APPLICATION FORM - NON ADVISED RETAIL OR INTRODUCED CLIENTS ONLY abc ESTATE PLANNING - IEP CLASSIC How to Complete If you are completing this form by hand, please print clearly in black ink and block capitals If you are completing this form electronically, please print and sign where indicated Investor to fill out Sections 1a, 1b, 1c, 1d (if applicable), 2b, 2d, 3, 4 and Investor Declaration Advisers/Introducers to fill out Sections 2a, 2c, 2e and Adviser Declaration or Introducer Declaration Attorney to fill out Attorney Declaration (if applicable) Next Steps Send this completed original Application Form to: Client Services Centre Ingenious 15 Golden Square London W1F 9JG Please see Section 3 for details of how to pay your subscription Any Questions If you have any questions when completing this form please contact your adviser or our Client Services Centre on 020 7319 4290 or email clientservices@theingeniousgroup.co.uk When you have completed the form, tick the following to confirm: You have answered all the required sections including all of the questions detailed in Section 4. You (or your Attorney, acting under a Power of Attorney) have signed the declaration in Section 5. You have enclosed the necessary verification of identity documentation OR you have confirmed your consent under Section 1b. If you are acting under a Power of Attorney you have provided; -- a certified copy of the Power of Attorney; plus -- the necessary verification of identity documentation for each Attorney appointed to act If you are paying for your subscription by cheque, you have enclosed your cheque made payable to WCSL IEP CARE/IEP CLASSIC CLIENT ACC. OR If you are paying by BACS/CHAPS, you have arranged to transfer your subscription amount to the account in Section 3. Manager s Use Only Person ID: Opportunity ID: Investor Name: 1
APPLICATION FORM - NON ADVISED RETAIL OR INTRODUCED CLIENTS ONLY 1a. About the Investor Title Previous Address (if changed within the last three years) First Name Middle Name(s) Last Name Address Postcode Date of Birth D D M M Y E A R US Person** Yes No Postcode Email Address (required if you wish to register to access your myingenious account, please see section 1c) **US Person includes: 1) individuals who are United States of America (US) citizens (including dual citizens) or resident, US passport holders, green card holders, individuals born in the US who have not renounced their citizenship, permanent residents of the US and those with a substantial presence in the US as defined in US tax law; 2) a partnership or corporation organised in the US or under the laws of the US; 3) certain trusts with a US nexus; and 4) a non-us entity which is controlled by US Persons (if you are in any doubt as to whether you are a US Person you should consult an adviser). Phone Number Please provide either your full 30 Digit UK passport number. UK Passport number Date of expiry D D M M Y E A R OR 16 Digit UK Driving Licence. UK Driving Licence Issue Date D D M M Y E A R For clients in Northern Ireland, please use passport number rather than driving license number. 2
abc ESTATE PLANNING - IEP CLASSIC 1a. About the Investor continued Please confirm if you are solely tax resident in the UK If you ticked no, please complete the following table indicating (i) where you are tax resident and (ii) Your Tax Identification Number ( TIN ) for each country indicated. If a TIN is unavailable please provide the appropriate reason A, B or C where indicated below: Reason A - The country where you are liable to pay tax does not issue TINs to its residents Reason B You are otherwise unable to obtain a TIN or equivalent number Reason C - No TIN is required. (Only select this reason if the authorities of the country of tax residence entered above do not require the TIN to be disclosed) Yes No Country Reference Number Country of Tax Residence Unique identification number TIN If a TIN is unavailable, please confirm the reason A, B, or C above. If you selected reason B, please explain the reason why you are unable to provide a TIN. 1 A B C 2 A B C 3 A B C Where you have indicated reasons A, B or C above for any country of residence, please complete the following table: Country reference number (as above) Other identification number (if no TIN available) Description** Number 1 2 3 **e.g. a social security/insurance number, citizen/personal identification/service code/number, and resident registration number. 1b. Investor Identification In order to verify your identity and address we will use an electronic verification service provided to us by GB Group plc, or such other third party service provider as may be engaged by us or GB Group plc from time to time to provide these or similar services. Please tick the box to indicate that you consent to the access, processing, use and storage of the identity information contained in this Application by GB Group plc and/or the Manager for the purpose of completing your identity verification check. If you do not consent to the use of the electronic verification process or in the event that we are unable to electronically verify your identity and/or address. We may request that you supply us with any of the following original certified copy documents: passport, photocard driving licence, utility bill, bank statement, credit card statement, council tax authority bill, full driving licence and/or introducer s certificate. We will contact you to inform you which of these are required. 3
APPLICATION FORM - NON ADVISED RETAIL OR INTRODUCED CLIENTS ONLY 1c. myingenious Registration Opt Out The Manager will provide you with access to myingenious, our online client portal which we will use to provide you and your adviser with information and documentation regarding your investment. If you do not wish to register to use myingenious and would prefer to receive hard-copy communications, please tick this box. 1d. Providing the person(s) appointed under a Power of Attorney with access to investment information and correspondence (if applicable) We will provide copies of, or access to, all correspondence and information provided to the investor regarding an investment, primarily in electronic format, to the person(s) appointed to act as Attorney under a Power of Attorney executed by the investor (if any) (Access). Please tick the box and complete the details below in order to authorise the Manager to provide Access. You may change or update these details at any time by contacting the Manager. Please provide us with an original or a certified copy of the Power of Attorney. Access should be provided to an Attorney Yes No Title First Name(s) Postcode Email Address Last Name Organisation Name (if applicable) Phone Number Address Date of Birth D D M M Y E A R Attorney: Please provide either your full 30 Digit UK passport number. UK Passport number Date of expiry D D M M Y E A R OR 16 Digit UK Driving Licence UK Driving Licence Issue Date D D M M Y E A R For clients in Northern Ireland, please use passport number rather than driving license number. Attorney Identification In order to verify your identity and address we will use an electronic verification service provided to us by GB Group plc, or such other third party service provider as may be engaged by us or GB Group plc from time to time to provide these or similar services. Please tick the box to indicate that you consent to the access, processing, use and storage of the identity information contained in this Addendum by GB Group plc and/or the Manager for the sole purpose of completing your identity verification check. If you do not consent to the use of the electronic verification process or in the event that we are unable to electronically verify your identity and/or address. We may request that you supply us with any of the following original certified copy documents: passport, photocard driving licence, utility bill, bank statement, credit card statement, council tax authority bill, full driving licence and/or introducer s certificate. We will contact you to inform you which of these are required. Investor Correspondence The person(s) appointed either as an Attorney under a Power of Attorney should receive all investment correspondence on the Investor s behalf. Yes No 4
abc ESTATE PLANNING - IEP CLASSIC 2a. About the Adviser/Introducer I am the Investor s: Adviser OR Introducer Title Postcode First Name(s) Email Address Last Name Company Name Phone Number Company Address Company FCA Number Individual FCA Number 2b. Providing your Adviser/Introducer with access to your investment information and vorrespondence We will provide copies of, or access to, all correspondence and information provided to you regarding your investment, primarily in electronic format, to one third party adviser or other person nominated by you (Access). Please either tick the box or complete the details below in order to authorise the Manager to provide Access. You may change or update these details at any time by contacting the Manager. Access should be provided to: Adviser/Introducer (please tick) OR (please fill in below): Title First Name(s) Postcode Email Address Last Name Organisation Name (if applicable) Phone Number Address 2c. Upfront Commission Commission available is 2.5% upfront I wish to waive % of my upfront commission* * Commission may be rebated to reduce an investor s net cost of investment. Waived upfront commission will be used to purchase further BR Shares for the investor. 2d. Ongoing Adviser/Introducer Charge Enter the total amount (in ) of any annual ongoing adviser/introducer charge (including VAT payable on such amount) that is required by the Applicant to be facilitated by the Manager (Ongoing Adviser/Introducer Charge Amount): 5
APPLICATION FORM - NON ADVISED RETAIL OR INTRODUCED CLIENTS ONLY 2e. Adviser/Introducer Bank Account Details If an Adviser/Introducer charge payment is being made, please provide details of the bank account to which you would like any Adviser/Introducer charge credited. Account Name Bank Name Account Number Sort Code 3. About the Investment Subscription Amount Amount to be invested (minimum 50,000):* *Subject to the Manager s discretion to accept a smaller amount. Please indicate how you will pay your subscription: By Cheque By Bank Transfer Cheques should be made payable to WCSL IEP CARE/IEP CLASSIC CLIENT ACC Bank transfer account details: Account Name: Sort Code: Account Number: Reference: WCSL IEP CARE/IEP CLASSIC CLIENT ACC* 80 20 00 10182760 Please quote your last name and initial(s) as a reference on any bank transfer. This will assist us in identifying your payment. *For electronic payments this can be abbreviated to WCSL IEP CLASSIC. Drawdown Election Please tick the box if you wish to drawdown the growth in the value of your BR Portfolio on an annual basis. Investor Bank Account Details Please provide details of the bank account to which you would like any distributions from the Service to be credited. Where the bank account is in the name of a third party you will need to provide documents verifying the identity of the account holder for anti-money laundering purposes. Account Name Sort Code Account Number Roll Number (if applicable) Bank Name 6
abc ESTATE PLANNING - IEP CLASSIC 4. Suitability - Your application cannot be accepted if this section is not fully completed The Manager is required by the FCA Rules to obtain sufficient information from you to determine whether your investment in the Service is suitable for you. Therefore it is important that you provide all of the information requested below. Please complete all sections. If you are completing this Application Form under a Power of Attorney, you should complete Sections (a) to (c) as the Power of Attorney and complete Sections (d) and (e) as the investor. (a) Investment Objectives IEP Classic offers investors an opportunity to acquire beneficial ownership of shares in unquoted companies conducting permitted activities for BR purposes. Investments in BR Companies must be held for at least two years (and held at the date of death) in order to benefit from inheritance tax relief. If the investment is made using the proceeds of sale of a previous BR qualifying asset the minimum holding period may be shorter. The Investment Strategies of the Service are set out in more detail in the Brochure. You may elect to receive regular Annual Payments, Drawdown Payments and request Emergency Payments at any time, subject to available liquidity and at the Manager s discretion. In line with the FCA s requirement to establish a meaningful benchmark, the performance of the Service will be assessed against cash (UK Sterling base rates). The Manager will not borrow money on behalf of Investors, nor lend securities or enter into stock lending or similar transactions. Confirmation Please tick the appropriate boxes below to confirm the following: You understand the investment objectives and risk profile of IEP Classic Yes No The objectives and risk profile of IEP Classic are consistent with your personal investment objectives Yes No You understand that your investment may be held for many years or indefinitely Yes No You understand that BR would not be available to the extent that your acquisition of the shares was funded by way of a liability (e.g. a loan) incurred on or after 6 April 2013 Yes No (b) BR (Business Relief) If you cannot take advantage of BR, the Service may not be a suitable investment for you. Please answer the questions below: Do you wish to take advantage of BR in respect of the investments made by the Service on your behalf? Yes No Do you consider it likely that you will personally hold this investment for at least two years? Yes No Are you funding this investment with the proceeds of disposal of a previous BR qualifying asset? Yes No (c) Investment Experience and Understanding Please confirm which, and how many, of the types of investments listed below you have previously made in the last five years: Tax efficient investments (including VCTs, EIS, EZT) 0 1-5 5+ Entities quoted on the main market of the London Stock Exchange 0 1-5 5+ AIM-listed companies, or companies which are not listed 0 1-5 5+ On average, how much do you cumulatively invest each year in new investments of the types listed above? None Less than 10,000 10,001-25,000 25,001-100,000 100,001+ 7
APPLICATION FORM - NON ADVISED RETAIL OR INTRODUCED CLIENTS ONLY 4. Suitability Continued (d) Employment and Source of Income Please provide the following employment details: Employment status (e.g. employed/self- employed/retired): Source of income (e.g. earnings/investment income): Occupation/professional position*: *Please indicate if you hold or have previously held a position in the financial services sector relevant to this investment, if you hold a professional qualification (e.g. ACA, ACCA, CTA, Securities Institute Cert/Diploma), or if you are a professional (e.g. accountant, stockbroker or solicitor). (e) Financial Situation Do you expect to request Annual Payments from the Service at any time in the future? Yes No Please state the source of your subscription: Capital gain Savings Earnings Other (please specify) Please indicate your annual disposable income (after all regular financial commitments): 0 1-50,000 50,001-100,000 100,001-500,000 500,001+ Do you expect your annual disposable income to meet your standard annual outgoings? Yes No If not, please confirm how you intend to meet your outgoing needs: Are you aware of any significant additional capital commitments over and above your standard outgoings which cannot be funded from your disposable income or liquid savings? If your answer is Yes, please confirm how this commitment will be funded: Yes No Please state the value of your net assets (other than your principal residence and net of any loans): 0 1-50,000 50,001-100,000 100,001-250,000 250,001-500,000 500,001-1million 1million+ Please state the value of your principal residence and any other property investments: Not a property owner 1-250,000 250,001-500,000 500,001+ 8
TERMS & CONDITIONS abc ESTATE PLANNING - IEP CLASSIC Investor Confirmations Capitalised terms not defined in this Application Form (which includes these Terms & Conditions) have the meaning given to them in the Brochure issued by the Manager in relation to the Service (the Brochure). In the event of any conflict between the provisions of the Brochure and this Application Form, the Brochure shall prevail. I confirm that: a) I am applying on my own behalf or under Power of Attorney; b) I have read the Brochure and the Investor Agreement, I have understood and I agree to be bound as a party to the terms of the Investor Agreement and authorise the Manager to enter into the Custodian and Depositary Agreements on my behalf; c) I accept that the information supplied at Section 4 above is only given to enable the Manager to assess the suitability of the Service for me. I acknowledge that the Manager is not providing investment, legal, financial, tax or other advice and that any tax information provided to me is in the context of an investment into the Service; d) I have read this Application Form and I confirm that I have provided information on my personal and financial circumstances which is true and accurate at the date of this Application Form in order that the Manager may assess the suitability for me of investment in the Service. I confirm that such information will be true and accurate at the date upon which this Application Form is accepted by the Manager. I understand that the Manager may decline to act on my behalf in the event that the information provided is incomplete or inaccurate; e) I will notify the Manager if the information on my personal and financial circumstances as provided in this Application Form changes; f) I have advised the Manager if I am a solicitor or accountant or other professional person who is subject to professional rules preventing me from making investments in particular BR Companies; g) I consent to the Manager s Order Execution Policy and provide my express consent that, on occasions when the Manager passes an order to another party for execution, the counterparty may execute the trade outside a regulated market or multi-lateral trading facility and may not publish any unexecuted client limit orders; h) I will notify the Manager if I become a US Person, or become a resident for tax purposes of any additional jurisdiction other than the UK; i) I consent to the holding and processing of my personal data in the manner and for the purposes described in this Application Form and the Investor Agreement; and j) I will notify the Manager if I become a US person as defined at Section 1 personal details above. Drawdown Elections and Ongoing Adviser/Introducer Charges The Manager will endeavour to facilitate all Drawdown Payments and Ongoing Adviser/Introducer Charges in February of each year. Note that all requests for Ongoing Adviser/Introducer Charges (including a request made on this Application Form) must be received prior to 1 August in each year to qualify for payment the following February. Drawdown Elections must be received before 31 December in the previous year to qualify for payment the following February. The Ongoing Adviser/Introducer Charge is only payable while the Investor remains in the Service. Where the investment is redeemed part way through the year, the Ongoing Adviser/Introducer Charge amount due to the Adviser/Introducer will be paid on a pro-rated basis. The instruction in this Application Form to pay the Ongoing Adviser/Introducer Charge will each be deemed to be a standing instruction until the Manager is notified otherwise in writing. All Payments and Ongoing Adviser/Introducer Charges will be facilitated by way of a transfer of shares or a reduction of share capital, reducing the number of shares held in the Service. All payments will be executed by reference to the latest published NAV on the date the relevant payment request is processed and will be subject to the deduction of the dealing fee and any other costs and expenses that are payable in accordance with the Investor Agreement. Data Protection Confirmation I confirm that by providing personal information as part of my application and by signing this Application Form, I consent to the holding and processing of my personal information as follows and as set out in the Investor Agreement. The Manager is registered under the data protection laws of the United Kingdom. Except as stated below, or as may be required by any bank (or other FCA regulated entity) with whom the Service, the Custodian, the Depositary or any BR Company has an account, the Manager will not make the personal information provided by me as part of this Application Form available to any person or entity outside the group of entities that are Associates of the Manager (the Group) other than to a third party service provider as part of the identification process set out in the Application Form, to the Custodian and its nominee(s), the Depositary where required by law or, if requested, by any regulatory authority having jurisdiction over any members of the Group, to investigate or prevent fraud or other illegal activity, or at my request or with my consent. This personal information may be used by the Manager and/or any member of the Group to send me details of new and existing investments or other opportunities which may be of interest to me (including by email) unless I notify the Manager in writing that it may not be used in this way. 9
APPLICATION FORM - NON ADVISED RETAIL OR INTRODUCED CLIENTS ONLY Investor Confirmations - Continued Risk Factors As investment in the Service involves a high degree of risk, it may not be suitable for all investors. I have read and understood the detailed risk factors relating to an investment in the Service, as set out in the Brochure, which include the following: a) share prices, their values and the income they generate through dividends can go down as well as up and investors may get back less than their original investment b) past performance is not a guide to future performance; the extent and value of any tax advantages or benefits arising from the use of tax advantaged services such as ISAs, SIPPs and CTFs will vary according to the individual s circumstances c) the levels and bases of taxation may change d) early encashment may lead to some loss of capital Cancellation Rights There is a limited period during which you have the right to cancel your Subscription. If you wish to exercise this right to cancel, you must notify the Manager in writing (to the contact details in Clause 20.2 of the Investor Agreement) within 14 days of the Manager accepting your Application Form. Investor Declaration I confirm by signing below that I have read, understood and agree with the Terms & Conditions set out in the following pages of this Application Form and I hereby give the confirmations and consents set out in them. Signature of Investor Date D D M M Y E A R Print Name Adviser Declaration I confirm by signing below that the Investor is a customer of our firm and I have assessed the suitability of this subscription for the Investor. I confirm that I have categorised the Investor as a professional client for the purposes of the advice I have given them in connection with this investment. Signature of Adviser Date D D M M Y E A R Print Name Introducer Declaration I confirm by signing below: a) The Investor has not received a Personal Recommendation in respect of their application to subscribe in the Service from me. b) I do not provide any Personal Recommendations to the Investor in respect of any retail investment products. c) I am not prohibited by any FCA rules or otherwise by law or any professional body s standards from receiving commission or introduction fees in respect of the Investor s subscription in the Service. Signature of Introducer Date D D M M Y E A R Print Name Attorney Declaration I confirm by signing below that I have read, understood and agree with the Terms & Conditions and give the confirmations and consents therein. Signature of Attorney Date D D M M Y E A R Print Name 10