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1 To start any Sheffield Mutual plan please follow the application checklist below or call during office hours to apply over the phone You can also apply online at Application Checklist and Documents that need returning: Enclose your signed cheque (payable to Sheffield Mutual ) and complete and sign the Direct Debit Mandate (if applicable). You can also include the policyholder in the payee section to safeguard against fraud e.g. Sheffield Mutual re John Smith. If you don t have a cheque book, you can call us and we can take your first premium or lump sum investment from your debit card. If you do not wish to start your plan by debit card your policy will commence on the date of your first direct debit payment. Complete, sign and date all application forms. Sign and return the Society Copy of the Client Agreement / n-advised Sale Letter and retain the Client Copy for your own records. Please send a copy of a birth certificate, passport or child benefit letter if the policy is for a child under age 18 (excluding the Junior ISA).* We will attempt to verify your identity electronically, however, if this is unsuccessful we may request further documentation such as a passport or driving licence and utility bill to confirm your identity.* * Photocopies of these documents are accepted, providing they are certified as a true copy of the original by an independent professional person or official. ID for a child would only need to be certified if the policy you are applying for exceeds 50 p.m. or is a single premium investment over 2,000. The professional person or official should sign the document/s and then print their name, address, position and telephone number. Should you have any questions after reading the above, please contact us by Telephone: enquiries@sheffieldmutual.com or via Online Chat at UPDATED MARCH 2017

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3 Tax Exempt Savings Plan with Life Assurance How do I start my plan? Simply decide how much you would like to save, for how long, and whether you would like to save monthly or annually. You should then study the Key Features literature and, providing you do not need any advice, complete and return the appropriate application form, medical questionnaire, client agreement, non-advised sale letter and direct debit authority and return them to Sheffield Mutual Friendly Society, 3 Maple Park, Maple Court, Wentworth Business Park, Tankersley, Barnsley, South Yorkshire, S75 3DP along with a cheque made payable to Sheffield Mutual for the initial premium if applicable. If you prefer, you can also pay the initial premium by debit card over the phone. You can also apply online at Please ask for details of our other products, which include: Capital Plan Investment Bond Tax Exempt Savings Plan Income Bond Regular Savings Plan Pension Bond Investment ISA Sheffield Protect Whole Life Plan Call our team Calls may be monitored and recorded for your protection. us enquiries@sheffieldmutual.com A friendly society tax-free savings allowance Opening hours: 9am-5pm facebook.com/sheffieldmutual Online chat available with added protection for you and your loved ones Issued by Sheffield Mutual Friendly Society, 3 Maple Park, Maple Court, Tankersley, Barnsley, S75 3DP. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority (Financial Services Register ). 3 Save from as little as An excellent service. Friendly, courteous and helpful staff and a very prompt and efficient service. I would recommend Sheffield Mutual to anyone. Mr B South Yorkshire Sheffield Mutual Friendly Society 3 Maple Park, Maple Court, Wentworth Business Park, Tankersley, Barnsley, South Yorkshire, S75 3DP Investment Junior ISA Quick and easy application process, get in touch today: 5 per month 3 Choose how long to save between 10 & 25 years 3 Guaranteed final amounts on maturity or death 3 Available from age 11 to 55 next birthday 3 Quick and easy Excellent customer service - lovely to have the phone answered by a real person (and someone who knew their stuff too!) Ms L Oxfordshire application process APRIL 2016

4 Owned by You. Working for You. Trusted by You. Tax Exempt Savings Plan with Life Assurance A warm welcome to Sheffield Mutual. We ve been helping our members make the most of their money since We d love to do the same for you. As a mutual society with no shareholders, our members are the people we care about the most. Any surplus profit is distributed to provide you with the best possible returns combined with the highest standards of personal service. Building on the experience of our heritage while always looking to the future, we ve developed a selection of straightforward trusted savings, investment and protection plans - with a particular emphasis on tax-efficient savings and investment policies. You also have the peace of mind that we are: Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority A member of the Financial Services Compensation Scheme A member of the Association of Financial Mutuals Take full advantage of your tax free allowance with the added peace of mind that life cover is included How much can I save in a tax exempt plan? Under current legislation, the maximum individual investment in a tax exempt savings plan is 25 per month or 270 annually. The minimum you can save in the Sheffield Mutual plan is as little as 5 per month or 50 annually. If you would like to save more than 25 per month, please ask us for details of our Regular Savings Plan or Investment ISA. It is also a qualifying life policy and you cannot pay in more than a total of 3,600 in a 12 month period into qualifying policies with Sheffield Mutual or any other life company or friendly society (excluding pure protection policies and protected qualifying policies issued before 21st March 2012). Who can save in a tax exempt plan? Anyone can start a plan or have several plans within the overall maximum levels of 25 per month or 270 annually. The maximum figure includes any tax-exempt savings plans held with another Friendly Society, but is in addition to your ISA/JISA allowance. Can I have a plan for a child? Anyone aged between 11 next birthday and 55 next birthday can start a plan or have several plans within the overall maximum levels of 25 per month or 270 annually. If the child is under 11 you may wish to consider our Tax Exempt Savings Plan without life assurance. Why save with Sheffield Mutual? As a mutual friendly society with no shareholders to satisfy, we are able to offer special plans that allow you to invest in these tax-exempt funds and receive tax-free returns on maturity.* We specialise in offering with-profits policies, which offer greater potential returns by investing in a range of different assets - without exposing your capital directly to the stock market. Where will my money be invested? The Society invests in a range of different assets with the aim of providing a higher return in the medium to long-term than is achievable with a bank or building society account. Sheffield Mutual s balanced with-profits fund is managed to provide a low to medium risk investment, appealing to individuals with a more cautious approach to investment. The types of asset we invest in are: The shares of UK companies, though we may also have a very small exposure to some overseas companies to provide diversity. These provide income from dividends with the possibility of capital growth Investments such as Government gilts or corporate bonds, which provide fixed interest Property - the Society owns properties which provide income from rentals and potential capital growth Fixed interest returns from a small portfolio of commercial mortgages How are bonuses calculated and paid? We invest our funds as described above and receive a return on those investments, which can vary from year to year. At the end of March or early April we review the returns achieved during the previous calendar year in consultation with our Actuary. The Committee of Management then declares a bonus rate for each policy type for that period. Obviously, the rate varies depending upon overall investment returns and is not therefore guaranteed to be paid at the same rate, or at all, in future years. However, once bonuses have been added to your policy they will not be taken away, providing the policy runs to maturity, or if you die before the end of term. Bonuses are calculated at the appropriate rate based on the sum assured (your guaranteed final amount), not the amount of premium paid. On maturity or death, you will receive the sum assured plus bonuses added during the life of the policy. The Society also tries to smooth returns over the life of the policy by retaining some of the investment return in good years to maintain bonus rates in poorer years. However, to ensure you receive your fair share of returns on your policy over its lifetime, an additional terminal bonus may be paid on maturity. Payment of this type of bonus depends entirely on investment performance and the rate at which annual bonuses have been added. It is not guaranteed and, if paid, the rate may vary from year to year. Are there any guarantees? Providing the plan runs to its planned maturity date, the Society will, depending on the amount you wish to save and for how long, guarantee a minimum sum assured (final amount). The final value of your plan will depend upon investment performance, but bonuses are declared by the Society s Committee of Management each year, and these are added to your guaranteed sum assured. Once added, these bonuses cannot be taken away. Can I select the term of my savings plan?, you may choose the period over which you would like to save, with a minimum term of 10 years and a maximum of 25 years. If you are aged 55 next birthday the maximum term will be 10 years. Can I make early withdrawals? You cannot make any withdrawals, but if your circumstances change, you can surrender your policy. However, the plan is designed for medium to long-term investment and the surrender value may be less than the amount you have paid in. You may also be liable for additional tax on any investment gain. The amount of the gain may result in a reduction in the amount of any old-age relief or child tax credit being received. Are there any charges?, the Society takes a management contribution of 50% of premiums paid in year 1 and in the second and subsequent years 6% of the annual premium amount. These are to cover the cost of expenses incurred in setting up the policy and maintaining it thereafter. The charges are deducted from the overall fund and taken into account when we calculate the level of bonuses we are able to pay. Where can I get further help or information? Our friendly and knowledgeable staff would be happy to provide you with factual information about the Society s products and services, so you can make your own decision about how to proceed. advice or recommendations will be given and if you are in any doubt about the suitability of a product, you should seek advice from a suitably qualified financial adviser, which may incur a fee. Do I need to provide any additional information? To comply with regulations, the Society will require confirmation of your identification and address. We ll aim to do this using an electronic verification system, but reserve the right to ask for appropriate documentation from you if this is not possible. We don t normally require identity documents from existing members. If the policy is for a child we ll need a copy of their birth certificate. *All references to taxation are based on the Society s understanding of current tax legislation and practice, which may change in the future. Cash The proportion held in each of these will vary depending on market conditions. We can provide you with a guide to the spread of investments. We seek to adopt an ethical approach to investing and it is our policy not to invest knowingly in industries relating to armaments, tobacco, gambling or pornography. Is life cover included?. The amount of life cover will be the guaranteed sum assured plus any bonuses which may already have been added. This will be paid if you die before the end of the selected term. In order for us to provide life cover we will require you to complete a short medical history questionnaire and we reserve the right to contact your Doctor for further information if necessary. Any undisclosed condition may result in a death claim being invalid.

5 Key features of the Tax Exempt Savings Plan with Life Assurance What is the purpose of this leaflet? The Financial Conduct Authority is the independent financial services regulator. It requires us, Sheffield Mutual Friendly Society, to give you this important information to help you to decide whether our Tax Exempt Savings Plan with Life Assurance is right for you. You should read this document carefully along with the illustration and general product leaflet, so that you understand what you are buying and then keep it safe for future reference. You can also find out more about how we manage our with-profits fund, in the booklet withprofits guide which is available on request or from our website. Who is the Tax Exempt Savings Plan with Life Assurance suitable for? Individuals who are looking to build a lump sum by saving a regular amount either monthly or annually for a period of 10 to 25 years with the added benefit of a guaranteed sum payable on the death of the policyholder before the end of the term. Its aims To give you the opportunity to build a guaranteed lump sum by paying regular monthly or annual premiums. To add additional bonuses to the guaranteed sum, though these are not guaranteed and depend on the investment performance of the fund. To provide access to a range of different assets e.g. equities, property, fixed interest and cash through a single with-profits fund. Subject to legislation, which may change in the future, to provide a tax free cash sum on maturity. To pay a minimum guaranteed sum assured, which depends on the premium paid and your age at outset, in the event of the policyholder s death before the end of the specified term. Your commitment You agree to pay a regular premium monthly from 5 to 25 or annually from 50 to 270 which cannot be varied, on the due dates throughout the selected term. You cannot withdraw cash from the policy other than by closing it and taking the available surrender value, if any. Risks Your circumstances may change and you may no longer be able to afford the regular premiums which could lead to the loss of both valuable life cover and some or all of your planned lump sum. If you stop paying your premiums, or encash your policy, a surrender value may be payable but this may be less than you have paid in, particularly during the early years. This can be seen in the illustration in the section headed The Early Years. Legislation may change to affect the Tax Exempt status of the fund. Bonuses will depend on the investment performance of the fund and may not be as high as anticipated. Inflation may reduce what you could buy in the future.

6 Questions and answers Can I choose the term of my savings plan?, you can choose the term over which you would like to save with a minimum of 10 years and a maximum of 25. Are there any guarantees? Providing the plan runs to its intended maturity date the Society will, depending on the amount you wish to save and for how long, guarantee a minimum sum assured. The final policy value will depend upon investment performance but bonuses are declared each year and are added to your guaranteed sum assured. Once added these cannot be taken away so that on maturity your policy value will be the guaranteed sum assured plus bonuses accrued. Are there any charges?, the Society takes a management contribution of 50% of premiums paid in year 1 and in the second and subsequent years 6% of the annual premium amount. These are to cover the cost of expenses incurred in setting up the policy and maintaining it thereafter. The charges are deducted from the overall fund and taken into account when we calculate the level of bonuses we are able to pay. What happens if I stop paying premiums? The Tax Exempt Savings Plan with Life Assurance is designed as a medium to long term savings plan and if you stop making payments, depending upon how long the policy has been running, there may be a surrender value. However, particularly in the early years, this may not be as much as you have paid in. The Society also reserves the right to surrender the policy if premiums are more than three months in arrears. Can I make withdrawals?, you cannot make any withdrawals other than by surrendering the policy. Other information Cancellation rights After your proposal is accepted you will receive a notice of your right to cancel. You will then have 30 days in which to change your mind, and you will be returned any money you have paid, free of any charges. Premiums Premiums are paid monthly or annually. Missed premiums could mean that your policy may lapse with no value. Bonuses Bonuses calculated on the basis of the profits of the fund are added to your policy. The bonus rate is decided by Sheffield Mutual Friendly Society acting on the advice of the actuary and is not guaranteed. Law In legal disputes the Law of England will apply. Legislation All or any of the benefits, the premiums, or the policy conditions may be adjusted as deemed appropriate: If there is any change in Law or Taxation affecting the policy If any levy is imposed on the Society under Statute or statutory authority As a consequence of any amendment to General Laws tice would be given of any such adjustments. Is there a tax liability? Under current legislation, which may change in the future, premiums are invested in a tax-exempt fund and providing the policy runs to maturity the proceeds are tax-free. However, if you surrender before the end of the term you may be liable to taxation on any investment gain. All references to taxation are based on the Society s understanding of current tax legislation and practice which may change in the future. What about protection for my dependents? By taking out this policy the Society guarantees a minimum benefit known as the sum assured and on the death of the policyholder before the end of the term this will be paid along with any annual bonus already added. The amount of the sum assured depends on the monthly/annual premium, term, age and medical history at the outset. Do I have to be in good health to start a Tax Exempt Savings Plan with Life Assurance? You will be required to give details of your medical history with your application which may result in the Society being unable to offer this type of policy. However, the Tax Exempt Savings Plan without Life Assurance may be an alternative option for saving where health is a problem. How will it work for me? Accompanying this leaflet you will find an illustration which shows how the Tax Exempt Savings Plan with Life Assurance might benefit you and you should read this with the Key Features as it contains other important information. If you require a specific illustration please contact us. Queries and complaints For further information or if you wish to complain about any aspect of the service you have received, please contact the Society s Chief Executive at the address shown below. We will attempt to resolve any problems immediately, but if a complaint is not dealt with to your satisfaction you can then complain to the Financial Ombudsman Service, Exchange Tower, London, E14 9SR, or telephone For further information visit Making a complaint will not prejudice your right to take legal proceedings. Compensation The Society is covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the scheme if we cannot meet our obligations. This depends on the type of business and the circumstances of the claim. Further information about compensation scheme arrangements is available from the FSCS by visiting or by calling or Sheffield Mutual Friendly Society Was founded in Total assets exceed 90 million and there are over 76,000 members. This leaflet is a brief guide to the Key Features of the product. Further details are contained in the policy document which is the legally binding contract between you and Sheffield Mutual Friendly Society. Sheffield Mutual Friendly Society 3 Maple Park, Maple Court, Wentworth Business Park, Tankersley, Barnsley, South Yorkshire, S75 3DP enquiries@sheffieldmutual.com. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority (Financial Services Register ). March 2016

7 Application for Tax Exempt Savings Plan/Tax Exempt Savings Plan With Life Assurance/Regular Savings Plan(s) All information given will be treated in the strictest confidence. Please complete this form in BLOCK CAPITALS Section A - Details of the Policyholder Title: (Mr/Mrs/Miss/Other) Forename(s): Surname: Sex: Permanent residential address: Do you have a National Insurance Number? If so you must enter it here: Date of Birth: D D / M M / Y Y Y Y Home Phone: Postcode: Is the Policyholder already a member of this Society? YES NO If YES, please give details if NO, where did you hear about us? Mobile: Occupation: If you have a promotional code, please enter it here: Section B - Details of the Proposer/Premium Payer (if different to the policyholder) Please complete section B if the Policyholder is under 16 and/or is not the premium payer 1. Is the Policyholder under 16? Title: Forename: (if so you must sign as Proposer in section B overleaf). Surname: Will premiums be paid by someone other than the Policyholder? Permanent residential address: Home Phone: Mobile: Postcode: Relationship to Policyholder: Section C - Direct Debit Details When would you like your Direct Debits to start? (please tick) 15th of the Month Last working day of the month Section D - Policy Details (you can apply for multiple policies using only one form, please complete one line for each policy required) Tax Exempt Savings Plan Max 25 per month / 270 Annually Tax Exempt Savings Plan With Life Assurance * Regular Savings Plan Term (Minimum 10 years) Premium Amount s Monthly Annually Sum Assured Figure s Please tick Please tick Please tick Please Tick Please Tick (From illustration) * Please also complete a medical questionnaire Continued overleaf

8 Section E te Carefully Failure to take reasonable care to provide accurate and complete information in response to the questions we ask could affect the terms of your insurance contract. Whilst the Society aims to treat members fairly, making a deliberate or reckless misrepresentation could result in your insurance contract becoming void, which means the policy will not pay out. Section F Declaration To be completed by the Proposed Policyholder (Section A) or in the event of the Proposal being made on behalf of a child aged 1-16 (next birthday), to be completed by the Proposer (Section B). I wish to apply for the Sheffield Mutual Plan(s) detailed overleaf. I declare that all the statements made in this proposal (and any notes and supplementary medical forms) are to the best of my knowledge and belief the truth, and that I have not knowingly withheld any material information. I agree that such statements and this declaration shall be the basis of the contract between me and the Sheffield Mutual Friendly Society and that any policy issued on the basis of this Proposal shall be subject to the rules of the Society, from time to time in force, to which I will abide and conform. I further declare (applicable only to proposals for a child aged 1-16 next birthday) that the Endowment hereby proposed is being taken up by me on behalf of and for the full benefit of the child and I will abide and conform to the rules of the Society from time to time in force. I further understand that I may cancel the policy by giving notice in writing and returning the policy documents within 30 days of the policy issue date and that I will be entitled to the full refund of any premiums paid less, (at the discretion of the Management Committee), any charge for management. If applying for a Tax Exempt Savings Plan (with or without Life Assurance) are you (or the Policyholder if you are the Proposer) a beneficiary under another qualifying policy issued on or after 6 April 2013 or issued before that date where a premium limit event has occurred (e.g. a significant modification/variation of the policy)? (please tick) If you ve ticked you may only proceed with the application if you are not in breach of the annual premium limit of 3,600 for qualifying policies, including this new policy. Pure protection policies (which pay out on death or disability only with no surrender value) and existing protected policies as at 5 April 2013 which are issued and maintained for a specified term for the sole purpose of repaying the capital of an interest only mortgage are excluded from the annual premium limit. Qualifying Policies Annual Premium Limit Statement In making this proposal for the issue of a qualifying policy I (or the policyholder if I am proposing the policy on their behalf) am not in breach of the annual premium limit for qualifying policies of 3,600 at the date this proposal and statement is made. Friendly Society Policies Premium Limit Statement In making this proposal for the issue of a friendly society tax exempt policy I (or the policyholder if I am proposing the policy on their behalf) do not already have Tax Exempt Savings Plans issued by friendly societies (excluding ISAs) that might cause the premium limit of 25 per month or 270 per annum to be breached. (The Premium Limit Statements do not apply if you are opening a Regular Savings Plan). I consider that I will be able to continue the contracted payment(s) overleaf for the full duration of the term. Data Protection You agree that the information we hold about you can be held on computer and / or paper files and that it may be disclosed to third parties for the purpose of processing your application, our Regulators and our Compliance Consultants. It will not be disclosed to any other parties without your express permission in writing. It is necessary for us to verify your identity. We will do this by obtaining evidence from various data sources including Credit Reference and Fraud Prevention agencies and the Electoral Roll. The agencies will record details of the search, whether or not your application proceeds. If we are unable to confirm your identity from these sources we will write to you asking you to supply us with adequate proof of identity. The only exception to this may be if you have an existing policy with us either solely or jointly. I agree to you contacting me with information about other products and services: By By Post: Important - By signing this declaration you are agreeing to our Tax Exempt and/or Regular Savings Plan terms and conditions, which are set out in the product brochure, product Key Features and policy conditions. For your own benefit and protection you should read these documents carefully before signing the proposal form. If you do not understand any point please ask for further information before proceeding. Signature of Policyholder (section A): Date: Signature of Proposer (section B): Date: If this application has been submitted by a Financial Adviser / Introducer please confirm your wish for us to supply information to them on request by signing below. I hereby agree to Sheffield Mutual providing information about this policy to the named company below at their request. Signature of Policyholder/ Proposer: For Financial Adviser / Introducer use only: Please complete as appropriate. IFA Advised Sale IFA n-advised Sale Introducer Agency Code Please note: if your client doesn t sign this section we may not be able to give you any information about this policy in the future. Date: Name of Intermediary Company name and address or stamp: Telephone Enclosures: Direct Debit mandate Cheque for Initial Payment Where do you want the documentation to go to? (Please tick): Client Adviser Original to Client & Copy to Adviser A COPY OF THE POLICY CONDITIONS ARE AVAILABLE ON REQUEST FROM THE SOCIETY. Published by: SHEFFIELD MUTUAL FRIENDLY SOCIETY, 3 MAPLE PARK, MAPLE COURT, WENTWORTH BUSINESS PARK, TANKERSLEY, BARNSLEY, SOUTH YORKSHIRE, S75 3DP, TEL: , FAX: Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority MAY17

9 Medical Questionnaire All information given will be treated in strictest confidence. To be used in conjunction with Sheffield Protect Plan and Tax Exempt with Life Assurance. Please complete this form in BLOCK CAPITALS where applicable A. Health and Lifestyle Height and Weight Please state your height without shoes ft ins or m Please state your weight in indoor clothes. If you are currently pregnant, please state your pre-pregnancy weight st lbs or kg Smoking Have you smoked any cigarettes in the last 12 months (including vaping with nicotine)? If, please state number of cigarettes smoked / mg nicotine juice vaped per day If you have given up smoking cigarettes within the last twelve months, please state your previous average daily consumption prior to giving up. (We may ask you to undergo a simple test to confirm your answers to these questions) Have you used any other tobacco products or any nicotine replacement products in the last 12 months? Other tobacco products include cigars, pipe smoking, vaping without nicotine and chewing tobacco. (We may ask you to undergo a simple test to confirm your answers to these questions) Alcohol Do you consume alcoholic drinks? If, how many units of alcohol do you drink on average each week? A unit of alcohol is the equivalent to each of the following: a half pint of normal strength beer, lager or cider ~ one standard glass of wine ~ a single measure of spirit units Alcohol advice Have you ever sought or been given medical advice to reduce the level of your drinking? If, please give details Drugs Within the last five years, have you taken drugs other than for the treatment of a medical condition? e.g. cocaine, heroin etc. If, please give details If you answer YES, to any part of section B and/or C, please provide details on a separate sheet B. Other life applications Has any application you ve made for life, health or critical illness cover been declined postponed or accepted with increased premiums, exclusions or restrictions? C. Health and Medical details a. Have you consulted your doctor during the last 12 months for anything other than minor ailments or those listed. Have you ever experienced: b. angina, heart attack or any other disorder of the heart? This question does include heart valve disorders, rheumatic fever, cardiomyopathy and heart abnormalities or defects present at birth. c. stroke, Transient Ischaemic Attack (TIA), brain haemorrhage or any permanent brain injury through accident? d. any form of cancer, leukaemia, Hodgkins disease, lymphoma, brain or spinal tumour? Continued overleaf

10 C. Health and Medical details continued e. multiple sclerosis, optic neuritis, Parkinson s disease, paralysis, cerebral palsy, dementia or Alzheimer s disease? f. blurred or double vision, loss of feeling, numbness, pins and needles, tingling of the limbs or face or any disease or disorder of the central nervous system (brain, spinal cord and nerves), which has not already been mentioned in earlier questions? g. diabetes? h. any disease or disorder of the arteries including disease in the legs or of the aorta? Within the last five years have you experienced: i. Anxiety state, stress, depression, chronic fatigue, any other mental or nervous illness? j. Any problem, disease or disorder affecting your digestive system, stomach, bowel, liver, pancreas or gall bladder? Within the last two years, have you had any treatment for raised blood pressure or been advised to take treatment, or to have your blood pressure monitored? Within the last five years, other than in respect of the conditions that you have already declared have you either received any medical attention at a hospital as an inpatient or outpatient or had or been advised to have any investigations, scans or blood tests including HIV Other than in respect of the conditions that you have already declared, are you currently: experiencing any symptoms or complaints for which you have not consulted a doctor or receiving any form of treatment or medication or awaiting any medical or surgical consultation or follow up or awaiting any test or investigation? If you answered YES, to any part of section B and/or C, please provide details on a separate sheet D. Doctor s details (A report from your doctor will not always be requested) Title Doctor s initials Doctor s surname Dr Practice Address Medical Centre Telephone. (please include the full code and any extensions) Postcode In connection with this application I hereby consent to the Society seeking medical information from any Doctor, who at any time has attended me or has been responsible for my medical care, and I authorise the giving of such information and agree that a copy of this consent will have the validity of the original. I do / not wish to see the Doctor s medical report before it is sent to the Society. (Please delete as appropriate). Signed Date: Published by: SHEFFIELD MUTUAL FRIENDLY SOCIETY, 3 MAPLE PARK, MAPLE COURT, WENTWORTH BUSINESS PARK, TANKERSLEY, BARNSLEY, SOUTH YORKSHIRE, S75 3DP, TEL: , FAX: Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority MAR17

11 PLEASE RETAIN THIS COPY Client Agreement (the Agreement ) Client Copy 1. We treat all customers who invest with us direct as retail clients. This gives you the greatest level of protection under the financial services regulations and ensures you get full information about the product(s) you buy. You should read this Agreement together with the product Key Features, product brochure and personal illustration, as they form the basis of your product relationship with us. 2. As Sheffield Mutual does not provide advice it will be classed as a n-advised Sale. All decisions in relation to the investment will be and have been made by you alone and the Society has provided you with factual information so you can make your own decision about how to proceed. 3. If you are not confident that you understand the product(s), its risks and whether it is right for you, please speak to a specialist adviser. If you wish to talk to an independent financial adviser in your local area you can find one online at or 4. Details about making a complaint and the Financial Services Compensation Scheme can be found in the Key Features document in the Other information section, which has been provided to you in your policy application pack. 5. We may need to undertake checks to comply with current anti-money laundering requirements. This will normally be carried out electronically through a credit reference agency, which may keep a record of the search on your credit file, but will not affect your credit rating. 6. The Society complies with data protection legislation and you agree that the information we hold about you can be held on computer and/or paper files as necessary and that it may be disclosed to third parties for the purpose of processing your application, our regulators and our compliance consultants; but not to any other parties without your express consent. You may ask for a copy of the information we hold about you by writing to us and we reserve the right to charge a small fee for this. 7. If you have given us consent to contact you regarding other products and services, either by post, telephone or , you may withdraw this consent at any time by notifying us in writing. 8. You understand that we have a legal obligation to ensure that the information within our records about you is kept up to date, so please let us know if any of your details change, such as your address. n-advised Sale Letter I confirm that I have received a copy of this Agreement and acknowledge that all decisions in relation to this investment will be and have been made by me, and that the Society has only provided me with factual information in relation to the product. I acknowledge that I have not received advice and/or a personal recommendation from Sheffield Mutual Friendly Society or its introducers. I understand that as this is a n-advised Sale Sheffield Mutual takes no responsibility for the suitability of the product and that I will lose some of the regulatory protection which I may otherwise have. Specifically, I understand that it is unlikely that I would be able to make a complaint against the Society should the product(s) prove to be unsuitable for me. (Words in the singular shall include the plural for joint policyholders) Name of Client(s): Signature of Client(s): Date: To be signed by the Proposer if the Policyholder is under 16. Joint applicants must both sign. Updated by D Gregory 03/02/2017

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13 Client Agreement (the Agreement ) - Society Copy 1. We treat all customers who invest with us direct as retail clients. This gives you the greatest level of protection under the financial services regulations and ensures you get full information about the product(s) you buy. You should read this Agreement together with the product Key Features, product brochure and personal illustration, as they form the basis of your product relationship with us. 2. As Sheffield Mutual does not provide advice it will be classed as a n-advised Sale. All decisions in relation to the investment will be and have been made by you alone and the Society has provided you with factual information so you can make your own decision about how to proceed. 3. If you are not confident that you understand the product(s), its risks and whether it is right for you, please speak to a specialist adviser. If you wish to talk to an independent financial adviser in your local area you can find one online at or 4. Details about making a complaint and the Financial Services Compensation Scheme can be found in the Key Features document in the Other information section, which has been provided to you in your policy application pack. 5. We may need to undertake checks to comply with current anti-money laundering requirements. This will normally be carried out electronically through a credit reference agency, which may keep a record of the search on your credit file, but will not affect your credit rating. 6. The Society complies with data protection legislation and you agree that the information we hold about you can be held on computer and/or paper files as necessary and that it may be disclosed to third parties for the purpose of processing your application, our regulators and our compliance consultants; but not to any other parties without your express consent. You may ask for a copy of the information we hold about you by writing to us and we reserve the right to charge a small fee for this. 7. If you have given us consent to contact you regarding other products and services, either by post, telephone or , you may withdraw this consent at any time by notifying us in writing. 8. You understand that we have a legal obligation to ensure that the information within our records about you is kept up to date, so please let us know if any of your details change, such as your address. n-advised Sale Letter I confirm that I have received a copy of this Agreement and acknowledge that all decisions in relation to this investment will be and have been made by me, and that the Society has only provided me with factual information in relation to the product. I acknowledge that I have not received advice and/or a personal recommendation from Sheffield Mutual Friendly Society or its introducers. I understand that as this is a n-advised Sale Sheffield Mutual takes no responsibility for the suitability of the product and that I will lose some of the regulatory protection which I may otherwise have. Specifically, I understand that it is unlikely that I would be able to make a complaint against the Society should the product(s) prove to be unsuitable for me. (Words in the singular shall include the plural for joint policyholders) Name of Client(s): Signature of Client(s): Date: To be signed by the Proposer if the Policyholder is under 16. Joint applicants must both sign. Updated by D Gregory 03/02/2017

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15 Instruction to your Bank or Building Society to pay by Direct Debit Please fill in the whole form using a ball point pen and send it to: Sheffield Mutual Friendly Society 3 Maple Park, Maple Court, Wentworth Business Park, Tankersley, Barnsley, South Yorkshire, S75 3DP Service user number For Sheffield Mutual Friendly Society official use only. This is not part of the instruction to your Bank or Building Society. Name(s) of Account Holder(s) Bank/Building Society account number Branch Sort Code Name and full postal address of your Bank or Building Society To: The Manager Bank/Building Society Address Instruction to your Bank or Building Society Please pay Sheffield Mutual Friendly Society Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Sheffield Mutual Friendly Society and, if so, details will be passed electronically to my Bank/Building Society. Signature(s) Postcode Date Reference Banks and Building Societies may not accept Direct Debit Instruction for some types of account. DDI 1 5/15 This guarantee should be detached and retained by the Payer. The Direct Debit Guarantee This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits If there are any changes to the amount, date or frequency of your Direct Debit Sheffield Mutual Friendly Society will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Sheffield Mutual Friendly Society to collect a payment, confirmation of the amount and date will be given to you at the time of the request If an error is made in the payment of your Direct Debit, by Sheffield Mutual Friendly Society or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society If you receive a refund you are not entitled to, you must pay it back when Sheffield Mutual Friendly Society asks you to You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.