Application form. For trustees and companies Wealth Management Portfolio. Please read these notes before completing this instruction.

Transcription

1 For trustees and companies Wealth Management Portfolio Application form Please read these notes before completing this instruction. About this form You should use this form if you re a company or a trust applying for a new Wealth Management Portfolio. If you re an individual investor, please complete the application form labelled For individual investors instead. Please complete all relevant sections of this form by typing in the fields. Once complete, please print and sign using a pen. Alternatively, please print and complete this form in BLOCK CAPITALS using a pen. If any of the information on this form needs to be changed, it should be initialled by all applicant(s). We can t accept your application if your principal place of residence or the country in which the trust is resident is outside the UK. You should speak to your financial adviser to get further information on the types of applications we can accept. When completed, please post this application, and your payment (if applicable) to: Aegon Ireland New Business c/o Aegon UK Edinburgh Park Edinburgh EH12 9SE Please make sure this application is sent to our address above and wait at least 24 hours before attempting to transfer funds electronically. This form is split into two parts: Part A contains the sections to be completed by you and your adviser. You should complete sections Your adviser should complete section 14. Part B contains important notes that apply to the application. Make sure you read the important notes before you sign the declaration, especially if you ve agreed to pay an adviser charge. Check details already filled in If any details are already completed (based on what you ve told your financial adviser), you should check these before you sign the declarations in sections 12 and 13. Additional information Depending on the choices you make, you may need to complete additional forms. These forms can be found by linking to them in this form or in our documents library at aegon.ie. Whenever you see this icon, we re asking you to send us additional material with this form. Where you see this icon i it means there s information in the Important notes section in Part B.

2 Part A 1. Ownership details The Wealth Management Portfolio is to be owned by please select: a company go to section 2 trustees of a new or existing trust go to section 3 2. Company details Company name Nature of business Registered number Phone number Company registered address address We ll only use the details you provide in this section to contact you about your application and bond. See section 10 for details. Principal business address (if different from company registered address) Page 2 of 30

3 3. Trust details If you want to add more than four trustees, give full details on a separate sheet of paper and attach it to this application. This separate sheet must be initialled by all applicants. Trust name Type of trust What s the life/lives assured relationship to the trust? Please note the life/lives assured should be the beneficiary/beneficiaries of the trust. We ll send all correspondence relating to this application to the principal trustee. Principal trustee Title Mr / Mrs / Miss / Ms / Other please specify Second trustee Title Mr / Mrs / Miss / Ms / Other please specify Address Address Date of birth (dd/mm/yyyy) Date of birth (dd/mm/yyyy) Nationality Nationality Occupation Occupation Gender Male Female Phone number Gender Male Female address We ll only use the details you provide in this section to contact you about your application and bond. See section 10 for details. Page 3 of 30

4 3. Trust details continued Third trustee Title Mr / Mrs / Miss / Ms / Other please specify Fourth trustee Title Mr / Mrs / Miss / Ms / Other please specify Address Address Date of birth (dd/mm/yyyy) Date of birth (dd/mm/yyyy) Nationality Nationality Occupation Occupation Gender Gender Male Female Male Female Page 4 of 30

5 4. Lives assured If this is a company application, all lives assured must be employees of the company. If this is a trust application, you should enter the beneficiary/beneficiaries of the trust as the life/lives assured. If the trust is a Discounted Gift Trust (either Bare or Discretionary), the settlor or their spouse can t be a life assured. There must be an insurable interest for all lives assured. First life assured Title Mr / Mrs / Miss / Ms / Other please specify Second life assured Title Mr / Mrs / Miss / Ms / Other please specify Address Address Date of birth (dd/mm/yyyy) Date of birth (dd/mm/yyyy) Nationality Nationality Gender Gender Male Female Male Female Page 5 of 30

6 4. Lives assured continued Third life assured Title Mr / Mrs / Miss / Ms / Other please specify Fourth life assured Title Mr / Mrs / Miss / Ms / Other please specify Address Address Date of birth (dd/mm/yyyy) Date of birth (dd/mm/yyyy) Nationality Nationality Gender Gender Male Female Male Female If you want to add more than four lives assured (six is the maximum), give full details on a separate sheet of paper and attach it to this application. This separate sheet must be initialled by all applicants. Page 6 of 30

7 5. Investment details There are important notes in Part B that you should read before completing this section, see i note Total amount to be invested the minimum premium is 15,000, unless you want to invest in external assets, in which case the minimum premium is 75,000. If you agree to pay your financial adviser an initial adviser charge, you can select for it to be deducted from the contribution amount stated here before any investment is made into the bond (see section 7.1). The remaining amount then becomes your premium. Currency Contribution amount Payment method please select: Cheque made payable to Aegon Ireland plc. Telegraphic transfer send us a copy of the telegraphic transfer form with this application. The original should be sent directly to your bank. Banker s draft made payable to Aegon Ireland plc. 5.2 Bond denomination currency please select: UK sterling Euro US dollar If you don t select a bond denomination currency, we ll convert the investment into, and value it in, UK sterling. Number of policies required If you leave this box blank, we ll issue your bond with 10 related policies. You can select from a minimum of 10 up to a maximum of 1,000 related policies. The premium will be divided equally among all related policies. 5.3 Illustration number Give the reference number from your personal illustration (you ll find this on the front page of your illustration). Page 7 of 30

8 5. Investment details continued 5.4 Investment strategy You must choose one of options a, b or c. I/We (the applicant/ applicants) advise that my/ our investment strategy is on the following basis: a Client instruction only I/We (the applicant/applicants) decide the investment strategy and give investment instructions on the basis of the advice I/we have received from my/our financial adviser on the merits of each transaction and that it s suitable and in line with my/our attitude to risk. or b Appointment of an investment adviser** Name of investment adviser Name of firm/company I/We (the applicant/applicants) acknowledge that, on the basis of my/our instructions or the instructions of the investment adviser acting on my/our behalf, Aegon may appoint another firm to provide investment management services in respect of some or all of the assets linked to the bond. or c Appointment of a discretionary investment manager** Name of investment adviser Name of firm/company **Important note: If you select option b or c here, you must also complete and attach an Investment services appointment form, or any other form that we may provide for this purpose. You should take some time to read the agreement and make sure you understand the obligations of each party Custodianship We ll assume that Aegon s usual custodian is to retain custody of the assets of your bond, unless the following box is marked. I/We (the applicant/applicants) recommend that the custodian named below is appointed to provide dealing and custodial services in respect of the portfolio. If you select a custodian other than Aegon s usual custodian, you ll also need to complete our Investment services appointment form, or any other form that we may provide for this purpose. Name of custodian Custodian contact details (for servicing enquiries) Page 8 of 30

9 5. Investment details continued 5.5 Investment funds Aegon international portfolio funds Please complete the following table if you re investing solely in our Aegon international portfolio fund range. The percentages you enter here apply to the premium, which may differ from the amount you ve entered in section 5.1. Instructions to buy external assets mustn t be entered in this table. Aegon international portfolio funds Percentage (%) Total 100% External assets Where Aegon s usual custodian retains custody and if your investment is 75,000 or more and you want to invest in external assets, please complete our Dealing instruction form. Please note your premium will be placed in the portfolio cash account until we receive a completed Dealing instruction form signed by the appropriate authorised individual(s). If this is a dual custodianship portfolio, a Dealing instruction form will need to be completed and signed by the investment adviser/manager. Risk warning You should always seek advice from your financial adviser if you re selecting an asset for your bond. We don t promote or market any asset and will process your instruction as an execution-only transaction (see section 5.4 a) on the basis that you ve received your own advice on the merits of the transaction and that it s suitable and in line with your attitude to risk. The risks you should consider, prior to completing this form, include but aren t limited to: the complexity of the investment strategy and the extent to which the underlying assets of the fund may be speculative or illiquid; the permissibility criteria set out in the policy conditions and the extent to which these are satisfied; whether an external fund is a non-mainstream pooled investment such as a professional investor scheme, a UCIS, close substitute of a UCIS, or other type of fund regulated outside the UK and any associated financial and governance risks; and the level of protection available to investors in circumstances where the fund is purchased through your bond (in the name of our usual custodian) with classification by the fund manager generally as professional rather than retail client. A UCIS is a collective investment scheme in relation to which the operator hasn t applied for or obtained FCA authorised or recognised scheme status. They re not generally subject to FCA or similar overseas rules on the operation of collective investment schemes. There are restrictions that apply to the promotion of UCIS type funds since these funds are only suitable for certain types of investors. Page 9 of 30

10 6. Regular withdrawals There are important notes in Part B that you should read before completing this section, see i notes 2 and Please give details of the regular withdrawal you wish to take (only select one option): Amount to be withdrawn: Percentage of the premium. % a year The amount to be withdrawn shall increase proportionately in line with future additional investments. However, it won t reduce proportionately in line with any individual policies you cash in. or Percentage of the remaining premium. % a year The amount to be withdrawn will increase proportionately in line with any future additional investments. It will also reduce proportionately in line with any individual policies you cash in. or Frequency of payment: Monthly Half-yearly Quarterly Yearly Regular withdrawal start date (dd/mm/yyyy) payments may take up to six business days from each withdrawal date to reach your account. The start date you choose can t be earlier than five business days after the start of this bond. If your selected regular withdrawal date has passed, or is within five business days of the start of this bond, we ll start your regular withdrawal on the next available date. If you d prefer it to start on that specific day in the following month, please mark this box. Fixed monetary amount of per instalment, in the bond denomination currency. 6.2 Payment of regular withdrawals We make all payments in the bond denomination currency and only into the bank account of the policyholder(s). We can t make payments to third parties. We can only make payments to bank accounts held in the European Union (EU). If you want to pay the regular withdrawals to two separate bank accounts, please complete both a and b below. If the regular withdrawal is only being paid to one bank account, you only need to complete section a. Where you re paying the regular withdrawal to two bank accounts, please make sure the percentage split for payment totals 100%. If it doesn t, then payment may be delayed. If you only provide one set of bank details, we ll pay the full regular withdrawal amount to that account. Page 10 of 30

11 6. Regular withdrawals continued a Payment details first account Percentage of the regular withdrawal amount to be paid to this account % Building society roll number/reference Sort code Name of bank Bank branch address For non-uk bank or building society accounts and non-sterling bank/building society accounts, (account must be held in the EU). IBAN number Account number Swift code Account name # Account name # # If a joint bank account holder isn t an applicant, please provide further information in section 11. b Payment details second account (if applicable) Percentage of the regular withdrawal amount to be paid to this account (the percentage here and in a must total 100%) % Name of bank Bank branch address Building society roll number/reference Sort code For non-uk bank or building society accounts and non-sterling bank/building society accounts (account must be held in the EU). IBAN number Swift code Account number Account name # Account name # # If a joint bank account holder isn t an applicant, please provide further information in section 11. Page 11 of 30

12 7. Adviser charge instruction There are important notes in Part B that you should read before completing this section, see i notes 3 and 4. If this bond is to be taken out along with a Discounted Gift Trust, you should also read i note 6. The amounts entered in this section should match your personal illustration. 7.1 Initial adviser charge You should only complete this section if you ve agreed to pay your financial adviser this one-off charge. Please complete the initial adviser charge you ve agreed to pay (only select one option). Fixed amount in your bond currency of or Percentage amount % Please confirm how we should make this payment to your financial adviser (only select one option): or From the contribution amount you send us. This means the premium invested into your bond will be your contribution amount less the initial adviser charge. From your bond. This means the full payment you send us is the premium invested into the bond. The initial adviser charge will then be deducted from your bond across all related policies. Withdrawing the initial adviser charge from your bond counts towards your yearly 5% tax-deferred withdrawal allowance. If you ve any questions, please speak to your financial adviser. 7.2 Ongoing adviser charge You should only complete this section if you ve agreed to pay your financial adviser this regular charge for their ongoing services. The ongoing adviser charge will be deducted across all related policies and it will count towards your yearly 5% tax-deferred withdrawal allowance. If you ve any questions, please speak to your financial adviser. Payments of this charge can t start sooner than five business days after the start date of your bond. If you don t advise us of a start date, if your selected charge start date has passed or is within five business days of the bond issue date, we ll start the charge as soon as possible at the end of the next available month. a Please complete the ongoing adviser charge you ve agreed to pay. You can select one option or you can choose to combine option a with one of the other options. Amount equal to a percentage of the bond value c Amount equal to a percentage of the premium % per year Please select the frequency of payment for option (a). Monthly Half-yearly Quarterly Yearly starting at the end of (mm/yyyy) d % per year or Amount equal to a percentage of the remaining premium % per year Please select the frequency of payment for options b, c or d. Monthly Quarterly b Fixed monetary amount in the bond currency of Half-yearly Yearly Starting at the end of (mm/yyyy) or per year Page 12 of 30

13 8. Source of wealth Aegon Ireland plc is required by law to check where the money you re investing comes from. In some cases, we may need to see documentation as proof of this. Your financial adviser will be able to tell you whether this affects you. If you need more space, you can continue on a separate sheet of paper and attach it to this form. This should be signed and dated by all applicants. If company profits are noted as the source of wealth, we require a certified copy of the company s most recent audited accounts. Give us full details of how you ve acquired the money you re investing (for example, inheritance, gift, pension, salary or sale of assets/property investments). 9. Source of funds You only need to complete this section if you re paying by a method other than personal cheque. Give details of the bank account that your contribution to the bond will come from. Name of bank Account name # Account number Sort code Branch # Please complete section 11 if one of the named account holders isn t an applicant. Page 13 of 30

14 10. How your information will be used Processing your personal data Your bond is administered in Ireland so it comes under Irish laws on privacy of personal data. These laws are the Data Protection Act 1988 and the Data Protection (Amendment) Act 2003, and any subsequent related legislation. In line with this legislation, Aegon Ireland plc is the data controller of the information you provide for this application. The information collected for your application will come to us in Dublin. Our confidentiality policy means that all personal data is held securely and access is limited to those who need to see it. We ll only use the information you provide for purposes in connection with the agreement between us (and related services) that you ve applied for. This includes for administration, managing claims and dealing with any issues you may have with your bond. We ll share permitted relevant information (which may include information about individuals and entities named in this application): with certain bodies when we legally have to, for example regulatory bodies or authorities such as the UK s Financial Conduct Authority, or the Irish Revenue Commissioners; with HM Revenue & Customs where one or more policyholders is either UK tax resident or has a UK address; to comply with international tax obligations for example Foreign Account Tax Compliance Act (FATCA) and Common Reporting Standard for Automatic Exchange of Financial Account Information (CRS); when we need to in order to comply with money laundering laws and for other purposes, for example detecting crime; to comply with anti-money laundering regulations we may verify your identity (or the identity of other interested parties) by carrying out a database search with a commercial agency. The search is carried out against public and other types of records. It will also check whether you have bank or credit facilities for identity verification purposes only. It won t disclose any information about your financial status in relation to these accounts. A record of the search will be retained but it won t affect your credit rating; with people who are acting on your behalf and with people who are acting as agents on your behalf (for example your financial adviser), so that they can fully carry out their role as your agent; with other companies in the Aegon group; with anybody you assign or transfer your policies to in the future; with third party providers where it s reasonably necessary to do so to enable them to provide services to us in relation to your policies; or with reinsurers we do business with. Page 14 of 30

15 11. Details of other interested parties If an interested party isn t an applicant (including a joint account holder, third party payor, power of attorney) the identity of that person must also be verified as per our anti-money laundering requirements. If you need to provide details of more than two interested parties, give full details on a separate sheet and attach to this application. This should be initialled and dated by all applicants. For individual(s) please provide: Title Mr / Mrs / Miss / Ms / Other please specify Nationality Date of birth (dd/mm/yyyy) Relationship to applicant (for example spouse, child, grandchild) Address (if different from applicants) For corporate entities please provide: Company name Company registered number Nationality Company registered address Date of birth (dd/mm/yyyy) Relationship to applicant (for example spouse, child, grandchild) Principal business address (if different from company registered address) Title Mr / Mrs / Miss / Ms / Other please specify Nature of business Address (if different from applicants) See section 14 for more information on how anti-money laundering verification is carried out. Page 15 of 30

16 12. Declaration by applicant(s) You should take some time to read the declaration before signing this form. You should only send us this instruction if you understand the contents of the declaration and the responsibilities of each party. Where this is a trust application, all trustees must sign and date this declaration. It s a legal requirement that the trust document must be dated on or before the date of the application. In this declaration, I/We means the applicant(s) and you means Aegon. I/We have read the important notes in Part B and acknowledge that they form part of this application. I/We/the company apply/applies for Wealth Management Portfolio policies on your standard terms. I/We declare that the answers to the questions on this form are true to the best of my/our knowledge and belief and I/we agree that they will form the basis of the contract. I/We have read over the answers filled in on my/our behalf and confirm that they are correct. I am/we are aged 18 years or over. I am/we are/the company is not, by virtue of my/our country of residence or nationality, subject to any taxation or legislation that would make this investment unlawful. I/We acknowledge that my/our/the company s policies will be set up under and governed by the law of Ireland. For companies only: I/We confirm that the life/lives assured are employees of the company and that the company has an insurable interest in the life/ lives assured of at least the amount invested. Consent to processing my data I/We consent to you processing and using my/our personal data (and, where appropriate, the personal data of other people named in this form) and we are authorised to give this consent on behalf of other people in this form as explained in section 10. Consent to adviser charges I/We authorise you to deduct the adviser charge(s) agreed with my/our financial adviser as set out in section 7 and facilitate the onward payment of the amount deducted to my/our financial adviser. I/We acknowledge that you in performing this role will be acting as agent for my/ our/the company s financial adviser for the sole purpose of transferring the amount equal to the adviser charge that has been deducted to my/our/the company s financial adviser. I/We acknowledge that if I/we/the company exercise(s) the right to cancel the policies, the amount I/we/the company get(s) back will be less any adviser charges I/we/the company have instructed you to facilitate. I/We hereby undertake to inform you in writing if I/we terminate my/our relationship with the financial adviser named in this form and appoint a new financial adviser. I/We acknowledge that I/we/the company have/has received copies of the pre-sale literature for the policies including the key features document and personal illustration, from my/our/the company s financial adviser and note the impact any adviser charges will have on the policies. I/We acknowledge and agree that, where I/we have instructed you to purchase external asset(s), or transfer funds to a particular custodian or platform for subsequent investment, that: i you will execute this instruction as an execution-only transaction on my/our specific instructions; Page 16 of 30

17 12. Declaration by applicant(s) continued ii by processing this instruction you are not endorsing, marketing or promoting any external asset selected and I/we accept full responsibility for all instructions placed; iii you have not given me/us advice on the merits of the transaction and that this instruction has been submitted by me/us on the basis of: investment advice I/we have received from my/our financial adviser in relation to my/our policies; or a discretionary investment mandate that has been established by me/us in relation to my/our policies; iv my/our investment adviser or manager who is acting on an advisory or discretionary basis is solely responsible for determining whether a particular fund is suitable for my/ our policies and whether I/we have the necessary experience and knowledge to understand the risks involved in relation to that fund. Date (dd/mm/yyyy) Capacity in which declaration is made (for example owner, trustee, authorised signatory, power of attorney ## ) Signature(s) of individual(s)/trustee(s) 7 7 Capacity in which declaration is made (for example owner, trustee, authorised signatory, power of attorney ## ) Capacity in which declaration is made (for example owner, trustee, authorised signatory, power of attorney ## ) Signature(s) of individual(s)/trustee(s) 7 7 Capacity in which declaration is made (for example owner, trustee, authorised signatory, power of attorney ## ) Signature(s) of individual(s)/trustee(s) 7 7 Capacity in which declaration is made (for example owner, trustee, authorised signatory, power of attorney ## ) Signature(s) of individual(s)/trustee(s) 7 7 Capacity in which declaration is made (for example owner, trustee, authorised signatory, power of attorney ## ) Signature(s) of individual(s)/trustee(s) 7 7 ## If a power of attorney applies, the identity of that person must also be verified as per anti-money laundering requirements. Please see section 11 for further information. Signature(s) of individual(s)/trustee(s) 7 7 Page 17 of 30

18 13. Declarations about international tax obligations Please complete the relevant sections below so we can fulfil our reporting obligations to Irish Revenue. For trust applications, please complete 13.1, 13.2, 13.3 (if appropriate) and The trustees and settlors should sign the declaration at For company applications, please complete section 13.5 and sign the declaration at *Taxpayer identification number this is the number that the tax authority use to identify you. For example, in the UK it would be your National Insurance number or your company tax number. **Please give details of all tax jurisdictions you re resident in For trustees (including corporate trustees) Name Date of birth Taxpayer identification number(s)* Jurisdiction(s) of tax residence** Please give details of the jurisdiction in which the trust is resident For settlors (if not also a trustee) Only complete this section if this is a trust application. Complete details of all settlors, including settlors who are no longer alive. Where the settlors are still alive, they ll also have to sign the declaration at 13.6 confirming they aren t resident or ordinarily resident in Ireland. If more than two settlors are involved, please copy all of this section of the form, complete and make sure the additional settlors sign the declaration. Title Mr / Mrs / Miss / Ms / Other please specify Date of birth Address Settlor one Settlor two Taxpayer identification number(s)* a. a. b. b. Jurisdiction(s) of tax a. a. residence** b. b. Page 18 of 30

19 13. Declarations about international tax obligations continued 13.3 Protectors details Only complete this section if this is a trust policy and if a protector has been appointed to the trust. Title Mr / Mrs / Miss / Ms / Other please specify Date of birth Address Protector one Protector two Taxpayer identification number(s)* a. a. b. b. Jurisdiction(s) of tax a. a. residence** b. b. Page 19 of 30

20 13. Declarations about international tax obligations continued 13.4 Beneficiaries details Only complete this section if this is a trust application. The following must be completed for all beneficiaries of bare trusts, beneficiaries who are to receive direct payments from discretionary trusts and for beneficiaries with an interest in possession of other trust types. Please speak to your financial adviser if you re unsure. If more than four beneficiaries are involved, please copy all of this section of the form and complete. This separate sheet must be initialled by all applicants. Title Mr / Mrs / Miss / Ms / Other please specify Date of birth Address Beneficiary one Beneficiary two Taxpayer identification number(s)* a. a. b. b. Jurisdiction(s) of tax a. a. residence** b. b. Title Mr / Mrs / Miss / Ms / Other please specify Date of birth Address Beneficiary three Beneficiary four Taxpayer identification number(s)* a. a. b. b. Jurisdiction(s) of tax a. a. residence** b. b. Page 20 of 30

21 13. Declarations about international tax obligations continued 13.5 For company applications only Only complete this section if this is a company application. Jurisdiction of tax residence of the company Is this company currently trading? Yes No Company tax number Beneficial owners Please complete the table below for beneficial owners who hold or control 25% or more of the shares or voting rights in a company or who otherwise exercises ultimate effective control over the management of the company. If more than four beneficial owners are involved, please copy all of this section of the form and complete. This separate sheet must be initialled by all applicants. Title Mr / Mrs / Miss / Ms / Other please specify Date of birth Address Beneficial owner one Beneficial owner two Taxpayer identification number(s)* a. a. b. b. Jurisdiction(s) of tax a. a. residence** b. b. Title Mr / Mrs / Miss / Ms / Other please specify Date of birth Address Beneficial owner three Beneficial owner four Tax identification number(s)* a. a. Jurisdiction(s) of tax residence** b. b. a. a. b. b. Page 21 of 30

22 13. Declarations about international tax obligations continued 13.6 Tax declarations I/We declare that the information completed in this section is true to the best of my/our knowledge and belief. I/We declare that: a. I/We have read the explanation of the terms detailed in section 13.7, Irish residence definitions ; b. I am/we/the company is are the policyholder (for the purposes of the Irish tax rules) in respect of whom this declaration is being made; and c. I am/we are/the company is not resident or ordinarily resident in Ireland. I/We/the company hereby undertake to inform you of any change in my/our/the company s country of residence and or jurisdiction of tax residence during the life of the policies. I/We shall cooperate with you and provide such assistance as you may require from time to time to ensure compliance with any legal and regulatory obligations, including FATCA and CRS. For trusts only: I/We declare that the settlor, beneficiaries, protectors and trustees of the trust named in this application form, are not resident in the US for tax purposes, are not US citizens and are not required to file US tax returns. I/We declare that a court within the US would not have authority under applicable law to render orders or judgments concerning substantially all issues regarding administration of the trust named in this application form. I/We declare that I am/we are not acting on behalf of an estate of a decedent that is a citizen or resident of the US. For companies only: I/We declare that the company named in this application form is not a partnership or corporation organised in the US or under the laws of the US or any State thereof. I/We declare that the beneficial owners of the company named in this application form are not resident in the US for tax purposes, are not US citizens and are not required to file US tax returns. Date (dd/mm/yyyy) Print name Signature 7 7 Capacity in which declaration is made (for example, authorised signatory, trustee, settlor or power of attorney*). Print name Signature 7 7 Capacity in which declaration is made (for example, authorised signatory, trustee, settlor or power of attorney*). Print name Signature 7 7 Capacity in which declaration is made (for example, authorised signatory, trustee, settlor or power of attorney*). Page 22 of 30

23 13. Declarations about international tax obligations continued Print name Print name Signature 7 7 Capacity in which declaration is made (for example, authorised signatory, trustee, settlor or power of attorney*). Signature 7 7 Capacity in which declaration is made (for example, authorised signatory, trustee, settlor or power of attorney*). Print name Signature 7 7 Capacity in which declaration is made (for example, authorised signatory, trustee, settlor or power of attorney*). Print name Signature 7 7 This form may be inspected by the Irish Revenue Commissioners. Under Irish law, it is an offence to make a false declaration. This declaration must be signed by individuals who are neither resident nor ordinarily resident in Ireland. Where the policyholder is a company, the declaration must be signed by the company secretary or such other authorised officer. It can be signed by someone who holds power of attorney from the applicant. If this is the case, please include a certified copy of the power of attorney with this declaration. *If a power of attorney applies, the identity of that person must also be verified as per anti-money laundering requirements. Please see section 13 for further information. Capacity in which declaration is made (for example, authorised signatory, trustee, settlor or power of attorney*). Print name Signature 7 7 Capacity in which declaration is made (for example, authorised signatory, trustee, settlor or power of attorney*). Page 23 of 30

24 13. Declarations about international tax obligations continued 13.7 Irish residence definitions Residence individual An individual will be regarded as being resident in Ireland (the State) for a tax year if s/he: spends 183 days or more in the State in that tax year; or has a combined presence of 280 days in the State, taking into account the number of days spent in the State in that tax year together with the number of days spent in the State in the preceding year. Presence in a tax year by an individual of not more than 30 days in the State will not be reckoned for the purpose of applying the two-year test. Presence in the State for a day means the personal presence of an individual at any time during that day. Ordinary residence individual The term ordinary residence, as distinct from residence, relates to a person s normal pattern of life and denotes residence in a place with some degree of continuity. An individual who has been resident in the State for three consecutive tax years becomes ordinarily resident with effect from the commencement of the fourth tax year. An individual who has been ordinarily resident in the State ceases to be ordinarily resident at the end of the third consecutive tax year in which s/he is not resident. Thus, an individual who is resident and ordinarily resident in the State in 2004 and departs from the State in that year will remain ordinarily resident up to the end of the tax year in Residence company A company which has its central management and control in Ireland (the State) is resident in the State irrespective of where it is incorporated. A company which does not have its central management and control in Ireland but which is incorporated in the State is resident in the State except where: the company or a related company carries on a trade in the State, and either the company is ultimately controlled by persons resident in EU member states or countries with which the Republic of Ireland has a double taxation treaty, or the company or a related company are quoted companies on a recognised stock exchange in the EU or in a tax treaty country; or the company is regarded as not resident in the State under a double taxation treaty between the Republic of Ireland and another country. It should be noted that the determination of a company s residence for tax purposes can be complex in certain cases and declarants are referred to the specific legislative provisions which are contained in section 23A of the Taxes Consolidation Act, Page 24 of 30

25 14. For financial advisers only declaration of anti-money laundering and international tax obligations You (as the adviser) must complete this section regardless of any other forms completed in connection with the prevention of money laundering. We require anti-money laundering verification for all applicant(s) and other interested parties such as joint account holder(s), power of attorney, or other third party payor(s). For individuals we can do this verification by carrying out a database search with a commercial agency. Where the applicant is a corporate entity we ll always require the documents listed below. Please let us know if any party to this application form is classed as a Politically Exposed Person, or if any party to this application form is classed as a close relative or business associate of a Politically Exposed Person. If this is the case, we reserve the right to request further information or documentation. We may need to do this to meet our obligations under the Criminal Justice (Money Laundering and Terrorist Financing) Act 2010, as amended, which implements the Third Anti-Money Laundering Directive in Ireland. We also reserve the right to request further documentation at any time in order to comply with anti-money laundering requirements. Please note that if we hold documentation on file for an individual that s out of date, we may need up to date proof. If you re unsure about anti-money laundering requirements please contact our Client Relations team on lo-call In addition, by submitting this application form you confirm that you ll cooperate with us and provide such assistance as we may require from time to time to ensure compliance with requirements for FATCA and CRS. Corporate entities Please mark the relevant boxes to indicate that the original copy documents, certified and dated *, are enclosed. * These can be certified by an authorised financial adviser. Enclosed 1. Certificate of incorporation 2. Memorandum and Articles of Association 3. Evidence of registered address and principal business address, for example company headed paper 4. A list of directors names. This must be provided on company headed paper 5. List of authorised company signatories with specimen signatures. This list should be provided on company headed paper and must advise who can sign on behalf of the company 6. Shareholder/member register of the company 7. Provide details (name, address, date of birth) of beneficial owners who hold or control 25% or more of shares or voting rights in a company, or who otherwise exercises ultimate effective control over the management of the company in section Latest set of audited accounts of company (if applicable) 9. Provide details (name, address, date of birth) of those who have signed the declaration in section 11 To verify identification for 7 and 9 please refer to the trustee investors section for details. Page 25 of 30

26 14. For financial advisers only declaration of anti-money laundering and international tax obligations continued Trustee investors Please mark the following boxes to indicate that the original copy documents, certified and dated *, are enclosed. * These can be certified by an authorised financial adviser. Enclosed Extract from the trust deed showing the appointment of trustees and execution page If one or more of the original trustees named in the trust deed/declaration have subsequently changed, we ll need to see a copy of the appropriate deed of appointment, removal or retirement Details (name, address, date of birth) of: each trustee; any beneficiary with an interest in possession in the trust or who is to receive direct payment from the bond; and any surviving settlor of the trust. If, for any reason we re unable to perform verification checks with a commercial agency, we ll ask for documentation to be provided. If this happens, we ll need to see an original certified and dated * copy of one document from section A and one document from section B: * These can be certified by an authorised financial adviser. Section A evidence of identity (photographic evidence currently valid) Full signed passport Full photographic driving licence Section B evidence of address Utility bill ** Mortgage statement ** Bank/building society statement ** Full current driving licence ** Dated within the last six months. Please note that a driving licence can only be used for either A or B. We can t accept it for both. Where the trustee is a company, please provide the information set out in the corporate entities section. Examples of reasons where we might be unable to perform verification checks and where we might require documentary evidence to be provided may include, but aren t limited to, the following: the person to be identified has recently moved to the UK; or the person to be identified resides in a care home or similar facility. Page 26 of 30

27 14. For financial advisers only declaration of anti-money laundering and international tax obligations continued Full name of financial adviser firm FCA regulatory number Aegon Ireland agency number AAG address (where receipt of application should be sent) Date (dd/mm/yyyy) Adviser s full name(s) Checklist Have the applicants read the literature relating to the bond, including the key features document? Have all appropriate parts of the application form been completed? Has the declaration in section 12 been signed and dated by the applicants? Has the declaration in section 13 been signed and dated by the relevant parties? Have the certified copies of the documents used for the purposes of anti-money laundering verification, been attached where applicable? Has a personal illustration been attached to this application? Signature 7 7 Page 27 of 30

28 Part B Important notes You should take some time to read Part B as this forms part of your application. 1. Investment details section 1.1 If your bond has a portfolio cash account, it may become overdrawn if insufficient funds are available for charges and/or withdrawals. If this occurs, interest will be charged. Please refer to your policy conditions for details of the minimum cash position that applies to your bond. 2. Regular withdrawals section 2.1 Please note that the minimum regular withdrawal is 60, no matter what payment frequency you choose. 2.2 Regular withdrawals will be taken equally across all related policies. 2.3 Where you re invested entirely in our Portfolio funds, and you don t have a portfolio cash account, regular withdrawals will be deducted from your bond by cancelling units proportionately from the investment funds in which you hold units. In all other cases, regular withdrawals will be deducted from the portfolio cash account. You should make sure you keep a sufficient balance in your portfolio cash account at all times to cover regular withdrawals. 2.4 All withdrawals are paid in the denomination currency of the bond and any foreign exchange required will be completed at the beneficiary bank. 2.5 If your portfolio assets are to be held on a platform, or managed through an external custodian, there may be a restriction on the date regular withdrawal payments can be made. Where this is the case and you select a different date, our confirmation letter to you will show the correct payment date for your withdrawals. You should refer to your platform provider, or external custodian, to check if there are any restrictions. 2.6 We divide the premium equally among all related policies. The remaining premium means the premium that relates to the related policies that remain in force on the business day that we deduct the adviser charge or take a withdrawal. 3. Adviser charge section 3.1 Where you ve agreed to pay a fee(s) to your financial adviser for their advice and/ or services and you want us to facilitate the payment, then you should complete section 7 which contains the adviser charge instruction. 3.2 It s your responsibility to make sure that the adviser charge instruction in section 7 sets out the correct adviser charges and is fully complete. Incomplete or unclear instructions may result in a delay in the issuing of your application and in the payment of the adviser charges to your financial adviser. Once the adviser charge has been deducted from the contribution amount, or bond, we ll hold it as agent for onward payment to your financial adviser. This means that, once it s been deducted, it s been paid to your financial adviser and we can t change or return it. 3.3 Where you re invested entirely in our Portfolio funds and you don t have a portfolio cash account, all adviser charges will be deducted from your bond by cancelling units proportionately from the investment funds in which you hold units. In all other cases, all adviser charges will be deducted from the portfolio cash account. You should make sure you keep a sufficient balance in your portfolio cash account at all times to cover adviser charges. This doesn t apply to the initial adviser charge deducted from the contribution amount. 3.4 If, at any time after the bond issue date, you want us to facilitate the payment of an adviser charge, you ll need to complete a new Adviser charge instruction. We ll always need a new Adviser charge instruction if the adviser charges change. If you want us to stop deducting adviser charges, you must give us written instructions. If you ask us to stop the adviser charge or cash in your bond, there will be no further payments made to your adviser. Page 28 of 30

29 Important notes continued 3.5 The adviser charge you ve agreed to pay your financial adviser is a matter between you and your financial adviser. Where we pass on an adviser charge to your financial adviser, this is a payment we re making on your instructions. It s not a payment for any services provided by your financial adviser to us. 3.6 You may remain liable to pay your financial adviser the adviser charges if the value of your bond isn t enough to allow us to deduct the adviser charges from it, or if the adviser charge is stopped. You should check the terms of the agreement with your financial adviser for details about your adviser charges. 3.7 Please contact your financial adviser if you consider the amount we ve deducted is incorrect. If there s a dispute between you and your financial adviser about the amount of adviser charges, you should contact your financial adviser. 3.8 All adviser charges are deducted in your bond denomination currency and paid out in UK sterling. 3.9 The ongoing adviser charge option you select when applying for your bond will also apply to any additional investments We divide the premium equally among all related policies. The remaining premium means the premium that relates to the related policies that remain in force on the business day that we deduct the adviser charge or take a withdrawal Where the ongoing adviser charge is equal to a percentage of the bond value, it will vary depending on the bond value at the time of taking the charge Where the ongoing adviser charge is equal to a percentage of the premium or a percentage of the remaining premium, it will increase proportionately in line with any future additional investments. This doesn t apply to an ongoing adviser charge that s equal to a fixed monetary amount Where the ongoing adviser charge is equal to a percentage of the remaining premium, it will reduce proportionately in line with any individual policies you cash in. This doesn t apply to an ongoing adviser charge that s equal to a percentage of the premium, or a fixed monetary amount Where you ve appointed your custodian bank for all or some of the assets of the portfolio and the ongoing adviser charge is equal to a percentage of the bond value, the charge will be based on the latest valuation we ve received from your custodian bank for a quarterly valuation date. This means that any additional investments or withdrawals made after that valuation date won t be taken into account when calculating this charge. If we ve an additional agreement in place with your custodian bank for more frequent valuations, we ll use these. 4. Taxation 4.1 The rules governing the taxation of taking withdrawals and adviser charges from your bond are complex and you should consult your financial adviser first. 4.2 If this is a trust application, a chargeable event may arise if the total of any ongoing adviser charge together with any regular withdrawals taken during a bond year is greater than 5% of the remaining premium. Any initial adviser charge deducted from your bond may also count towards this allowance for the first year of your bond. 5. Contact details 5.1 If you ve any additional queries, you can contact our Client Relations team on lo-call if you re calling from the UK, or if you re calling from outside the UK. Page 29 of 30