THE ITC BUY OUT BOND APPLICATION PACK.

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1 THE ITC BUY OUT BOND APPLICATION PACK

2 Buy Out Bond Application Form Investor Details Title First Name Financial Advisor Surname Address Address Date of Birth / / Home Tel Mobile Work Tel Fax You must notify ITC in writing of any future change in the address stated above. Marital Status Married Single Widow(er) Separated Divorced Civil Partnership PPS Number Normal Retirement Age Spouse s Name Spouse s Date of Birth / / Date Employment Commenced / / Date Employment Ended / / (a) Salary at date of leaving (b) Other earnings in last three years before leaving employment (eg bonuses) (c) (20% directors only) Total earnings for each of the last three years before ceasing employment Asset Transfer Scheme Provider NRA ARF Option* Transfer Value *Note: Has the scheme the option to buy an ARF, or annuity only? Revenue Details This information is required in order to calculate the Revenue Commissioner s maximum limits. Failure to provide this information is a breach of Revenue rules and could result in Revenue taking action regarding member s benefits under this Buy Out Bond (the Bond ). Page 2 of 11

3 Please tick the appropriate box for each of the following- if neither box is ticked, we will assume the answer is no. If you answer yes to any of the questions, please give details in the notes section at the end of this application form. Are you entitled to benefits from another pension scheme? Have you previously received any pension benefits (including a tax free lump sum payments or a refund of previous contributions)? Do you and/or your dependent(s) hold 20% or more of the shares/equity and/or the voting control of the employer company? Have you irrevocably surrendered your right to take a tax free lump sum in respect of some or all of your pension? Does any of the transfer relate to benefits from more than one previous pension scheme? If yes, please fill in details relating to each transfer in the table below Is there a Pension Adjustment Order in place against any of your pension benefits? If so, please provide a copy of the Pension Adjustment Order. Yes No Advisor Details Advisor Advisor Company Address Telephone Fax Special Instructions & Additional Information Representations and Warranties of the Investor 1. I instruct ITC to invest in this Bond. I understand that this investment will be used to purchase units in a unit trust and such investment will be subject to the terms of the trust deed and supplemental declaration of trust of the unit trust. I authorise ITC to subscribe for units in the unit trust on behalf of my Bond. I acknowledge and understand that ITC will be trustee of the unit trust. 2. I confirm that I am 18 years of age or over. 3. I confirm that having received, read and considered a copy of the Application Form and General Conditions relating to this investment (the Documents ), my application regarding the investment is based solely on the Documents and I am not relying on any other information or representation. I understand and agree to the terms and conditions stated in the Documents. 4. I declare that I am fully aware of the risks and the costs relating to my Bond. I understand that the value of my Bond can rise as well as fall. I also understand that if my Bond includes assets which are leveraged, there may be higher risks involved regarding the investment performance of my Bond. Regarding the Bond, I acknowledge and understand that ITC shall not be responsible for any loss or damage, whatsoever or howsoever occurring, or for Page 3 of 11

4 any depreciation in value howsoever arising by reason of the exercise or non-exercise of the powers hereby imposed on or undertaken by ITC or any diminution in the value of assets or any part thereof or by reason of the assets or any part thereof failing to appreciate in value or failing to produce any return on the capital invested, save for any loss or damage resulting directly from ITC s fraud, wilful default or negligence. 5. I have been provided with a copy of the fee schedule and all fees relating to this Bond have been explained to me, and I understand and agree to those fees. 6. I understand that ITC requires that a minimum of 10% of the Bond be held in cash and/or liquid investments, as well as sufficient cash to cover any pension levies payable. 7. I agree that all representations, warranties and declarations which I make or give here will apply with respect to my future investments pursuant to the Bond, as if repeated in full at the time of the future investment. 8. I acknowledge the right of ITC to compulsorily redeem my Bond in the event that the representations or warranties set out herein above are not accurate. 9. I acknowledge the right of ITC to compulsorily redeem my Bond if any governmental authority requires ITC to do so. 10. I shall provide ITC with any additional information which it may require in connection with my tax status and authorise ITC to disclose such information relating to this application to such Revenue authorities as ITC considers appropriate. 11. I acknowledge that pursuant to the anti-money laundering requirements of the Criminal Justice (Money Laundering and Terrorist Financing) Act 2010 (as amended), that proof of my identity may be required by ITC before this Application Form can be processed. 12. I confirm, represent and warrant that I have taken my own investment advice in relation to the Bond and acknowledge that ITC, its employees, officers and agents have not made any representation or warranty to me in relation to the Bond and that I have not received or relied on any advice from ITC and its employees, officers or agents in relation to the Bond. I acknowledge that ITC and its employees, officers or agents have no liability to me in relation to my decision to make this investment, or any losses which I may incur in relation to the Bond. 13. I have read the Data Protection Notice below and I agree that my personal information may be used for the purposes described in that Notice. I hereby consent to ITC and any of its delegates and duly authorised agents and any of their respective related, associated or affiliated companies obtaining, holding, using, disclosing and processing my data: (i) to manage and administer my investment and any related accounts on an on-going basis; (ii) for any other specific purposes where I have given specific consent to do so; (iii) to comply with legal or regulatory requirements applicable to the Bond or me; or (iv) for disclosure to the tax authorities. I hereby acknowledge my right of access to and the right to amend and rectify my personal data, as provided herein. ITC will hold any personal information provided by me in confidence and in accordance with the Data Protection Act 1988 as amended by the Data Protection (Amendment) Act I authorise Revenue and the Department of Social Protection to give ITC my most recent address held on their records, at any time in the future. 15. I declare that the information provided in this application form and other related forms (if any) is true and complete to the best of my knowledge and belief whether in my handwriting or not and that this application and declaration shall form the basis of my contract with ITC which relates to the Bond. 16. I consent to ITC seeking relevant information relating to my past, present, future employments and pension arrangements from any employers, trustees, administrators or pension providers and I authorise the giving Page 4 of 11

5 of such information. 17. The representations and acknowledgements under this Application Form shall be binding upon my representatives, successors and assigns. 18. I acknowledge that the terms and conditions of my investment shall be governed by and construed in accordance with the laws of Ireland. Data Protection and Notices and Consents You have a right to request a copy of the information we hold about you for which we may charge a small fee and to have any inaccuracies in your information corrected. ITC may use the information you have provided for the purposes of providing you with additional information relating to the goods and services of ITC, its associated companies and/or third parties. ITC may share information with its associated and affiliated companies and/ or carefully selected third parties, to enable those associated and affiliated companies and/or carefully selected third parties, to contact you directly in relation to their goods and services. If you do not agree to ITC s use of the information for such purposes, please tick the box provided. WARNING: If you propose to take out this Bond in complete or partial replacement of any existing policy, please take special care to satisfy yourself that this Bond meets your needs. In particular, please make sure that you are aware of the financial consequences of replacing your existing plan. If you are in doubt about this, please contact your current provider or financial advisor. WARNING: Please note that the provision of this product or service does not require licensing, authorisation, or registration with the Central Bank of Ireland and, as a result, it is not covered by the Central Bank s requirements designed to protect consumers or by a statutory compensation scheme. WARNING: This document is based on our understanding of current Revenue Law and Practice which is subject to change without notice. Signature of Bondholder: Date: Page 5 of 11

6 Purchasing Scheme - To be completed by Trustees or Existing Provider Name of Pension Scheme Revenue Reference Number Is the ARF option available under the scheme rules? Pensions Board Reference Number Normal Retirement Age Total value of AVCs paid to the scheme: Is the scheme a preserved benefit? Name(s) of Trustee(s) Name of Employer Is the transferring scheme? Defined Benefit / Defined Contribution (delete as appropriate) We hereby enclose with this application, a copy of the rules of the Purchasing Scheme as at the date of the investor s withdrawal from service of the Employer as specified in this application form. We declare, represent and warrant that the information given by us in connection with this application is accurate and complete to the best of our knowledge and belief. We confirm that this application is to be the basis for the benefits to be provided under this Bond. We confirm that no pension adjustment order has been served on the trustees in respect of this member. Trustee / Provider Signature: Date: I authorise the Trustees of the above scheme to transfer to the Bond the amount which in the opinion of the Trustees represents the value of my benefits on withdrawal under the pension scheme. In consideration of the payment of such transfer value to the Bond, I hereby release the Trustees from all liability to me and my dependents in respect of all benefits under the pension scheme with effect from the date of such transfer. Signature of Bondholder: Date: Page 6 of 11

7 Custody Trust Subscription (Application for Units) This application form relates to all initial and subsequent subscriptions for Units in the Custody Trust made by me on behalf of the Pension Investor as evidenced by the transfer of subscription monies into the appropriate Sub-fund account. Applicant Information Name of applicant(s): Address: To be completed by ITC Trust Reference: To be completed by ITC The Pension Investor: Representations and Warranties The capitalised words and expressions used in this application form shall have the meaning ascribed to them in the Custody Trust Declaration of Trust dated 25th April 2014, available to view on the ITC website at 1. I confirm that having considered the Declaration of Trust and a specimen Supplemental Declaration of Trust in relation to the Sub-fund, this application is based solely on the Declaration of Trust and the Supplemental Declaration of Trust and I am not relying on any other information or representation. 2. I agree that all representations, warranties and declarations which I make or give here will apply with respect to future acquisitions of Units in the Custody Trust as if repeated in full at the time of the future acquisition. 3. I hereby acknowledge and agree that the Trustee reserves the right at its sole discretion to accept or reject in whole or in part my application. 4. I acknowledge the right of the Trustee in its capacity as trustee of the Custody Trust to issue such number of Units to the Pension Investor upon the transfer of initial or subsequent subscription monies into the account of the Sub-fund as the Trustee may in its sole discretion determine in accordance with the provision of the Declaration of Trust. I further acknowledge and agree that the transfer of monies by me into the account of the Sub-fund will be deemed to be an irrevocable subscription for Units on behalf of the Pension Investor in the Custody Trust. 5. I acknowledge the right of the Trustee in its capacity as trustee of the Custody Trust, to redeem the Units in the event that the representations or warranties set out herein above are no longer accurate. Page 7 of 11

8 1. I acknowledge the right of the Trustee in its capacity as trustee of the Custody Trust to compulsory redeem Units in the event that the Pension Investor (i) hold such Units in breach of any law or requirement of any country or governmental authority; (ii) hold such Units in circumstances which in the opinion of the Trustee might result in the Trust incurring any liability for taxation or suffering any legal, pecuniary, regulatory or material administrative disadvantage which the Trust might not otherwise have incurred or suffered; or (iii) are not or cease to be a Pension Investor (as defined in the Declaration of Trust); or (iv) hold such Units in circumstances in the opinion of the Trustee might result in the Series Trust or Trust being deemed to be a unit trust scheme as defined in Section 1(1) of the Unit Trusts Act, 1990; (v) hold such units in the circumstances in the opinion of the Trustee might result in the Sub-fund or Trust being deemed to be an Alternative Investment Fund (as defined in the European Union (Alternative Investment Fund Managers) Regulations 2013). 2. I understand that during the Term of the Sub-fund, the redemption of Units shall be subject to restrictions which may adversely affect the ability to redeem Units. 3. I shall provide the Trustee with any additional information which it may require in connection with my tax status and authorise them to disclose such information relating to this application to such persons as it may be required for taxation, legal or regulatory purposes. 4. I acknowledge that it is envisaged that additional subscriptions for Units in the Custody Trust shall be made in such an amount as shall be determined by me. Where additional subscriptions are not made and where, as a result, there may not be sufficient assets within the Series Trust to discharge its liabilities from time to time I acknowledge that this may result in the Trustee being obliged to sell or otherwise dispose of some or all of the assets of the relevant Series Trust. 5. I have consulted to the extent I have determined appropriate with my own advisers as to the financial, tax, legal and related matters concerning an investment in the Custody Trust and on that basis believe that an investment in the Custody Trust is suitable and appropriate. Acknowledged and agreed by; Applicant (Investor) / / Date: Page 8 of 11

9 ITC Buy Out Bond Application Checklist Please return the following documents to ensure the successful acceptance of your application. 1. Proof of ID Check One of the following: a. Current (i.e. in date) and valid passport. b. Current and valid Driving Licence Certified as a true copy of the original by an Accountant, Solicitor or Regulated entity based in Ireland. 2. Proof of address Check Two of the following & less than 3 months old from the issue date: a. A recent Utility Bill for the client s home address such as landline phone, gas and electricity b. Bank / Building Society/ financial institution statement c. Revenue documents (these three only) a) Tax Credit Statement b) Revenue Balancing Statement c) Revenue C2 Tax Certificate Certified as a true copy of the original by an Accountant, Solicitor or Regulated entity based in Ireland. Page 9 of 11

10 ITC Fee Schedule for Buy Out Bonds Initial Charge ITC will not apply a set up charge on establishment of the Buy Out Bond. No contribution charge will apply to transfers received from other pension schemes. Management Charge The management charge is based on the Net Asset Value of the assets held as follows; Type 1 e.g. cash, portfolio of shares held by stockbroker, tracker funds, life bond Type 2 e.g. property 0.25% NAV 0.50% NAV Minimum management charge 900 Additional Information 1. ITC will apply the management charge in advance on an annual basis. 2. The management charge will be deducted from the funds in the Buy Out Bond. 3. Furthers charges may be applied in respect of particular investments made within your Buy Out Bond. You will be notified of these charges at the time of investing by the promoter/asset manager of the investment. 4. Any annual fees charged in excess of the amounts above will be paid to your advisor. Propertyline There is a once-off legal and administrative fee for property purchases that will be outlined in advance of the purchase process proceeding. Page 10 of 11

11 Independent Trustee Company Limited Harmony Court Harmony Row Dublin 2 Tel: (01) Fax: (01) info@independent-trustee.com PR Effective from April Independent Trustee Company Limited, part of the ITC Group, is regulated by the Central Bank of Ireland. Please note that the provision of this product or service does not require licensing, authorisation, or registration with the Central Bank of Ireland and, as a result, it is not covered by the Central Bank s requirements designed to protect consumers or by a statutory compensation scheme.

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