Pension Trustee Application Form

Transcription

1 Pension Trustee Application Form XSG/TA/PENSION This application form is for pension transfer monies only. For use with the following products: Pension Type QROPS SIPP Global Portfolio Global Wealth Manager Please tick appropriate product and pension choice. Complete sections relating to your product choice. Financial Adviser Details Company name Agency number Contact details for acknowledgement/queries on the application: Contact name Phone number address Plan Number Plan number if known Please contact Friends Provident International Limited Singapore Branch (Friends Provident International) to obtain a pre-allocated plan number if desired. Please indicate the application type which was carried out during the sale of this product by ticking the appropriate box: Full fact-find Partial fact-find No needs analysis (product explanation given) Where the full fact find or partial fact-find is conducted, I have ensured that the fact find form is duly completed. I have also submitted the page where the client had indicated his/her choice of fact find. Checklist please tick to confirm you have included with this application: (To be signed by the Adviser) Signed Personal Benefit Illustration (Global Portfolio only) Signed Personal Charging Structure (Global Portfolio only)

2 Failure to disclose relevant information may delay the processing of your application Please complete all sections Failure to provide all relevant information and documentation will result in a delay to the proposal being processed. Further information may be required during the validation process (i.e. questions arising from the information provided). Please note that even if the premium has been received and banked, the policy will not be issued until all documentation has been received and validated. This application form must be completed in English The form should be read in conjunction with the current edition of the following documents, which set out the terms and conditions of the policy and the various investment options available to you: the product Brochure the relevant Product Summary the relevant Technical Guide(s) and your Personal Charging Structure (Global Portfolio only) Your personal benefit illustration the relevant Policy Conditions Your Guide to Life Insurance Global Mirror Fund Guide (Global Wealth Manager only) Copies of all documents referred to throughout this application form can be obtained from your financial adviser. Please complete this application form in black ink, and use BLOCK CAPITALS. If you make any mistakes, cross out the error and write the new information CLEARLY. Each correction must be initialled by the person or persons completing the form. Do NOT use correction fluid or other ways of deleting incorrect information. Warning: Pursuant to section 25(5) of the Insurance Act of Singapore (CAP. 142), you are to disclose in this application form, fully and faithfully, all the facts which you know or ought to know, otherwise the policy issued hereunder may be void. Please select which investment you require (tick one box only) Personalised Assets Collective Investments Global Portfolio applicants will be treated as an accredited investor, as defined under the Securities and Futures Act (Cap. 289) ( SFA ). Discretionary Fund Manager (for Global Portfolio only) Do you wish to appoint a Discretionary Fund Manager? Yes Full Yes Partial No If yes, please complete the separate Discretionary Fund Manager & Custodian Form (XSG/DFM-SEPCUST), a copy of which can be obtained from your financial adviser. (s) Trustee Trustee Name Position Date (dd/mm/yyyy) Name Position Date (dd/mm/yyyy) 2 XSG/TA/PENSION 05.13

3 Failure to disclose relevant information may delay the processing of your application Replacement of Life Policies 1 Does the life to be assured have any life insurance policy(ies)? Yes (If Yes, please complete the following table) No Name of Company Country of Insurance Type of Policy Sum Assured Year of Issue 2 Is this proposal intended to replace any policies with this or any other life office? Yes (If Yes, please complete the following table) No If Yes, which policies? Name of Company Country of Insurance Type of Policy Sum Assured Year of Issue Warning: It is usually disadvantageous to replace an existing life insurance policy or investment-linked life insurance policy with a new one. Some of the disadvantages are: (i) You may not be insurable on standard terms or may have to pay a higher premium in view of older age or the financial benefits accumulated over the years may be lost (ii) You may incur penalties for terminating the existing policy (iii) You may incur transaction costs without gaining any real benefit from the replacement In your own interest, we would advise that you consult your present insurer before making a financial decision. Hear from both sides and make a careful comparison. You can then be sure that you are making a decision that is in your best interest. The policy is underwritten by Friends Provident International and will be entered in the register of Singapore policies. Additional information / Special instructions XSG/TA/PENSION

4 Failure Section to 1: disclose Setting up relevant the policy information may delay the processing of your application Corporate Trustee Company name Registered address Country of registration Registration number Regulated by/authorisation number Telephone number Correspondence address (if different) Contact name Correspondence telephone number address We wish for the policy documents to be sent to us, with a copy to the introducing financial adviser. Please note, if this box is left blank, the initial policy documents will be sent direct to the introducing financial adviser. Lives Assured (if more than two lives assured are required, please complete the supplementary form for Additional Lives Assured). First Life Assured Second Life Assured 1 Title Mr Mrs Miss Mr Mrs Miss Other (please specify) Other (please specify) 2 Name(s) (as shown on ID Card/Passport) Surname First name(s) 3 Date of birth (dd/mm/yyyy) 4 Nationality 5 Country of residence 6 Residential address 7 Relationship to scheme 8 Please explain your insurable interest if the life assured is not the pension scheme member 4 XSG/TA/PENSION 05.13

5 Setting up the policy (continued) *Delete as appropriate Total premium USD/SGD/GBP/EUR* Please refer to the relevant principle brochure for the minimum premium. Note: When investing monies, please indicate your chosen investments in Investment Instructions on page 7. Number of policies For Global Portfolio (Maximum 100. Minimum 5) if this box is left blank 100 policies will be issued. For Global Wealth Manager (Maximum 25. Minimum 5) if this box is left blank 5 policies will be issued. Policy currency Please select the currency in which you wish your bond to be denominated. Valuations will be produced in the same currency. Once selected, the policy currency cannot be changed. US Dollars (USD) Singapore Dollars (SGD) Sterling (GBP) Euro (EUR) Source of Wealth Please provide details below of the source of the premium for your policy. Transfer of pension Pension name Pension account number Pension currency and value Transfer date Transfer of pension Pension name Pension account number Pension currency and value Transfer date Transfer of pension Pension name Pension account number Pension currency and value Transfer date Transfer of pension Pension name Pension account number Pension currency and value Transfer date XSG/TA/PENSION

6 Failure Setting to up disclose Global Portfolio relevant (continued) information may delay the processing of your application Valuations and Reports (for Global Portfolio only) Valuations We wish for the valuations to be sent to us, with a copy to the introducing financial adviser. Please note, if this box is left blank, all valuations will only be sent direct to the introducing financial adviser. If you require a quarterly valuation in digital format, please tick the box below. If this box is ticked we will only send valuations electronically. We confirm that we wish to receive quarterly valuations by electronic mail to the address provided on page 4. I understand if this option is selected paper copies will not be provided. If this option is selected we will also send the trade contract notes in this format. All s will be encrypted using WINZIP software and a PDF reader will be required. A password will be sent to you directly to access this file. Reports Where available, we will provide documents or reports from providers of the underlying assets in which your Global Portfolio invests, including prospectuses and reports & accounts. We will charge the Ad Hoc charge (see the relevant Technical Guide) for every document which we forward to you. Please tick the box below if you do NOT want to receive these reports. We do not wish to receive any documents or reports from providers of the underlying assets in which our Global Portfolio invests. Choice of Funds (Global Wealth Manager only) Please indicate the funds in which you wish your plan to invest, up to a maximum of 10, showing the percentage of each investable premium you wish to be invested in each fund. The total percentage must add up to 100% (please note we can only accept whole percentages). Failure to include all relevant information accurately may delay the processing of your application. Fund Code Fund % of premium Total 100% 6 XSG/TA/PENSION 05.13

7 Failure Setting to up disclose the policy relevant information may delay the processing of your application Investment instructions (for Global Portfolio only) If you would like Friends Provident International to place your investments for you please indicate the assets for your Global Portfolio to invest into below. If there is insufficient room, please use a separate sheet, signed by all applicants. Charges will be deducted from the General Transactions Account; therefore, if an overdrawn balance is to be avoided, please ensure sufficient cash is retained in line with your investment strategy. Please refer to the relevant Global Portfolio Product Summary for guidance. Currency Units/Shares/ Bonds/Cash Amount SEDOL/ISIN (Essential) Full Security/Fund Name Description If no SEDOL or ISIN is provided, Friends Provident International accepts no liability for the funds selected. If a choice of Income or Accumulation is offered, we will opt for Income Units unless advised otherwise. For Income Units we will only accept the cash option rather than reinvested dividends. XSG/TA/PENSION

8 Failure Declarations to disclose for Global relevant Portfolio information (continued) may delay the processing of your application These declarations are for Global Portfolio only. For Global Wealth Manager, please go to page 10. Important Notes 1 A specimen policy document and/or copy of this completed form are available on request. 2 You are advised to satisfy yourselves that, under any taxation, exchange control or insurance legislation to which you may be subject, you are permitted to effect the policy. 3 You should seek guidance from your usual financial adviser as to the suitability of the policy to your own particular circumstances. Global Portfolio should be regarded as a medium to long-term investment. 4 Information which you provide in connection with this application and any subsequent policy will be held (whether stored electronically or otherwise), used or disclosed by Friends Provident International or any associated company that exists from time to time. You have the right to obtain access to and to request a correction of any personal information about you. Requests can be made to the Compliance Officer at Royal Court, Castletown, Isle of Man, British Isles IM9 1RA or the Principal Officer, 63 Market Street #06-05, Bank of Singapore Centre, Singapore Each policy is governed by and shall be construed in accordance with the law of Singapore. Declarations 1 Fund Acknowledgement Before you invest in any of the funds we offer through your policy, Friends Provident International wishes to ensure that you are aware of the nature and possible risks associated with them. Would you therefore please make the following declarations: (i) We acknowledge that it is our responsibility to ensure that the fund is suitable bearing in mind our investment objectives and attitude to risk, and our status as an accredited investor. (ii) We confirm that we understand that certain funds may have restrictions on their ability to raise cash in the future, and that further details are included in the Prospectus issued by the respective Fund Manager. We further understand the risks associated with investment in these funds and we have read and understood the liquidity information in Important Notes above. (iii) We acknowledge that Friends Provident International is not responsible for the investment performance or any loss suffered or reduction in the value of our Global Portfolio policy, arising from our chosen investment. Friends Provident International does not have any responsibility for the management of the assets within our Global Portfolio policy and Friends Provident International does not approve any asset as a suitable investment. (iv) We acknowledge that Friends Provident International reserves the right to reject any asset, for example if certain administration criteria are not met. (v) We acknowledge our investments may be delayed if Friends Provident International requires a signed declaration in respect of our chosen investments. (vi) We acknowledge our investments are processed according to the Terms & Conditions of the relevant Institution. (vii) We acknowledge that specific investor protection and compensation schemes that may exist in relation to collective investments and deposit accounts are unlikely to apply in the event of failure of such an investment held within insurance contracts. 2 Declarations We, the current Trustees of the Trust created on the day of (month) (year) confirm the following to Friends Provident International: Name of the Trust (i) (ii) (iii) That we have the necessary powers of investment to invest in policies of Life Assurance. That the Trustees detailed in SECTION 1 of this application form are the current Trustees of the Trust. The principal Beneficiary/Member is Full Name Address Date of birth (iv) (v) That without prejudice to the generality of this clause, the trust company s required number of authorised signatories must sign all types of instructions (for example, instructions to change underlying investments, make cash withdrawals, totally encash the contract). That we will advise Friends Provident International in writing immediately of any changes in the Trustees. and that, to the best of our knowledge and belief, all the above statements are true. We agree that they, together with any other statements made to Friends Provident International, now or in the future, shall form the basis of the contract under the law of Singapore. We have read and understood all the materials relevant to this contract and we have acquainted ourselves with the management charges made by Friends Provident International. We understand that we may choose the investments to which our 8 XSG/TA/PENSION 05.13

9 Failure Setting Declarations to up disclose Global for Global Portfolio relevant Portfolio (continued)tion information may may delay delay the the processing of your of your application Policies are to be linked. Consequently, Friends Provident International shall not be responsible for the investment performance or for any loss or liability arising from our choice of investment, however arising. We understand that this application can only be accepted by employees of Friends Provident International situated at the Company s Head Office in the Isle of Man and that no other employees or third parties have the necessary authority to create a binding contract. We understand that Friends Provident International will report this business in its register of Singapore policies. 3 Cancellation Rights We understand that if we are resident in Singapore, or have signed this application form in Singapore, we are able to cancel our investment during a 14-day period after concluding the agreement. We understand that we will receive a refund of premium less a deduction for shortfall to reflect any fall in the markets in the interim. 4 Data Protection We consent that any personal information collected or held by Friends Provident International (whether contained in this application or otherwise) is provided and may be held (whether stored electronically or otherwise), used or disclosed to enable Friends Provident International to: (i) transfer the information between its offices wherever they are situated; and (ii) to use and to transfer the information to its agents for administration, underwriting, claims, research and statistical purposes, to pass information to medical practitioners, underwriters and reinsurers and any agency appointed for these purposes. (These agents may be located in countries that do not have laws to protect your information. Details of the agents and countries involved in your case will be provided on request. Friends Provident International will remain responsible for making sure that the information is held securely); and (iii) communicate with us, our financial adviser and investment adviser whether directly or indirectly for any purpose; and (iv) to supply the details or provide a copy of the information to any financial services company wherever they are situated to enable the purchase of assets requested to be linked to the contract. (v) transfer information to relevant regulatory bodies to enable them to carry out their regulatory functions. We understand and agree that we shall update Friends Provident International immediately on any changes of our personal information and any other information provided in relation to this policy. 5 Financial Adviser We acknowledge that Friends Provident International and our financial adviser have entered into an agreement ( terms of business ) which sets out the basis upon which Friends Provident International is prepared to accept applications submitted by the financial adviser on our behalf. This agreement categorically states that the financial adviser acts as our agent, and not the agent of Friends Provident International. We acknowledge that our financial adviser, or any other, has no authority to act as the agent of Friends Provident International or to state, suggest or imply that it has such authority. 6 Fees and Commissions We are aware that certain investments the adviser makes from time to time may contain fees which exist partly to meet promotion and distribution expenses of the investment, including commission paid to our adviser. We understand that full details of any commissions paid in respect of certain investments held within the Global Portfolio policy are available on request from our adviser. 7 We declare that this application was signed in (country) and the advice was given in (country) and that, to the best of our knowledge and belief, all the above statements are true. We agree that they, together with any other statements made to a medical examiner in the event of a medical examination or to the Company, now or in the future, shall form the basis of the contract under the law of Singapore. 8 We can confirm that we have seen and received a personal illustration. 9 We acknowledge that the above fees and commissions in clause 7 are in addition to Friends Provident International s Global Portfolio policy charges and any annual fee taken on our Global Portfolio policy by our independent financial adviser. We do not wish to receive marketing information. (s) Trustee Trustee Name Position Date (dd/mm/yyyy) Name Position Date (dd/mm/yyyy) XSG/TA/PENSION

10 Failure Declarations to disclose for Global relevant Wealth information Manager may delay the processing of your application These Declarations are for Global Wealth Manager only. For Global Portfolio, please go to page 8. Important Notes 1. A specimen policy document and/or copy of this completed form are available on request. 2. You are advised to satisfy yourself/selves that, under any taxation, exchange control or insurance legislation to which you may be subject, you are permitted to effect the policy. 3. You should seek guidance from your usual Financial Adviser as to the suitability of the policy to your own particular circumstances. Global Wealth Manager should be regarded as a medium to long-term investment. 4. You are obliged to provide the information as required in this application and it is a condition precedent for you to apply for the policy. Information which you provide in connection with this application and any subsequent policy will be held (whether stored electronically or otherwise), used or disclosed by Friends Provident International or any associated company that exists from time to time. You have the right to obtain access to and to request a correction of any personal information about you. Requests can be made to the Compliance Officer at Royal Court, Castletown, Isle of Man, British Isles IM9 1RA or the Principal Officer at 63 Market Street #06-05, Bank of Singapore Centre, Singapore Each policy is governed by and shall be construed in accordance with the law of Singapore. 6. Liquidity information Some of our mirror funds, particularly our specialist ones, and also some of the underlying funds may have restrictions on their ability to pay cash due to the type of investments they hold. This could limit your ability to raise cash from the mirror fund in the future, although any restriction is only likely to occur in extreme market conditions. Information and definitions for our specialist mirror funds are available on Friends Provident International recommends that you visit our website and take time to read and understand the definitions if you intend to invest into our mirror fund range. Investment into specialist funds via our mirror funds should be considered as a long-term investment. You, in conjunction with your Financial Adviser, should consider the amount you invest via your policy if it is likely that you will need access to your capital quickly in the future. Declarations 1 Fund Acknowledgement Before you invest in any of the mirror funds we offer through your policy, Friends Provident International wishes to ensure that you are aware of the nature and possible risks associated with them. Would you therefore please make the following declarations: (i) (ii) (iii) (iv) (v) We acknowledge that it is our responsibility to ensure that the mirror fund is suitable bearing in mind our investment objectives and attitude to risk and any appropriate legislative restrictions. We confirm that We understand that certain mirror funds may have restrictions on their ability to raise cash in the future, and that further details are included in the Prospectus of the underlying funds issued by the respective Fund Manager. We further understand the risks associated with investment in these mirror funds and We have read and understood the liquidity information in Important Notes above. We acknowledge that Friends Provident International is not responsible for any loss suffered or reduction in the value of our policy arising from our investment. Friends Provident International does not have any responsibility for the management of the underlying fund and Friends Provident International does not recommend any asset as a suitable investment. We confirm that we are happy to receive information about the mirror funds and the underlying funds by electronic mail. We confirm that we are happy to receive the underlying fund reports prepared by the managers. 2. DECLARATIONS We, the current Trustees of the Trust created on the day of (month) (year) Name of the Trust 10 XSG/TA/PENSION 05.13

11 Declarations for Global Wealth Manager (continued) confirm the following to Friends Provident International: (i) (ii) That we have the necessary powers of investment to invest in policies of Life Assurance. That the Trustees detailed in SECTION 1 of this application form are the current Trustees of the Trust. This application was signed in (country) and the advice was given in (country) (iii) The principal Beneficiary/Member is Full Name Address Date of birth (iv) (v) That without prejudice to the generality of this clause, the trust company s required number of authorised signatories must sign all types of instructions (for example, instructions to change underlying investments, make cash withdrawals, totally encash the contract). That we will advise Friends Provident International in writing immediately of any changes in the Trustees. and that, to the best of our knowledge and belief, all the above statements are true. We agree that they, together with any other statements made to Friends Provident International, now or in the future, shall form the basis of the contract under the law of Singapore. We have read and understood all the printed materials relevant to this contract and we have acquainted ourselves with the management charges made by Friends Provident International. We understand that we may choose the investments to which our Policies are to be linked. Consequently, Friends Provident International shall not be responsible for the investment performance or for any loss or liability arising from our choice of investment, however arising. We understand that this application can only be accepted by employees of Friends Provident International situated at the Company s Head Office in the Isle of Man and that no other employees or third parties have the necessary authority to create a binding contract. We understand that Friends Provident International will report this business in its register of Singapore policies. 3 Cancellation Rights We understand that if we are resident in Singapore, or have signed this application form in Singapore, we are able to cancel our policy during a 14-day period after We have received the policy. We understand that Friends Provident International will reflect any change in the market value of the assets which back the policy when it works out the amount to be returned to us. 4 Data Protection We consent that any personal information collected or held by Friends Provident International (whether contained in this application or otherwise) is provided and may be held (whether stored electronically or otherwise), used or disclosed to enable Friends Provident International to: (i) (ii) (iii) (iv) (v) transfer the information between its offices wherever they are situated; and to use and to transfer the information to its agents for administration, underwriting, claims, research and statistical purposes, to pass information to medical practitioners, underwriters and reinsurers and any agency appointed for these purposes. (These agents may be located in countries that do not have laws to protect your information. Details of the agents and countries involved in your case will be provided on request. Friends Provident International will remain responsible for making sure that the information is held securely); and communicate with us, our Financial Adviser and fund adviser whether directly or indirectly for any purpose; and to supply the details or provide a copy of the information to any financial services company wherever they are situated to enable the purchase of assets requested to be linked to the contract. transfer information to relevant regulatory bodies to enable them to carry out their regulatory functions. We understand and agree that We shall update Friends Provident International immediately on any changes of our personal information and any other information provided in relation to this policy. 5 FINANCIAL ADVISER We acknowledge that Friends Provident International and our Financial Adviser have entered into an agreement ( terms of business ) which sets out the basis upon which Friends Provident International is prepared to accept applications submitted by the Financial Adviser on our behalf. This agreement categorically states that the Financial Adviser acts as our agent, and not the agent of Friends Provident International. We acknowledge that our Financial Adviser, or any other, has no authority to act as the agent of Friends Provident International or to state, suggest or imply that it has such authority. XSG/TA/PENSION

12 Declarations for Global Wealth Manager (continued) 6 We declare that this application was signed in (country) and the advice was given in (country) and that, to the best of our knowledge and belief, all the information provided, including the above statements, is complete and true. We agree that they, together with any other statements made to a medical examiner in the event of a medical examination or to the Company, now or in the future, shall form the basis of the contract under the law of Singapore. If a material fact is not disclosed in this application, any policy issued may not be valid. If you are in doubt as to whether a fact is material, you are advised to disclose it. This includes any information that you may have provided to the financial adviser but was not included in the application. Please check to ensure that you are fully satisfied with the information declared in this application. We do not wish to receive marketing information. (s) Trustee Trustee Name Position Date (dd/mm/yyyy) Name Position Date (dd/mm/yyyy) 12 XSG/TA/PENSION 05.13

13 Section 2: Appointment of Investment Adviser Friends Provident International will only trade on the underlying assets in the Fund to which your policies are to be linked upon receiving written instruction from you or any party to which you have conferred, in writing, the discretion to make trading decisions. If you wish to appoint a party to make these trading decisions on your behalf, please complete this form. Please note that if an overdraft on your General Transaction Account balance has accrued to more than 5% of the policy value of Global Portfolio and is not cleared within three months, Friends Provident International does reserve the right, in the absence of instructions from your appointed investment adviser, to place deals to realise sufficient cash to clear the overdraft. Please see the relevant Product Summary for more details. Important: once this appointment has been accepted by Friends Provident International, we will continue to act on instructions received from your appointed investment adviser until you notify us in writing that the appointment has been revoked. Investment Options Important notes for Global Portfolio (a) Global Portfolio Personalised Assets version Most forms of investment are available for inclusion in the Fund. The only assets which cannot be included are: Shares in the Friends Life group of companies Commodities Real property Futures and Options Precious metals UK National Savings and Investments Capital Bonds US and Canadian Mutual Funds. This is not an exhaustive list and we reserve the right to refuse other assets which we regard as unsuitable. (b) Global Portfolio Collective Investment version For an asset to be available, it must be structured as follows: Authorized or recognised schemes as defined in Sections 286 and 287 of the Singapore Securities & Futures Act (Cap. 289) A UK authorized unit trust within the meaning of section 468 of the UK s Income & Corporation Taxes Act 1988 (ICTA) A UK investment trust, excluding warrants, within the meaning of section 842 ICTA 1988 An open ended investment company (OEIC) within the meaning of section 236 of the UK Financial Services & Markets Act 2000 An interest in an overseas collective investment that is structured as one of the following: an open ended investment company a unit trust offshore reporting and non-reporting funds Collective investment as defined in section 235 of the UK Financial Services & Markets Act 2000 Hedge Funds and exchange traded funds are permitted, providing they comply with one of the fund structures above. US and Canadian Mutual Funds are permitted only while Global Portfolio is discretionary managed (c) The holding of cash, including bank and building society deposits and the General Transactions Account (or Current Account) is permitted provided it is not held for the purpose of realising a gain on disposal. (d) The Fund shall not at any time be more than 100% invested, i.e. no overdrafts shall be created nor any other commitments made beyond the extent of the investible cash available in the Fund without the prior formal approval of the Company. (e) Any assets purchased shall be purchased at the open market price as shown on the contract note issued by the fund manager or stockbroker. (f) All assets are held to the beneficial ownership of the Company and in the name of the Company. All dealing and contract notes must be made in the name of the Company. XSG/TA/PENSION

14 Section 2: Appointment of Investment Adviser (continued) *Delete as appropriate Part 1 For completion by the Trustees Only applicable to applications for Global Portfolio. If you wish to appoint an Investment Adviser for Global Wealth Manager, please complete an Optional Management Authority Form (XSG/OMA), a copy of which can be obtained from your financial adviser. Section A Policy Number Name of Financial Adviser Company Address We hereby declare that the Adviser has been appointed as Adviser to the Fund to which our Policies are to be linked in accordance with the investment options specified in Section C. We authorize and request Friends Provident International ( the Company ) to enter into any formal agreements required by the Adviser to facilitate this appointment. Authority granted (please tick one box only) We grant the Adviser authority to act in the following capacity (please read the two options carefully before indicating the authority you have granted to your Investment Adviser): OPTION 1: Investment Advice, our signed consent required: We declare that the Adviser will discuss any proposed alterations to the composition of the Fund with us, and the Company will only act upon investment instructions that we, as trustees, have signed. The Company will not action any instructions that have not been signed by us. OPTION 2: Delegated Investment Management: We declare that we have delegated investment decisions to the Adviser, who has complete discretionary authority to make all investment decisions to buy or sell assets, hold cash or other investments, within the boundaries of the investment options detailed in page 13. We authorize the Company to act upon the investment instructions of the Adviser as if the Adviser was the policyholder. We agree that the Company shall not be responsible for any loss or liability to the Fund arising from this appointment or from reliance upon advice given or investment instructions rendered by the Adviser to the Company or for any other action or failure to take action on the part of the Adviser giving rise to any loss in the value of the Fund howsoever arising (including but without limitation failure on the part of the Adviser to produce a reasonable investment return in relation to the Fund). Further, we for ourselves and our estates indemnify the Company against all claims demands and actions against the Company in respect of such loss as aforesaid and all costs and expenses howsoever arising from or in respect of the activities and performance of the Adviser (including but without limitation the cost of defending in any court of law any such claim demand or action against the Company). We acknowledge that the Company may terminate the appointment of the Adviser at any time by giving written notice to us and the Manager. Section B We have selected OPTION 1/OPTION 2* above and we authorize the Company to make a quarterly withdrawal from the Fund of an amount of USD/SGD/GBP/EUR* per quarter or % per annum, up to a maximum of 1.5% per annum, of the value of the Fund at the quarterly valuation point. We understand that an amount equivalent to this withdrawal shall be payable by Friends Provident International to the Adviser on our behalf. Section C Investment options We agree to the investment options listed on page XSG/TA/PENSION 05.13

15 Section 2: Appointment of Investment Adviser (continued) *Delete as appropriate Section D Fees and Commissions We are aware that certain investments the Adviser makes from time to time may contain fees which exist partly to meet promotion and distribution expenses of the investment, including commission paid to our Adviser. We understand that full details of any commissions paid in respect of certain investments held within the policy are available on request from our Adviser. We acknowledge that the above fees and commissions are in addition to Friends Provident International s policy charges and any Investment Adviser fee taken under Section B. (s) Trustee Trustee Name Position Date (dd/mm/yyyy) Name Position Date (dd/mm/yyyy) PART 2 For completion by the Adviser On behalf of the Investment Adviser named in Part 1, Section A, I have read and understood the Investment Options specified in Part 1, Section C and agree to act in accordance with them. The capacity in which I will act as Investment Adviser will be (indicate below by ticking the appropriate box): Please tick one box only Advisory Basis only (the Trustees have selected OPTION 1). I confirm that I hold the appropriate authorization from the Monetary Authority of Singapore (MAS), to provide ongoing investment advice to the Applicant(s). I understand that the Company can only act upon investment instructions that have been signed by the Applicant(s). My MAS license number is Delegated Basis (the Trustees have selected OPTION 2). I confirm that I hold a Capital Markets Services (CMS) license enabling me to provide investment instructions to the Company, and that I have the agreement of the Applicant(s) to issue investment instructions on their behalf. My CMS license number is Section E I confirm that I will comply with all legal and regulatory requirements of Singapore. I confirm that I will notify you of any changes to my authorization including any disciplinary action taken against me. of Adviser Date Name of Adviser For and on behalf of (Name and address of firm) Telephone / Fax number / address XSG/TA/PENSION

16 Important Information The information given in this document is based on the understanding of Friends Provident International of current Singapore law and taxation practice, as at May 2013, which may change in the future. No liability can be accepted for any personal tax consequences of this policy or for the effect of future tax or legislative changes. Loans against the value of your policy are not available. Fund prices may go down and up depending upon investment performance. Past performance is not an indication of future performance. Please note that securities held within a fund may not be denominated in the currency of that fund and, as a result, fund prices may rise and fall purely on account of exchange rate fluctuations. You may get back less than you have paid in. Should Friends Provident International become unable to meet its liabilities to its policyholders, they will receive the protection of the Life Assurance (Compensation of Policyholders) Regulations 1991 of the Isle of Man. Investors should be aware that specific investor protection and compensation schemes that may exist in relation to collective investments and deposits accounts are unlikely to apply in the event of failure of such an investment held within investmentlinked life insurance policies. Complaints we cannot settle may be referred to the Financial Insurance Disputes Resolution Centre Limited ( FIDReC ) for assistance within six months from the date you failed to reach an agreement with Friends Provident International. You can contact FIDReC at 112 Robinson Road, #08-01, Singapore Tel: ; Fax: ; Website: info@fidrec.com.sg Some telephone communications with the Company are recorded and may be randomly monitored or intruded into. Legal Interpretation Each policy is governed by and shall be construed in accordance with the law of Singapore. Copyright 2013 Friends Provident International. All rights reserved. Friends Provident International Limited (Singapore Branch) 63 Market Street, #06-05, Bank of Singapore Centre, Singapore Telephone: Fax: Website: Registered in Singapore No. F06835G Registered by the Monetary Authority of Singapore to conduct life insurance business in Singapore Member of the Life Insurance Association of Singapore Member of the Singapore Financial Dispute Resolution Scheme Friends Provident International Limited Registered & Head Office: Royal Court, Castletown, Isle of Man, British Isles, IM9 1RA Telephone: +44(0) Fax: +44(0) Incorporated company limited by shares Registered in the Isle of Man No XSG/TA/PENSION 05.13