Withdrawal/closure form

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1 Withdrawal/closure form With this form you can*: sell all of your bond/plan...section 3 make a withdrawal by selling individual numbered policies...section 4Ai) raise a specific sum of money by selling individual policies...section 4Aii) raise a specific sum of money by selling proportionally across all policies...section 4B * the options available will depend on the product you have It can be used for the following: Capital Accumulation Plan (CAP) Maximum Investment Plan (MIP) Skandia Endowment Plan (SEP) Investment Bonds (SIB, CAB, SDB, HIB, EAB, APB, CIB, FIB) The Skandia Plan (TSP) Personal Protection Plan (PPP) Skandia Lifetime Plan (SLP) It cannot be used for: any product that is not listed above regular income withdrawals, for which you will need our automatic withdrawal authority form. NOTE Please read the accompanying Questions and Answers document; it will help you complete this form and clarify whether any additional documents are needed (for example proof of identification). Provided we have received everything we need at our Head Office before 10am, transactions will be based on the prices on the following working day. If we need any additional information to enable us to carry out your request, we will let you know as soon as we can. We normally pay proceeds within 5 working days of receiving your instruction (excluding the time it takes for the payment to reach your bank). 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 withdrawal/closure.! Before you complete this form, it is important that you understand the following: You may incur early encashment charges more information is in the accompanying Questions and Answers document Any additional life cover on a bond could be reduced as a result of a withdrawal. There are tax implications when making withdrawals There are two ways to make a withdrawal from a life assurance plan/bond: - full surrender of individual policies - PARTIAL surrender from 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. Whatever the reason for selling your investment(s), we strongly 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. 1 of 8

2 Please tick/complete this form using BLOCK CAPITALS and blue or black ink reasons for selling (completion of this section is optional) At Old Mutual Wealth, we are keen to improve our products and services and we value your feedback. We would be grateful if you could take a few moments to answer the questions below to help us understand your decision to sell your Old Mutual Wealth investment. Q1 Did you seek advice from a professional financial adviser before deciding to sell? (tick) Yes No Q2 What is the main reason for deciding to sell your investment? Please tick one of the following Poor fund performance Customer service experience Premium/charges too high or not as expected To invest in a different product Money required for another purpose No specific reason Q3 If you are going to use the money from this sale to invest in another product, is it: (tick) an Old Mutual Wealth product? another company s product? It would help us if you state the name of the company here 1 Bond/Plan details Bond/Plan number (eg SIB ) Full name(s) of investor/trust Address of investor/ trust (Please complete the number carefully because we cannot be held responsible for any consequences if it is incorrect) (If your address has changed within the last 12 months, or is different from the one we have on our records, we will need proof of your new address, for instance a recent original bill showing the new address, eg phone, electricity, gas, water etc but not a mobile phone bill.) If the address given above is a correspondence address for the bond/plan, tick here Telephone number address u We will not share your contact information with other parties; it is just for our reference Tick below to indicate whom we should contact if we have any queries about your instruction: My/Our financial adviser OR Me/Us using the contact details shown above Full names of other investors (if applicable) details of Assignee (if applicable) Please give the details of the assignee - this means 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). The authority in Section 7 must then be completed by the assignee. Assignee s full name Assignee s address 2 of 8

3 3 to close your bond/plan Tick here to surrender (sell) your entire bond/plan u speak to your financial adviser about possible tax consequences NOW GO TO SECTION 5 4 TO MAKE A WITHDRAWAL NOTE There are different tax implications depending on the method you choose below. There may be early encashment charges. SELECT THE METHOD FOR WITHDRAWAL A) FULL SURRENDER OF INDIVIDUAL POLICIES Complete ONE of the following three options OR B) PARTIAL SURRENDER FROM ALL POLICIES u not available for TSP or the SLP u for MIPs this option is only available at the review date and provided premiums have been paid Ai) I want to sell the following individual policies: u state the policy numbers, eg 1-20 Now go to section 5 OR I want to withdraw: by selling from each policy, proportionally across the funds within the policies Now go to section 5 Aii) I want to sell individual policies to withdraw: u We will calculate the number of policies to sell to raise this sum, 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 receive more than requested; however, if the prices are lower on that day, it could mean that you receive less than requested. However, if you want us to raise the exact amount shown, tick here (this option is not available for MIPs) u We will then calculate the number of policies to sell and, if the sale of the policies does not raise the sum required, we will meet the shortfall by selling from each remaining policy (proportionally across the funds within the policies). Now go to section 5 3 of 8

4 5 Payee details Complete this section to tell us whom to pay (see the accompanying Questions and Answers for guidance). We will assume option i) if you do not state otherwise. u If there is more than one payee, please indicate how the proceeds are to be split (either as a percentage of the total proceeds or as a monetary amount). (i) Pay the investor(s) u this includes payment to trustees as a whole and pension scheme trustees (ii) Pay a beneficiary Beneficiaries must be at least 18 years old. If payment is to be made to more than two beneficiaries, please provide the same details for each additional beneficiary on a copy of this page. Please enclose proof of each beneficiary s identification, as outlined in the checklist on page 6. 1 Beneficiary s full name Beneficiary s address Beneficiary s date of birth 2 Beneficiary s full name Beneficiary s address Beneficiary s date of birth (iii) Pay the following financial institution, financial adviser or solicitor u payment will be made into the payee s Client Money Account Payee s name Payee s address (iv) Invest the proceeds in the following Old Mutual Wealth product Submit your application for the product at the same time as this instruction. If you are investing in more than two products, please provide the same information for each additional one on a copy of this page. 1 Product name Product number/application reference u if known 2 4 of 8

5 6 PAYEE S BANK DETAILS If you selected options i), ii) or iii) in section 5, please complete this section with the payee s bank details. NOTE If we are paying investors, trustees or beneficiaries, we will need to see proof of the bank account ownership, if not already provided. We will only send a cheque in exceptional circumstances; see Q3 in the accompanying Questions and Answers. Bank or building society name and address u must be in the UK Branch sort code Name of bank/building society account holder Bank/Building society account number Building society roll number u if applicable 7 Authority and signature(s) The declaration and personal data statement are made by each person authorising the withdrawal/closure. 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 Questions and Answers 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 and/or not deemed to be insolvent in accordance with the meaning of the Insolvency Act 1986 or Enterprise Act 2002 (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 4 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 bond/plan. PERSONAL DATA STATEMENT I agree that you may use my personal data, including any sensitive personal data ( my data ) to process my instruction and to service my investment. I understand that: You may provide my data, by electronic or other means to: a) other companies within the Old Mutual Wealth and Old Mutual groups of companies if you regard this as necessary to service my investment b) my financial adviser c) a third party to verify my identity in line with money laundering or other requirements, which may involve carrying out checks with credit reference databases d) third parties who perform tasks for you to help you service my investment. These third parties may be based in countries outside the EEA. I understand that these countries may not have laws to protect my data equivalent to those of the UK. However, I understand that you will ensure that any such third parties agree to treat my data with the same level of protection as if you were dealing with it. To prevent and detect fraud you may: a) share my data with other organisations, including the police b) check and/or file my data with fraud prevention agencies and databases, and if I give you false or inaccurate information and you suspect fraud, you will record this. You and other companies within the Old Mutual Wealth and Old Mutual groups of companies may use my data for assessment and statistical analysis purposes. My data may be made available to third parties where required by law, court order or regulation. On payment of a small fee, I am entitled to receive a copy of my data which is subject to the Data Protection Act I also have the right to require you to correct any inaccuracies in my data. In such circumstances, I can contact you at Old Mutual Wealth Life Assurance Limited, Southampton, SO14 7AY. All investors including trustees and/or 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 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 (dd/mm/yyyy) 2 0 Print full name Capacity u eg investor, trustee, signatory, attorney, assignee 2. Signature Date (dd/mm/yyyy) 2 0 Print full name Capacity u eg investor, trustee, signatory, attorney, assignee continued 5 of 8

6 7 Authority and signature(s) (Continued) 3. Signature Date (dd/mm/yyyy) 2 0 Print full name Capacity u eg investor, trustee, signatory, attorney, assignee 4. Signature Date (dd/mm/yyyy) 2 0 Print full name Capacity u eg investor, trustee, signatory, attorney, assignee Checklist Before you send us this form, make sure you have: read the accompanying Questions and Answers completed all applicable sections in the form signed the form in section 7 included any additional documents required (see Q4 in the accompanying Questions and Answers), for example: Proof of your residential address if it has changed within the last 12 months or it is different from the address we have on our records. Proof of identification for all bond/plan holders and any parties linked to the investment (eg attorneys, trustees or trust beneficiaries who are receiving payment). Proof of bank account ownership. Trust documents. Once completed, please send the form 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 Life Assurance Limited is registered in England & Wales under number Registered Office at Old Mutual House, Portland Terrace, Southampton SO14 7EJ, United Kingdom. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services register number 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. 6 of 8

7 withdrawal/closure form Questions and Answers These are for you to keep; please read them before completing and sending your instruction to us. 1. are there any tax implications if I make a withdrawal?! Yes the information below is also on page 1 of the form but it is important that you understand it: There are two ways to make a withdrawal from a life assurance plan/bond: - full surrender of individual policies - PARTIAL surrender from 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 decision to surrender from your bond. 2. are there any early encashment charges? Not for the following products: TSP, MIP, SEP and SLP. For other products there could be early encashment charges; however they vary by product and can depend on the length of time you have held the bond/plan. Details will be in your product terms and conditions. If you require more information, please contact us using the details shown in in Q How long does it take to receive my money? We normally release the money within five working days of receiving an acceptable instruction (excluding the time it takes for the payment to reach the bank). Payments will be made to a UK bank account* using BACS (Bankers Automated Clearing System), whereby the money reaches the bank account three to five working days after it leaves us. * We will send a cheque if we are unable to send payment to the bank for any reason. Cheques will then be payable to all bond/plan holders/ trustees jointly if we are unable to pay the nominated payee. 4. do you require anything in addition to this form? Proof of your residential address if it is different from the address we have on our records. For example an original household bill dated within the last six months (mobile phone bills are not acceptable) Proof of identification if not already provided by you or your financial adviser, for all bond/plan holders and any parties linked to the investment (eg attorneys, trustees or trust beneficiaries who are receiving payment). Please enclose either a passport or a photo-card driving licence either the original or a certified copy*. Proof of the bank account ownership If the money is going to the investor(s), trustees or beneficiaries. The proof can be a voided cheque or a certified true copy* of your bank account statement dated within the last six months. If you have online bank account statements, a printed copy certified by your adviser will suffice. for trust investments, if the trustees signing the 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. * Copies must be certified on each page in ink by a professional such as your financial adviser, solicitor, accountant, GP or bank manager (including the bank s stamp). 5. What happens if something is missing? If, in our view, your instruction is not clear or we are missing key information, we will be unable to proceed and we will typically contact you or your financial adviser. This may mean that your request will be delayed. 6. Are there any limits when withdrawing from my bond/plan? The minimum withdrawal payment is 50. The minimum value to be kept in a bond/plan to keep it open after a withdrawal is made is of 8

8 Questions and answers continued 7. Who can be paid the proceeds? You, the investor the payee will ordinarily be you, the investor; this is therefore the first option shown on the form. Trustees payments can be made to a trustee(s) into a UK bank account held in their capacity as trustee (eg Trustee of the John Smith Will Trust); this is Option i) on the form in section 5. If there is no trustee bank account, please contact us. Beneficiary of a Trust we can pay a beneficiary provided he/she is at least 18 years old and we have proof of the beneficiary s identity. Payments will only be made to an account of a UK financial institution held in the name of the beneficiary. A Client Money Account we can make payment to a client money account of a financial institution, a financial adviser or a solicitor provided they are authorised to handle client money. Payment to another Old Mutual Wealth Product If you want to transfer the proceeds to invest in another of our products, you must submit your application for that product at the same time as the withdrawal/closure 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. 8. Who has to sign the form? All investors including trustees and/or assignees (where applicable) must sign. 9. What is required if the form is being signed by an attorney? The attorney must add as attorney after his/her signature. We need to see the original Power of Attorney, if not already sent to us. We can also accept a copy provided it is certified as a true copy of the original, in ink on each page by a solicitor. We also need proof of the attorney s identification if not already provided (for details of what we can accept as proof, see Q4). 10. What if I have more questions? Your financial adviser should be your first point of contact. However, if you would like to speak to us, please call our Customer Contact Centre on or us at ask@omwealth.com. Glossary/definition of terms Some of the terms we use in the withdrawal/closure form are explained below: BACS Bankers Automated Clearing System. This is the method we ordinarily use to make direct, electronic payments to banks. Beneficial interest Beneficiary Client Money Account Early encashment charges EEA Financial institution Investor Trustees 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. Charges imposed for selling investments. Details will be in the Key Features Document and Terms & Conditions for the product. European Economic Area. An organisation such as a bank. References to investor in the withdrawal/closure form mean the bond/plan holder. Those who are holding property in trust on behalf of someone else. Calls may be monitored and recorded for training purposes and to avoid misunderstandings. Old Mutual Wealth Life Assurance Limited is registered in England & Wales under number Registered Office at Old Mutual House, Portland Terrace, Southampton SO14 7EJ, United Kingdom. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services register number 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. SK5169/ /October 2016 (H Withdrawal/Closure form non pension) 8 of 8

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