CONFIRMATION OF VERIFICATION OF IDENTITY (COVI)

Transcription

1 CONFIRMATION OF VERIFICATION OF IDENTITY (COVI) Where required to support Old Mutual Wealth applications submitted online. Please note: this form cannot be used for the Offshore Collective Investment Bond (OCIB) because the anti-money laundering requirements differ. FM PURPOSE This form can be used to provide identity information and verification of identity as set out in the Joint Money Laundering Steering Group (JMSLG) guidance notes for the following: Individuals (ie individuals investing on their own or jointly, or other individuals associated with the investment, for example attorneys or third parties paying for the investment). Our application processes capture anti-money laundering regulation requirements for individuals. However, for online applications the identity of any third parties or employers associated with the investment will need to be verified using this form. Non-private client applications (eg trusts, companies, SIPPS) use this form to provide the required information for all associated relevant parties (for example to support an online application). Where a third party is involved (eg a payer of contributions who is different from the investor) the identity of that person must also be verified. You can also use this form to confirm whether any parties/individuals are exempt from CoVI rules. This form is to be completed by a regulated UK or EEA intermediary. We will implement enhanced monitoring of higher-risk business. Please use BLOCK CAPITALS only and blue or black ink. Sections in this form: Section 1) Details of applicant Complete 1a) for private individual investors or individuals associated with the application (eg attorneys and third parties paying for the investment) Complete 1b) for non-private investors (eg trusts, companies, SIPPS) Section 2) Section 3) Section 4) Section 5) Scheme details (SSAS/EFRBS/SIPP) Trust beneficiary details Additional details (ie details for additional parties, including third parties, trustees, attorneys and employers) CoVI declaration Complete sections 1 and 5 in all cases; include sections 2-4 where applicable continued 1 of 5

2 1 DETAILS OF APPLICANT Please state the application reference number u if applicable 1a) Individuals Please state your client reference number u if known Mr Mrs Miss Surname Other u please specify Permanent UK residential address Correspondence address u if different from residential address Nationality(ies) Country(ies) of residence for taxation Tax reference(s) Contact telephone number u in case of query address 2 of 5

3 1 DETAILS OF APPLICANT (CONTINUED) 1b) Non-private applicants Please tick as appropriate to confirm the type of applicant and complete the details below. Trust* Corporate Club/association Charity EFRBS (FURBS) SIPP SSAS/Occupational Pension Scheme Please state your client reference number, u if known Full name of corporate entity/trust/scheme/charity Registered office address u UK, Isle of Man, Guernsey or Jersey Registered charity number u if applicable Trust date u if applicable (this is the date of the declaration of trust or the testator s death) u dd/mm/yyyy Name of person dealing with correspondence Correspondence address u if different from above Names of all directors u private companies only Contact telephone number u in case of query address u optional * We do not need the trust deed to complete the investment. However, if the trustees change in the future we will need all trust documents showing the changes (or certified copies) before carrying out instructions or paying money from the investment. for cases other than SIPP applicants I have verified the identity of the corporate entity/trust/scheme/charity named in this section, in line with money laundering regulations. 2 SCHEME DETAILS (SSAS/EFRBS/SIPP) u if applicable Principal employer details (SSAS/EFRBS only) u if there are additional trustees, please give details in section 4 Full name of principal employer Registered office address u UK, Isle of Man, Guernsey or Jersey Company registration number u UK companies only PSO/PSTR number u SIPP/SSAS only 3 of 5

4 3 TRUST BENEFICIARIES u if applicable Is/are the beneficiary/beneficiaries known? Yes u please complete the beneficiary details in section 4 No u please state the class of the beneficiary/beneficiaries: Class u eg grandchildren 4 DETAILS OF OTHER PARTIES Use this section to give details of individuals and other parties to the investment who fall into one of the categories listed. If there is not enough space in this application for all related parties, please provide the same information for any others on a separate sheet or by using a copy of this page. Please tick to indicate whose details are shown: Trustee Protector Beneficiary* Charity officer/trustee Club/association officer Company shareholder with a shareholding of 25% or more Attorney Third party payer/employer If this party has an Old Mutual Wealth client reference number, please enter here u if known Mr Mrs Miss Surname/company name Other u please specify Permanent UK residential address/registered office address Please tick to indicate whose details are shown: Trustee Protector Beneficiary* Charity officer/trustee Club/association officer Company shareholder with a shareholding of 25% or more Attorney Third party payer/employer If this party has an Old Mutual Wealth client reference number, please enter here u if known Mr Mrs Miss Other u please specify Surname/company name Permanent UK residential address/registered office address * Identity verification is not required for beneficiaries under 18 years of age. Verification will be required, however, should a payment direct to a beneficiary be requested at a later date. 4 of 5

5 5 CONFIRMATION OF VERIFICATION OF IDENTITY DECLARATION uto BE COMPLETED BV THE FINANCIAL ADVISER Confirmation of Verification of Identity I confirm that: i) I have verified the identity of all parties in line with UK Money Laundering regulations, except where I have ticked to confirm their exemption ii) the information in this form was obtained by me in relation to all relevant parties iii) the evidence I have obtained to verify the identities of the relevant parties, or to prove their exemption, can be produced on demand, and meets the standard of evidence set out within the guidance for the UK Financial Sector issued by the Joint Money Laundering Steering Group (JMLSG) iv) if a relevant party has changed residential address within the previous three months, I can provide relevant evidence on demand v) this section is signed below by the person who has seen the documentary evidence (which may include an electronic identity check). Tax information Based on the knowledge I have gained of the relevant parties, I have no reason to believe that the tax residency self-certification requires any follow up action. Financial adviser s signature Print name Position Contact telephone number (in case of query) Full name of regulated firm (or sole trader) Financial Services number Date dd mm yyyy 2 0 Tax Declaration For new investments by non-private applicants, you must include the Tax Declaration for trusts and corporates (available from our website If the completed form is not returned to us in respect of the application, the investment could be delayed. Calls may be monitored and recorded for training purposes and to avoid misunderstandings. Old Mutual Wealth is the trading name of Old Mutual Wealth Limited which provides an Individual Savings Account (ISA) and Collective Investment Account (CIA) and Old Mutual Wealth Life & Pensions Limited which provides a Collective Retirement Account (CRA) and Collective Investment Bond (CIB). Old Mutual Wealth Limited and Old Mutual Wealth Life & Pensions Limited are registered in England and Wales under numbers and respectively. Registered Office at Old Mutual House, Portland Terrace, Southampton SO14 7EJ, United Kingdom. Old Mutual Wealth Limited is authorised and regulated by the Financial Conduct Authority. Old Mutual Wealth Life & Pensions Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Their Financial Services register numbers are and respectively. 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. PDF10642/ /January of 5