entity. Notwithstanding the foregoing, HMRC may treat an entity as not a Related Entity of another entity if the two entities are not members of the same expanded affiliated group as defined in section 1471(e)(2) of the US Internal Revenue Code; Reporting United Kingdom Financial Institution any United Kingdom Financial Institution that is not a Non-Reporting United Kingdom Financial Institution; Specified Insurance Company any entity that is an insurance company (or the holding company of an insurance company) that issues, or is obligated to make payments with respect to, a Cash Value Insurance Contract or an Annuity Contract; and Application Form for Companies VERSION APR 2016 Page 30 of 32