Cannon SuperDogs Investment Application

Transcription

1 Cannon SuperDogs Investment Application 1. Notes and Requirements 1.1. Requirements on submission of this investment application, without which it will not be processed: Verification of the identity of the policyholder by either a verified copy of a South African Identity Document or valid passport where the photograph is clear and text is legible; Verification of residential address for the policyholder by way of: A verified copy of a utility bill, e.g. telephone or electricity account showing policyholder name and residential address, or; A recent statement of your bank account details printed by the bank (screen dump) showing policyholder name and residential address, such statement that is stamped by the bank in question; 1.2. Verification of residential address may not be more than 3 months old from the date of application. 2. Individual Applicant Details Title: Surname: First Name(s): Residential Address: Postal Address: Postal Code: Contact Details: Tel: Mobile: Date of Birth: ID No.: Income Tax No: Tax Office: Page 1 of 7

2 3. Trust Applicant Details This product is only available to trust applicants where the beneficiaries of the trust are all natural persons. Registered Trust Name: Reg. Number of Trust: Registered Address: Contact Details: Name: Tel: Fax: 4. Person Acting on Behalf of Applicant Capacity*: Power of Attorney Curatorship Court appointed guardianship Estate Late Executor * Please note that certified proof of the capacity stated above will be required on the submission of this application, without which it will not be processed. Title: Surname: First Name(s): Date of Birth (dd/mm/yy): ID/Passport No.: Residential Address: Code: Postal Address: Code: Contact Details: Home: Mobile: Signature of person acting on behalf of applicant Date: Page 2 of 7

3 5. Life Assured If no life assured is completed in this section it will be assumed that in the case the applicant is an individual, they will be considered the life assured. Should the applicant be a trust, this section is mandatory and the life assured must be a natural person. Title: Surname: First Name(s): Contact Details: Tel: Mobile: Date of Birth: ID No.: 6. Beneficiary Details for Proceeds If you have nominated someone other than your estate or your spouse as beneficiary and you are married in community of property, in terms of the Matrimonial Property Act, 1984, the consent of your spouse is required to authorise your beneficiary nominations Are you married in community of property? Yes No (If you are not married, please select NO) If you answered YES to the above question please ensure the signature of a spouse below I, the spouse of the applicant named herein, hereby agree to the nomination/s made by the applicant below. Signature of Spouse: Date: 6.3. Beneficiary Nominations: Title Initials Surname Relationship ID Number Share of Benefits (Total 100%) If no beneficiary is nominated above, it will be assumed, in the case of the investor being a natural person and on their death, that the beneficiary will be the estate of the deceased. In the case of trust investors, beneficiary status will fall to the trust. 7. Financial Services Provider Details and Declarations 7.1. Financial Services Provider Details: FSP Name (Corporate): FSP Name (Individual): Contact Details: Name: Tel: 7.2. Financial Services Provider FAIS Declaration: I declare that I have made the disclosures required in terms of FAIS, to the applicant. Page 3 of 7

4 7.3. Financial Services Provider Policy Replacement Declaration: Important note: Replacement of any insurance is generally to the disadvantage of the proposer Is this application to replace the whole or any part of your existing insurance with any assurer, whether replacement is to occur immediately or to replace an insurance discontinued within the past four months? Yes No (Please tick as appropriate) If Yes the financial services provider (Financial Services Provider/FSP) must discuss with the applicant and complete the Replacement Policy Advice Record and attach it to this Investment Application I hereby declare that I have requested and recorded the client s response to the question above with regard to replacement and that the client is fully aware of the possible detrimental consequences of the replacement of an insurance policy I further declare that, irrespective of the client s response to the question above, I explained the following to the client: The meaning of replacement; That a replacement is potentially prejudicial and; That where a replacement is considered, the client is legally entitled to comprehensive information regarding the consequences of replacement. FSP Signature: Signed in agreement and in confirmation of all the above. 8. Payment Details No cash deposits will be accepted. Any amounts in excess of ZAR 5 million must be sent as an EFT, unless a stock transfer is being made to fund the investment. Payment made by Cheque EFT Stock Transfer Hollard Life will process this application form only upon receipt of funds and confirmation thereof by our bankers. If as a result of funds not being cleared and subsequent investment losses are experienced, the applicant will be liable for these losses. Payment should be made to either of the following bank accounts: Bank Name STANDARD BANK Bank Name FIRST NATIONAL BANK Branch Name Johannesburg Branch Name Corporate Account Services Branch Code Branch Code Acc Name Hollard Wealth Management Investment Products A/C Acc Name Hollard Life Assurance Co. Ltd Wealth Management Premium Acc Number Acc Number Please indicate into which bank account you will be depositing your funds. Standard Bank First National Bank 9. Source of Funds This is a requirement in terms of the Financial Intelligence Centre Act (FICA) and both below must be completed Source of funds being invested (e.g. savings/ bonus/ inheritance) 9.2. Source of applicant s income (e.g. salary/ dividends) Page 4 of 7

5 10. Reporting Monthly valuations will be monthly by the 10 th working day following month end and sent by either or facsimile. Please specify how you would prefer your valuations be sent and supply details accordingly: Per Att: Per fax: ( ) Att: 11. Charges Product Charge 0.50% p.a FSP Initial Commissions Between 0% and a maximum of 3.0% + VAT on the value of initial premium FSP Ongoing Service & Advice Fee p.a Tax Charge on Taxable Income 15.00% p.a Tax Charge on Taxable Capital Gains 3.75% p.a. Between 0% and a maximum of 0.5% + VAT on the value of the investment account* Asset Manager Fees Asset Management Fee Performance Fee Cannon SuperDogs Portfolio 1.50% flat fee (excl. VAT)** 15% over benchmark*** * This may be over and above the FSP s participation in the asset management fee. ** Introducing FSP s participate in 0.5% of the flat fee (excl. VAT). *** Please refer to the relevant fact sheet for a reference to the appointed benchmark for this portfolio. 12. Investment Details Please note: The minimum investment amount may not be less than R100,000; From time to time new investment portfolios will be made available, some of which may have a sub-minimum investment amount; Each investment portfolio will attract investment portfolio charges/fees, dependant on the applicant s selection made; The Cannon SuperDogs Investment does not offer any capital guarantee, or any guarantee on investment returns; All performances quoted on the relevant fund fact sheets are net of all asset manager fees. INVESTMENT PORTFOLIO NAME RiY^ Worst Case Return after expenses^ INVESTMENT AMOUNT (Enter either ZAR or Percentage) Cannon SuperDogs Portfolio 3.5% 6.5%% % R ^ Effect of expenses The reduction in yield (RIY) shows the extent to which the return on the assets will be eroded due to expenses charged against the policy. The assumed gross investment return of 10% used to calculate the RiY shown in the table is not guaranteed, but merely used to illustrate the impact of expenses. The actual investment return earned on premiums paid in, will depend on the gross investment return earned on the assets and the extent to which this return is reduced by taxation and expenses. Note on performance fee The above RIY figure includes a performance fee levied on the underlying funds. This amount assumes that the fund return is the same as that of its benchmark, as disclosed in the relevant fund fact sheets produced by the investment manager in question. The actual performance fee could be higher or lower depending on the performance of the underlying fund. The performance fee is specific to the fund and is also disclosed in the investment manager fund fact sheets. Effect of Inflation The gross investment return will depend on financial market conditions and the rate of inflation during the policy term. Inflation has a major impact on investment returns, and in general higher inflation leads to higher investment returns and lower inflation leads to lower investment returns. Real rates of return (the excess of the investment return over the inflation rate) give a more meaningful indication of how the investment has performed. Effect of Taxation Depending on the type of policy, insurance companies pay different rates of tax on investment returns. The effective tax rates may also be different between insurance companies, based on their level of expenses. All benefits paid out under a policy are net of tax and there are thus no further tax obligations for the policyholder. Any reduction/changes in these charges will reduce the RiY, which may be higher or lower, depending on the performance of the underlying investment portfolio. Page 5 of 7

6 13. Applicant Declaration and Signature I understand and acknowledge that the Cannon SuperDogs Investment is a single endowment policy issued by Hollard Life; I declare that all statements given in this proposal are true and correct, and agree that they shall form part of the contract between Hollard Life and me with regard to the policy. I also understand that the answers to all questions and statements given herein, and any other documents required by Hollard Life, shall be the basis of the contract; I agree that my policy will not commence until receipt, by Hollard Life, of my duly completed investment application, supporting documentation and initial premium. I further understand that the policy will not participate in investment returns of the selected portfolios until the allocated amount is invested; I hereby authorise Hollard Life to deduct from the policy all policy charges as set out in the policy schedule and policy conditions; I understand that due to the nature of this policy a cooling-off period is inappropriate and therefore does not apply; I acknowledge that a notice period, as specified in the investment portfolio rules is required for surrender/encashment purposes, and that the surrender/encashment amount is limited to the value of the underlying investments, less any fees applicable; I understand that in addition to point 6 above, the surrender value of this investment is limited by legislation. In terms of current legislation the surrender value in the first five years of the policy may not exceed the premium plus 5% per annum, compounded; I understand that Additional premiums are subject to constraints as specified in the Long-Term Insurance Act 52 of 1998, which may be updated/amended from time to time and that should any additional premiums be outside the constraints mentioned therein, that particular premium will be subject to the five (5) year restrictions; I understand that no advice has been or will be provided to me by Hollard Life and that I am solely responsible for the selection of the investment portfolios to be held within the policy; I understand that Hollard Life is not responsible for the returns, the investment manager charges or the performance of the investment portfolios held in the policy; I understand that the Cannon SuperDogs Investment does not guarantee any capital, or any investment returns, however some of the available underlying linked investment portfolios may offer a guarantee. The policy benefits are determined solely by reference to the returns of the selected linked investment portfolios held for the purpose of the investment; I acknowledge and agree that all facsimile/electronic representations of all documents, including this investment application, and any other instructions hereafter, including mandates, consents, commitments and the like, which purport to emanate from me, shall be deemed to have been given by me in the form actually received by Hollard Life. I hereby waive any rights I may have or may obtain against Hollard Life arising directly or indirectly from any losses or damages that I may suffer because Hollard Life acted on any purported facsimile/electronic representations, and I indemnify Hollard Life against any claims, demands or actions suffered by them because they acted on a facsimile/electronic representation; I confirm that the funds invested in terms of this agreement are not the proceeds of any unlawful activity, as defined in the Prevention of Organised Crime Act 21 of 1998 and the Financial Intelligence Centre Act (FICA) 38 of 2001, including any other applicable and existing regulatory framework; I, the undersigned, confirm that I have read and completed, whether in my handwriting or not, this declaration and understand its implications; I understand and accept all risks associated with this investment. In addition, I confirm that I have read all relevant documentation associated with this policy and I fully understand the financial risks associated therewith; I confirm I have reviewed the criteria necessary for investment in this policy and that I meet the investor criteria; I have satisfied myself that under any taxation or assurance legislation to which I may be subject, I am permitted to effect the policy, I furthermore confirm that I have signed this declaration of my own free will and I regard it as binding; I hereby consent to the disclosure to and use by third parties (wherever situated) of my personal data for administrative and/or servicing purposes in connection with the re-insurance, administration and/or servicing of this contract and related purposes Page 6 of 7

7 I hereby acknowledge that my financial services provider, as specified herein, is my appointed financial services provider; I hereby agree to the annual product charge, payable to Hollard Life as specified in the investment portfolio guidelines; I hereby agree to the payment of all commissions, charges and fees associated with this policy as set out in the signed quotation, attached hereto, and any other documentation in which it is appropriate to declare such commissions, charges and fees; I hereby confirm that my financial services provider will be paid the following upfront commission and ongoing service and advice fee, and am aware that the payment of these amounts will directly influence my initial investment value and my ongoing unit balance respectively I hereby agree to allow Hollard to retain the right to delay redemptions from the fund based on the underlying liquidity of the portfolio Upfront commission % (Between 0% and 3.0% + VAT) Ongoing service and advice fee % (Between 0% and 0.5% p.a. + VAT p.a.)^ ^ The above Ongoing Service and Advice Fee is paid for the provision of ongoing financial advice in relation to this investment. This will be calculated on the policy value and taken as a monthly charge from the value of my investment account. I understand that I am entitled to change this percentage or redirect this charge to another appointed FSP, at my discretion. This fee may be over and above the FSP s 0.5% participation in the asset management fee I authorise my financial services provider to act on my behalf and give investment instructions on my Cannon SuperDogs Investment. Yes No Signed at on this day of (Place) (Day) (Month) (Year) Signature: Official capacity: Underwritten by Hollard Life Assurance Company Limited 22 Oxford Rd, Parktown, Johannesburg, 2193 Tel: Fax: linkedfundsadmin@hollard.co.za Page 7 of 7