Flexible Savings Plan

1of14 Clerical Medical Flexible Savings Plan Protection benefits explained abcd

2of14 Protection benefits explained The Clerical Medical Flexible Savings Plan includes a number of optional protection benefits that can help protect you and your family should the worst happen. Basic life cover Your Flexible Savings Plan will already include a basic level of life cover, which means that, if the relevant life assured dies the amount paid will be: the bid value of the units allocated to your Plan, plus (in the case of units in Guaranteed Growth Funds) any claim bonus dividend plus, an extra 1% where selected. The protection benefits set out in this guide can give you additional security. Selected protection benefits and basic life cover on your Plan, will be subject to a maximum number of lives assured. This is two for joint life first death plans (the first to die of two lives), and six for joint life last death plans (the last to die of up to six lives). You choose the life basis of the Flexible Savings Plan on the main application form. Where there are more than two lives assured, charges and underwriting for the selected protection benefits will apply to the two youngest lives assured. The optional protection benefits available are: 1. Life cover, available in a range of options: standard cover over the term of your plan, term cover to give you extra security over a selected period of time a combination of standard cover and term cover. 2. Waiver of premium, to protect the ongoing regular premiums to the plan should the relevant assured life suffer from an illness or an accident. Selected protection benefits You can choose protection benefits at the start of your Flexible Savings Plan. You can also add the life cover options during the term of your Plan, subject to satisfactory evidence of health, or other evidence as CMI Insurance Company Limited may require. You can only choose waiver of premium at the start of your Flexible Savings Plan. Life cover i. Standard cover You can select a standard cover sum assured to be paid on the death of the relevant life assured for your plan. This can be either on the death of a single life, joint life first death or joint life last death, and must be selected in your Flexible Savings Plan application form. By selecting standard cover, you can choose the sum assured that you wish to be paid on the death of the relevant life assured, instead of the basic life cover. Standard cover applies for the whole plan term. Where standard cover is in place the amount paid on the death of the relevant life assured is either the bid value of units allocated to your Plan, or the sum assured, whichever is higher. Example If you select standard cover and you choose a life cover amount of $400,000, on the death of a relevant life assured, then if the fund value is $300,000, the plan would pay out a total amount of $400,000. 1

3of14 ii. Term cover The alternative cover will enable you to choose a level of life cover that you wish to be paid on the death of the relevant life assured. Term cover is, however, paid in addition to the basic cover available through your plan, or in addition to standard cover if also selected. Example If you select term cover and you choose a life cover amount of $400,000, on the death of a life assured if the fund value is $300,000, the plan would pay out a total amount of $700,000. You can select how long the term cover continues for (ie it does not have to continue for the whole plan term as standard cover does). You can select standard cover and term cover to apply to your Flexible Savings Plan at the same time. Example If you select standard cover and term cover together, and you choose $400,000 standard cover and $500,000 term cover (for the first ten years of the Plan), and if the relevant life assured dies during the first ten years of the Plan they would receive the greater of the standard cover and the Plan value, under the standard cover option, as well as $500,000 from the term cover. After ten years the term cover will cease and the amount of cover would be the greater of the standard cover and the Plan value. Waiver of premium This benefit can only be selected at the start of your Plan. Regular premiums will be paid by CMI Insurance Company Limited. If the relevant life assured suffers an illness or accident and becomes unable to work. The definition of unable to work varies according to the country in which the life assured resides. Please ask your financial adviser for details of which definition applies in your jurisdiction. The definition used will be one of the following: a. the life assured is temporarily unable by reason of sickness or accident to follow his own occupation, is not following any other occupation(s) and is unable to follow any other occupation for which he is fitted by reason of education, training, or b. the life assured is temporarily totally unable by reason of sickness or accident to follow his own occupation and any other occupation(s), or c. the life assured is permanently totally unable by reason of sickness or accident to follow his own occupation and any other occupation(s). If definition a. applies to the lives assureds country of residence, and they are not in employment, waiver of premium will not be available. Where definition a. applies, the plan owner must inform CMI Insurance Company Limited of any change in occupation of the relevant life assured (including unemployment and retirement). This may result in one of the other definitions being applied or, the benefit being cancelled. The regular premiums will be paid by CMI Insurance Company Limited after 26 weeks of disability and will continue to be paid by CMI Insurance Company Limited until the earlier of: a. recovery of the life assured b. the life assured reaching the age of 65 c. the end of any limited premium payment term you have selected d. the death of the relevant life assured. Any future increases due under the automatic premium increase option will also be paid by CMI Insurance Company Limited. While your premiums are being paid, all protection benefits in your Plan will be maintained, providing there are sufficient funds to support the charges and, if you have selected the automatic benefit increase option, (see section on page 3) your protection benefits will continue to increase. Benefits cannot be increased under the standard benefit increase option while your premiums are being paid by CMI Insurance Company Limited. If you select a joint life basis for your Plan and two lives for waiver of premium benefit, and both lives become unable to work at the same time, a claim can only be made for one life. 2

4of14 Charges for selected protection benefits We make a monthly charge to cover the cost of providing your selected protection benefits. It is taken by cancelling the appropriate number of accumulation units. During the initial period, when no accumulation units are held, the cost of selected protection benefits will accumulate as a debt, and will be paid off using the first accumulation units purchased after the initial period ends. The charge for the cost of providing your selected protection benefits is based on factors relating to the life or lives assured including: Age Health Sex Smoker status Country of residence. These charges may vary from time to time, in line with the expected costs of providing these benefits. If your plan is paid-up, any selected protection benefits will continue for as long as there are sufficient accumulation units to pay the cost of providing the cover. Where there are insufficient accumulation units available to pay the cost of the selected protection benefits, the cover provided by the protection benefits will cease. If you wish to reinstate regular premiums, to a paid-up or lapsed Flexible Savings Plan, the reinstatement or continuation of any selected protection benefits will be subject to further underwriting. Automatic benefit increase option You can choose for your selected protection benefits to increase each year, without the need to provide any further of evidence of health. At the start of the Plan, you can select this option when you have chosen for your premiums to automatically increase. If chosen, your initial maximum sum assured for life cover and waiver of premium will be reduced. Standard benefit increase option Any one or more of your selected protection benefits can be increased on any date when a premium is due. An appropriate increase in the selected protection benefit premiums will be necessary. The standard benefit increase option is not available with joint life last death plans. Increase under this option will be subject to: i. Satisfactory evidence of health or other evidence as CMI Insurance Company Limited may require ii. Acceptance of the increase by CMI Insurance Company Limited on the same underwriting terms as existing benefits iii. The total benefits following the increase must not exceed those set out opposite. iv. The increase must be on the same life/lives assured and on the same basis (eg joint life first death) as existing benefits v. The minimum levels for single or increases to regular premiums are set out in the Flexible Savings Plan technical guide (reference HE103) vi. If waiver of premium applies to the Plan, any increase in regular premiums to the Flexible Savings Plan must have waiver of premium cover, and will be subject to further underwriting. Reducing protection benefits One or more of your selected protection benefits may be reduced on any date when a premium is due. Minimum and maximum ages of lives assured The minimum and maximum ages for the relevant lives assured, at the start of the Plan vary with the types of protection benefit. Benefit Minimum Maximum age age Basic life cover 18 years 69 years Standard cover 18 years 64 years Extra cover 18 years 64 years Waiver of premium 18 years 59 years Automatic benefit increase option 18 years 54 years Ages outside the above ranges will be considered by CMI Insurance Company Limited and will be allowed at its discretion. 3

5of14 Minimum sums assured Type of benefit Plan currency US$ E sterling HK$ Standard cover 1,000 1,000 1,000 10,000 Term cover 1,000 1,000 1,000 10,000 Maximum sums assured from outset of the Plan Type of benefit Plan currency US$ E sterling HK$ Standard cover/term cover 2,500,000 2,000,000 1,660,600 20,000,000 Waiver of premium (annual amount of cover) 50,000 40,000 33,300 400,000 Notes The maximum sums assured are the overall maxima. Further restrictions may apply depending on the combinations of protection benefits you select for your Plan and the country of residence of the life/lives assured. Higher amounts of benefit may be permitted at the discretion of CMI Insurance Company Limited. Where automatic benefit increase option has been chosen, the maximum amounts of protection benefits that can be selected will be reduced. The words Clerical Medical means HBOS Financial Services Limited (previously Clerical Medical Investment Group (Holdings) Limited) and its subsidiaries. 4

6of14 This leaflet is not intended for distribution in the UK, and is not for UK investors. Issued by CMI Insurance Company Limited, Clerical Medical House, Victoria Road, Douglas, Isle of Man IM99 1LT, British Isles. Registered No. 33520 Isle of Man. Telephone: +44 (0)1624 638888. Fax: +44 (0)1624 625900. Hong Kong Representative: CMI Financial Management Services Limited, Unit 2408, 9 Queen s Road Central, Hong Kong. Telephone: +852 2956 1288. Fax: +852 2956 2302. The above companies are part of the HBOS Group www.clerical-medical.com E964/1106 (HE104/1106)

7of14 Clerical Medical Flexible Savings Plan Protection benefits application form Please ensure that the application is accompanied by the required certified information. Failure to provide ALL relevant documentation will cause delay in the processing of this application. A. How to complete this form If you are applying for a Flexible Savings Plan at the same time as applying for protection benefits, please attach this completed supplementary application form to the main application form (reference HE101). Please answer all questions in English, in CAPITAL LETTERS using a blue or black pen. The two youngest lives assured named in sections B and D of the main application form, should complete this form when applying for selected protection benefits. 1

8of14 B. Details of applicants (to be completed by the applicant(s)) Please add the details of the applicant(s) who is/are applying for a Flexible Savings Plan and wish to have protected benefits added. This information must be the same as that completed in section B of the main application form (reference HE101) for the Flexible Savings Plan. Policy number (if known) Applicant one Applicant two Mr/Mrs/Miss/Ms or other title Mr/Mrs/Miss/Ms or other title First name(s) (in full) First name(s) (in full) Family name Family name Permanent address (in full) Permanent address (in full) Contact telephone number Contact telephone number Date of birth (DD/MM/YYYY) / / Date of birth (DD/MM/YYYY) / / Is the applicant a life assured? Yes No Is the applicant a life assured? Yes No Please enter amounts in your Plan currency i. Standard cover Amount for the term of your plan ii. Term cover (minimum of five years) Amount term (whole years only) iii. Waiver of premium Life one Life two Automatic benefit increase option By ticking this box your selected benefits will increase in line with the automatic premium increase option selected on your Flexible Savings Plan. This is only available if automatic premium increase option has been chosen. Where this option has been selected, the maximum amounts of protection benefits at the start of the Plan will be reduced. C. Medical questionnaire This section should be completed by the two youngest lives assured named in sections B and D of the main application form (reference HE101). If you answer Yes to any question, please provide additional information in the section at the back of this form, or complete the appropriate form if required. Live assured name Life one Life two 1. Is there any feature of your lifestyle, work or leisure activities or any other circumstances or fact, which might affect or threaten your health or life expectancy? 2. Has any insurer ever declined, postponed or accepted an application on your life on special terms, or have you withdrawn an application? If Yes, please state company(ies), reason(s), and date(s). Company(ies) Company(ies) Reason(s) Reason(s) Date(s) Date(s) 2

3. Please answer Yes, if any of the following apply: Do you have any existing insurance benefits (including benefits with CMI Insurance Company Limited)? Are you applying or expecting to apply for insurance benefits with other companies? Do you intend to discontinue any existing cover? 9of14 4. Please state total amount of cover (including currency) taken out on your life in the last 12 months, including reinstated policies. 5 Please state your height and weight *please delete as appropriate Total cover Currency Height Weight (lbs/kg*) Total cover Currency Height Weight (lbs/kg*) 6. In the past 12 months have you used tobacco products? If Yes, what is your daily consumption? 7. Do you intend to: i. Fly, other than as a fare-paying passenger on scheduled airlines or participate in any hazardous pursuits (eg underwater diving, parachuting, motor racing)? If Yes, please complete the supplementary aviation or pursuit questionnaire which can be obtained from your financial adviser. ii. Will you be out of your stated country of residence for 30 days or more in any one year? 8. Do you expect to seek a medical opinion within the next eight weeks? 9. Current doctor Please provide details of your usual doctor. If you have no usual doctor, please supply details of the last doctor you consulted, including the reason. Name of doctor Address of doctor Name of doctor Address of doctor No of years attended Country Telephone number No of years attended Country Telephone number Reason for visit Reason for visit 10. Have you ever been advised to give up smoking for any specific reason? 11. Please give your average weekly consumption of alcohol (quantity and type). Please complete all boxes. Beer Wine Spirits Beer Wine Spirits 12. Have either your drinking or your smoking habits altered in the last five years? 3

10 of 14 Do you have or have you ever had any of the following? 13. Heart or circulatory disorders (eg high blood pressure, stroke, chest pain, heart murmur, palpitations, rheumatic fever, blood vessel disorders, elevated cholesterol level)? 14. Respiratory or lung trouble (eg asthma, bronchitis, persistent cough, tuberculosis)? 15. Disorder of the digestive system, gall bladder or liver (eg duodenal ulcer, bleeding from the bowel, hepatitis)? 16. Disease or disorder or infection of the kidneys, bladder or reproductive organs (eg protein or blood in urine, stones, prostatitis, venereal disease)? 17. Nervous, neurological or mental complaint (eg fits, epilepsy, blackouts, persistent headaches, paralysis, anxiety state, depression)? 18. Ear, eye, nose, throat or skin disorders (eg ear discharge, defective vision, recurrent tonsillitis, porphyria, psoriasis, dermatitis)? 19. Disorders or disease of muscles, bones, joints, limbs or spine (eg rheumatism, arthritis, gout, slipped disc, other back or neck troubles)? 20. Diabetes, sugar in urine, blood, spleen or bleeding disorders, thyroid or other glandular disorders? 21. Cancer, leukaemia, tumour or growth of any kind? 22. Are any medicines or drugs currently prescribed to you, or are you receiving any medical or psychiatric treatment or advice or awaiting surgery? 23. Have you received, or do you expect to receive, any advice, counselling, treatment or blood tests in connection with AIDS, HIV or an HIV related disorder or any sexually transmitted disease including hepatitis B? 24. Have you ever been counselled or treated in connection with alcohol or drugs? 25. Does/Has any member of your immediate family suffer/suffered from cancer, diabetes, stroke, multiple sclerosis, kidney disease, heart disease, high blood pressure or any hereditary disease before the age of 65? If Yes, please provide full details, including the family member and age. Life one Life two Females only (questions 26 and 27) 26 Have you, or have you ever had, any disorder of the female organs (breasts, ovaries, uterus) or any abnormality of pregnancy or confinement (eg caesarean section or miscarriage)? 27. Are you now pregnant? If Yes, how many months? Months Months 4

11 of 14 D. Important notes Your answers to the questions on this form will be used to assess the application and you must, therefore, answer them fully and to the best of your knowledge and belief. You must give us any other information which might be relevant and which could influence our decision. If you are unsure whether a particular fact is relevant, you should disclose it. Protection benefits may be forfeited, if relevant information is found to have been withheld. Any policy of insurance issued pursuant to this application may be declared void, even if the application has been formerly accepted by CMI Insurance Company Limited ( the Company ), where facts which are material to this application have been withheld. In such event, all monies paid may be forfeited. Please give careful consideration to the declaration before signing it. Before the Plan comes into force, any change of facts contained in the answers given in this application must be notified to the Company in writing. The Company reserves the right to amend the terms on which your application may have been accepted or to withdraw acceptance in the event of any such change. You should remember that any person (except for a member of the Company s staff) who is advising you regarding the Plan(s) for which you are applying, is acting for you and not on behalf of the Company. Your application is not binding and no contract will exist until the Company has issued a letter of acceptance or your Policy Certificate and all conditions therein have been complied with. Full details of the Plan can be found in the Principal Brochure. Copies of the completed Flexible Savings Plan application form, this protection benefits application form and the policy conditions will form part of your policy document. E. Notice and Consent in relation to the Personal Data (Privacy) Ordinance of Hong Kong 1. In order to enable us to assess your application, you are required to supply all the information requested in this application form ( personal data ) and your failure to do so may result in our inability to assess your application. 2. The personal data will be used by us for considering your application for the requested policy or investment and related services. The personal data and details of, or information relating to, all or any transactions or dealings involving such policy or investment and services will be used in connection with our provision of such policy or investment and services to you. Without restricting the general scope of the aforesaid, we will use, hold, store, disclose, transfer (whether within or outside Hong Kong) and/or exchange such personal data, details and information to or with all such persons and/or entities as we may consider necessary (including, without limitation, the persons and entities specified below for any and all purposes specified below). Persons and entities Any of the persons or entities referred to below may utilise the personal data in the course of any business carried on by such person or entity. a. Any part of the HBOS Group of companies b. Any agent, broker and/or sub-contractor appointed or engaged by us or you c. Any insurance or reassurance company d. Any medical society, hospital or institution providing health or medical advice e. Any bank or other financial institution f. Any other persons or entities providing banking or financial services or facilities to enable payment by electronic means or via other communication media or similar or related services or products. Purposes a. In connection with our assessing and providing the financial product or service requested by you from time to time and related services b. In connection with matching for whatever purpose (whether or not with a view to taking any adverse action against you) any such personal date with other personal data concerning you in our possession c. In connection with any verification or exchange of information, or investigation d. In connection with any system or facility for payment by electronic means or via other communication media in which we participate e. Promoting and improving the provision of services and products by us and/or any other company to customers generally f. Any other purpose which we may from time to time specify 3. You have the right to request access to and correction of any of the personal data. Any request may be made in writing to the Hong Kong representative. We will comply with your request unless we may, or are required to, refuse to do so under the applicable law and regulations. By signing section F, you accept this notice and give your consent in relation to the Personal Data (Privacy) Ordinance of Hong Kong. 5

F. Declaration and applicants/lives assured signatures I/We declare that I/we have read and understand the important notes within this application and that all the statements made by me/us whether in my/our handwriting or not, are true and complete to the best of my/our knowledge and belief and I/we have disclosed all relevant information concerning this application, whether or not covered by the questions in the main Flexible Savings Plan application form, this protection benefits application form and any supplementary questionnaires which might influence the Company s decision concerning this application, including whether to assume risk and the amount of premium(s). I/We will disclose to the Company any changes to the information given in this application which occur following the completion of Signatures of applicants and lives assured (this section MUST be completed) In which country was this application form signed? this application but prior to the receipt by me/us of an acceptance letter/the policy documentation. I/We irrevocably consent to the Company seeking from any doctor, hospital, medical institution or other person, information which may be related to my/our occupation, physical or mental health, including the results of any tests, and I/we authorise the giving of such information. This authorisation shall remain in force after my/our death. In relation to the Personal Data (Privacy) Ordinance of Hong Kong, I/we accept the notice in section E and give my/our consent. 12 of 14 Name of first applicant Signature Date / /20 Name of second applicant Signature Date / /20 Lives assured (if different from the applicant(s)) This should only be signed by the two youngest lives assured, unless applicants. Details of lives assured must be supplied in section D of the main application form. In which country was this application form signed? Life assured Signature Date / /20 Life assured Signature Date / /20 Financial adviser details Witnessed by financial adviser (signature) Date / /20 Name of financial adviser (in CAPITAL LETTERS) Financial adviser s stamp Name of financial adviser s company (in CAPITAL LETTERS) Financial adviser s reference number Notes relating to all selected protection benefits 1. Not all of the selected protection benefits are available for lives assured resident in certain regions of the world. All selected protection benefits are subject to minimum and maximum levels. 2. Life cover benefit will not be paid as a result of suicide in the first year of cover or the first year of cover following a reinstatement. Other exclusions may apply in certain regions of the world. 3. Waiver of contribution benefits will not be paid if a claim arises directly or indirectly from: Unreasonable failure to seek or follow medical advice Drug or alcohol abuse Wilful self-inflicted injury Any Acquired Immuno-Deficiency Syndrome (AIDS) or infection by any Human Immuno-Deficiency Virus (HIV) Material violation of law Participation in a hazardous sport or pursuit Pregnancy War. 4. Any claim under your Plan will be subject to a specified period of notification of the event giving rise to the claim, together with specified evidence that the event has occurred and relevant circumstances of the event. 5. If the value of your Plan is likely to be insufficient to sustain the cost of selected protection benefits, it will be necessary for you to pay a further single premium, increase your regular contributions or reduce the level of the selected protection benefits. CMI Insurance Company Limited guarantees that all selected protection benefits chosen at commencement of your Plan will be maintained for five years, irrespective of investment returns and charges, provided that a. any regular contributions are maintained at the contracted level, and b. throughout this period your Plan is linked exclusively to the Guaranteed Growth Funds and no switches and no encashment (not specified at outset) from the Guaranteed Growth Funds take place. 6. IMPORTANT The descriptions of selected protection benefits in this section are intended as a guide only and for full details of the terms, conditions and exclusions applicable to these benefits you should refer to the policy conditions, which are available separately. 6

13 of 14 Additional information Please provide any additional information in this box. Please quote the question number and the life assured details to whom this information relates. 7

14 of 14 Additional information continued Please quote the question number and the life assured details to whom this information relates. This form is not intended for distribution in the UK, and is not for UK investors. Issued by CMI Insurance Company Limited, Clerical Medical House, Victoria Road, Douglas, Isle of Man IM99 1LT, British Isles. Registered No. 33520 Isle of Man. Telephone: +44 (0)1624 638888. Fax: +44 (0)1624 625900. Hong Kong Representative: CMI Financial Management Services Limited, Unit 2408, 9 Queen s Road Central, Hong Kong. Telephone: +852 2956 1288. Fax: +852 2956 2302. The above companies are part of the HBOS Group www.clerical-medical.com E964a/1106 (HE104a/1106)