APPLICATION FORM This form should be used for a Retirement Annuity Trust Scheme. Separate forms are available for charities, trusts, corporate accounts and deceased estates. We are required to obtain the following information from you. It is important that all the questions are answered as incomplete forms may need to be returned. Please inform us immediately if your circumstances change as this may affect the suitability of any investment decision or recommendation we make. ACCOUNT NAME DETAILS OF THE Scheme name SERVICE CATEGORY Please tick the category of service required Discretionary Portfolio Service (DPS) Our principal bespoke investment management service where your manager is directly responsible for every aspect of your portfolio and can undertake transactions without prior reference to you. Taking into account your investment objective, attitude to risk and any other relevant information, your investments are individually tailored to best match your requirements. Is the scheme approved? Yes If yes, Full or Provisional Reference number Tax district Tax ref number Contributor to the scheme No Advisory Portfolio Service (APS) Our investment management service for accounts where it is not possible to delegate the day to day decisionmaking process. When appropriate, we will contact you with recommendations and comments on the portfolio but we will not undertake transactions without your prior agreement. Name and address of the principal employer (where applicable) Portfolio Administration Service (PAS) A dealing service (with advice if required) for clients who require regular valuations together with nominee/safe custody facilities for their assets. Stockbroking An execution only service for clients who wish to remain in control of their investment decisions. Nature of business Any member trustee who is a signatory must complete their details on the following pages. 01
Any pensioner trustee(s) should give their full name and address below: Title Surname Forename(s) Are you, or have you ever been, a US citizen, the holder of a US passport, Green Card or US bank account: or have you ever resided in or owned property in the US? * *If yes, please state the name of the individual(s) below and provide details: Permanent residential address (a care of or post box is not acceptable) CONTACT DETAILS Permanent residential address Is the person a politically exposed person now or at any time in the past? * *If yes, please provide details: Preferred correspondence address (if this is not the permanent residential address) MEMBER S PERSONAL DETAILS Title Surname Forename(s) Email Number of dependants Preferred telephone number Date of birth (DD/MM/YYYY) Fax number Nationality Country of birth Tax manager 02
We will send a half yearly investment summary (not available for Stockbroking or Listed Derivatives accounts) that includes a valuation, performance summary, transaction schedule and capital and income statements to your appointed pension adviser (their details are required on page 5). If you do not have an appointed pension adviser, a half yearly investment summary will be sent to you at the address above. EMPLOYMENT/OUTSIDE BUSINESS INTERESTS Are you a director or significant senior manager of a Plc? * *If yes, which company(ies)? If you require further reporting please indicate below: Online access (not available for Stockbroking accounts) Contract notes Additional statements SOURCE OF OVERALL WEALTH Please tick all applicable sources of wealth. Please note that we may ask for evidence of source(s) of wealth in some cases: Employment* Investment or savings Inheritance* Family trust Business ownership or sale Property Other* * If employment, please state the nature of the business or occupation from which your wealth derives. Do you have a shareholding of 5% or more in any Plc? * *If yes, which company(ies)? Are you or have you ever been employed in the financial services industry? Are you a politically exposed person or associated with one now or at any time in the past? * *If yes, please state your position and/or association * If inheritance, please state the full name of the deceased or donor (as applicable), their relationship to you and their primary source of wealth. If this source of wealth derives from any activities abroad, please state which country(ies). Does your employer need to receive contract notes? * *If yes, please provide details *If other, please specify. 03
INVESTMENT EXPERIENCE Your answers to these questions will enable us to determine your familiarity with particular types of services and investment. We would draw your attention to the risk warnings outlined in Annex 1 of our Terms and Conditions booklet in respect of some of these types of investment Have you been an investor in financial markets for more than 5 years? Do you have experience of managing your own investments and directing deals? Do you have experience of using derivatives (including options), warrants, leveraged or unregulated products? ANTI-MONEY LAUNDERING VERIFICATION REQUIREMENTS We are required to verify the identity of the member. We cannot conduct business with you until this process is complete. For UK and Jersey resident clients, we will use the following information to perform electronic identification checks. For overseas residents, or where the electronic identification check fails, we will ask you for certified copies of identity documentation. Previous surname (if applicable) e.g. if married or deed poll Previous residential address, if less than 1 year at current address (a care of or post box is not acceptable) Passport number (this is at the very bottom of the photo page) l l l l l l l l l / l l / l l l l l l / / l Date of expiry (DD/MM/YYYY) INVESTMENT STRATEGY For PAS and Stockbroking accounts, please complete the Investment Restrictions section only. A good starting point for any investment portfolio is a clear definition of the aims, objectives and constraints as well as the anticipated time horizon. The following questions will help us recommend and implement a suitable longterm investment strategy. It is important that you keep us informed of any changes to your circumstances so we can review the strategy. INVESTMENT OBJECTIVE Please indicate the investment objective for this account by ticking one of the following boxes: Wealth accumulation: Your main objective is capital growth and you do not expect to have any capital or income requirements from the portfolio. Wealth preservation: You expect to use the portfolio to help fund a financial requirement (e.g. property purchase, education costs, retirement planning) at some stage but are unlikely to make any sizeable capital withdrawals in the foreseeable future. You have other sources of income which cover your normal expenditure. Supplementing income: You will use the income from the portfolio but have other sources which cover a significant proportion of your normal expenditure. You may use capital to maintain your overall level of income in future. Regular income: Your main objective is for the income from the portfolio to cover a significant proportion of your normal expenditure. This income objective will limit the scope for capital growth. RISK Investment is the purchase of an asset with the hope that it will generate income or appreciate in the future. All investments involve risk and while we will help you to understand what these are you should be aware that your capital is at risk and you may not receive the amount you originally invested. Risk capacity - Your overall financial circumstances will principally determine your capacity for risk and ability to absorb a loss of capital. Please indicate by ticking one of the boxes whether a significant fall in the value of your investment portfolio would have: No material impact on my standard of living A small but acceptable impact on my standard of living A large but acceptable impact on my standard of living An unacceptable impact on my standard of living 04
Risk tolerance - You may have to accept more risk than you initially anticipate in order to achieve your long-term objective. Please show the extent to which you are able to tolerate short-term fluctuations in capital and income by ticking one of the following boxes: I can tolerate significant fluctuations in the capital value in order to generate potentially higher investment returns. In normal market conditions, I can tolerate fluctuations in both the capital value and income. I can tolerate some fluctuation in capital value providing current income is maintained in normal market conditions. Regardless of market conditions, my tolerance of fluctuations in the capital value and income is very limited. TIME HORIZON It is important to define the investment time horizon for a portfolio because this helps determine the suitability of different asset classes. If the time horizon is relatively short, this will generally suggest a high weighting to fixed interest and little or no exposure to equities or other risk assets. For a medium to long-term time horizon, we would normally recommend that a portfolio has a sizeable exposure to risk assets. While the expectation is that these will generate higher returns, this cannot be guaranteed. Please show the investment time horizon for this portfolio by ticking one of the following boxes: Less than 3 years 3-5 years 5 years plus INVESTMENT RESTRICTIONS Do you wish to exclude certain investments and/or asset classes for tax or ethical reasons from your portfolio? If yes, please contact us for our Investment Restrictions supplement. Address Telephone Email Can we take investment instructions from your pension adviser? SOURCE OF FUNDS Please tick the applicable sources of how you fund your pensions: Surplus earned income Existing fund Additional contributions Employee share (or share option) sales or sale of business Existing fund Additional contributions Transfer from/consolidation of other schemes Existing fund Additional contributions Savings previously held outside of the pension scheme Existing fund Additional contributions Inherited capital Existing fund Additional contributions Other source(s) Existing fund If other, please provide details: Additional contributions YOUR PENSION ADVISER Contact name Name of company Existing fund Additional contributions 05
DETAILS OF YOUR PENSION FUND(S) This section can be answered by your pension adviser. Are there any other considerations we should be aware of in respect of managing this Retirement Annuity Trust Scheme? Where applicable, please indicate relevant currency i.e. /$/ Please indicate the amount being invested into this Retirement Annuity Trust Scheme What is this Retirement Annuity Trust Scheme s annual reporting date? (DD/MM/YYYY) If in pension withdrawal, when is the formal review of pension? (DD/MM/YYYY) Are you making or do you plan to make additional contributions into this fund? If yes, how much each year What is the approximate value of your invested pension funds? What are the benefits within any Final Salary schemes you have? Pension Lump Sum What is the approximate asset allocation of your pension funds not managed by Quilter Cheviot? Cash and bonds UK equities % % Does Quilter Cheviot manage any of your other investments? Yes No No other investments INCOME INSTRUCTIONS The income payment facility is only available in sterling. Please tick one: Transfer to capital account for re-investment Monthly payments of income received Monthly fixed standing order Quarterly payments of income received (Jan/Apr/Jul/Oct) Quarterly fixed standing order (Jan/Apr/Jul/Oct) Retain on income account BANK DETAILS Bank account details are required even if no income is being withdrawn. We can also hold details of additional bank or building society accounts if other payments are anticipated. If this includes HMRC details for tax payments, please include your unique tax payer reference in the account name line. Standing orders for different amounts to different banks can be arranged if the payment frequency is the same. Principal account name Overseas equities Alternatives % % What percentage of your Quilter Cheviot fund is available as a tax-free lump sum? % What percentage of your overall retirement income do you expect this Retirement Annuity Trust Scheme to provide? % Sort code l / l / l Building society ref Standing order (if applicable) Account number If known, what is the anticipated annual pension withdrawal? /$/ or % 06
Address Address IBAN IBAN Account name Sort code l / l / l Building society ref Account number TRUSTEES DETAILS Pension trustee(s) legal name Contact name Standing order (if applicable) Date of incorporation (DD/MM/YYYY) Address Full postal address Registered office address (if different) IBAN Account name Sort code l / l / l Account number Telephone Building society ref Fax Standing order (if applicable) Email 07
Member trustee name (where applicable) SCHEME ADMINISTRATOR Full name of pension provider Please tick if you would like the trustee to receive the following: Half yearly investment summary (not available for Stockbroking or Listed Derivative accounts) Online access (not available for Stockbroking accounts) Contract notes Contact name Full postal address SCHEME PROVIDER Full name of pension provider Contact name Full postal address Telephone Fax Email Telephone Fax Email ADDITIONAL AML REQUIREMENTS FOR THE PENSION FUND Please note that for requirements marked * verification of identity for individuals will be performed electronically using the information provided on page 4. For overseas residents, or where the identity check fails, we will ask you for certified copies of identity verification. Certified copy of deed (if settlement) Establishment certificate Regulatory Licence Number Evidence of official scheme approval (where applicable) *Verify the member Verify trustees and any other controller in accordance with their legal form (e.g. company, individual, regulated firm etc) Evidence that those operating the account are duly authorised to do so (e.g. minutes of meeting or authorised signatory list). 08
TRUSTEES DECLARATION We acknowledge receipt of and confirm our agreement to Quilter Cheviot s Terms and Conditions. (If you do not understand any point, please ask for further information). In addition, we consent to your Order Execution Policy and to Quilter Cheviot (or any affiliate, as the case maybe) effecting transactions on our behalf outside a regulated market or multilateral trading facility. Where there is more than one contributor to the scheme, we confirm that the identity and source of funds of each contributor have been verified by us. Furthermore, we hereby delegate authority to the member (as our agent in respect of this account) to: (a) Agree the investment objective, risk preference and any investment restrictions applicable to the management of the investments; (b) Elect to receive internet access and various reports for either him or herself and/or his/her adviser, as noted on page 8. DECLARATION We confirm and agree with all stated to the left. Signatory 1 Date (DD/MM/YYYY) Print name Capacity/position Signatory 2 Date (DD/MM/YYYY) Print name Capacity/position 09
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QUILTER CHEVIOT Jersey Office PO Box 276 28-30 The Parade St Helier Jersey Channel Islands JE4 8TE t: +44 (0)1534 506 070 w: quiltercheviot.com Quilter Cheviot Limited is registered in England with number 01923571, registered office at One Kingsway, London WC2B 6AN. Quilter Cheviot Limited is a member of the London Stock Exchange, authorised and regulated by the UK Financial Conduct Authority and regulated under the Financial Services (Jersey) Law 1998 by the Jersey Financial Services Commission for the conduct of investment business in Jersey and by the Guernsey Financial Services Commission under the Protection of Investors (Bailiwick of Guernsey) Law, 1987 to carry on investment business in the Bailiwick of Guernsey. Accordingly, in some respects the regulatory system that applies will be different from that of the United Kingdom. 12