DATA CAPTURE FORM COLLECTIVE INVESTMENT BOND

Transcription

1 DATA CAPTURE FORM COLLECTIVE INVESTMENT BOND For financial adviser use only. 3 Editable fields to allow you to input information electronically. 3 Space to embed your company logo and footer. 3 Data fields follow the same sequence as the online application process. 3 You can delete this page if you wish. HOW TO CUSTOMISE THIS FORM Firstly, save the form to your desktop. To add a logo: Open the form from your desktop in Acrobat Standard 7* or above. In the toolbar, click on Document. Select Add a Watermark & Background. Under Source, select From file, where you can browse pdf, jpg or bmp files for your logo. Use the Position and Appearance options to alter the size and location. Use the Page Range option to select the page(s) for your logo. To add a footer: Open the form from your desktop in Acrobat Standard 7* or above. In the toolbar, click on Document. Select Add Headers & Footers. Select the footer tab and type the text required in the fields required. Use the options underneath the footer tab to adjust the style and location. To delete this page: Open the form from your desktop in Acrobat Standard 7* or above. In the toolbar, click on Document. Select Delete Pages. * For Acrobat 10 users, this can be found under Tools then pages. IMPORTANT NOTES This form is updated on a regular basis. It is your responsibility to ensure you are using the most up-to-date version which can be found on the Old Mutual Wealth Literature Library at Literaturelibrary Please ensure that all applicable sections are completed, as you may not be able to submit the application online if information is missing. Ensure that your client has checked the data that is captured on this form. To reset the editable data fields simply click on the reset button at the end of this form For new investments by non-private applicants (eg trusts/companies), the form entitled Tax Information for Trustees and Corporates MUST also be completed and returned to us, otherwise the investment could be delayed. SUPPLEMENTARY FORMS WHICH MAY BE REQUIRED Where you see an symbol, more information is provided. If you have further queries please refer to the online help options, or call This is to enable us to comply with regulations concerning taxation (These can be found on the Old Mutual Wealth Literature Library). Adviser fee authorisation form this needs to be completed and signed by your clients if they agree to pay fees. Power of attorney form this form will instruct us to allow one or more people to act as your attorney for the bond selected. Confirmation of verification of identity (COVI) the online application process will capture all money laundering requirements for individuals. However, the identity of any third parties paying for private investments will need to be verified using this form. Power of Attorney Form - if an attorney is acting on the client s behalf. A personalised version of this form can be printed during the online application process. This form should not be used for corporate or trustee applications. Please complete a paper application available from the Old Mutual Wealth Literature Library. 1 of 10

2 DATA CAPTURE FORM COLLECTIVE INVESTMENT BOND Form purpose This form is for financial advisers to gather the necessary information and declarations from a client to input new business online for a Collective Investment Bond on Old Mutual Wealth s platform for lump sum payments. If Old Mutual Wealth does not already hold a signature for your client then the last page can be detached and sent to us for this purpose. Please be aware that this form is not an application and will not be accepted as such if sent to us. You must submit this information online. PERSONAL DETAILS APPLICANT S DETAILS For existing clients, please enter the client reference : You will need to declare online that your client has seen the latest Key Information Document (KID) in respect of the Collective Investment Bond. More information is on our website: www. oldmutualwealth. co.uk/fund-info *Title (3) *First name *Surname For new clients: You may not need to capture all of the detailed information if the client s details are already held. To identify existing clients online, you can use all or part of the client name or client reference. * Date of birth *UK residence status (3) Resident *National Insurance (NI) Your client has never had an NI (3) * Relevant UK individual (3) *Individual status (3) Employed Pensioner Self-employed Caring for children under 16 Permanent UK residential address *Address *Town/City County *Postcode Caring for person aged 16 or over Full time education Other (please state) Home phone Work phone Mobile phone address Unemployed *Country Occupation Industry *Nationality(ies) * Country(ies) of Tax Residence * Tax Reference Number(s) * This is a mandatory field when creating a client online. Investment range WealthSelect or SelfSelect Your choice here will determine the funds available to choose from during the online process. 2 of 10

3 PERSONAL DETAILS JOINT APPLICANT S DETAILS (if applicable) For existing clients, please enter the client reference : *Title (3) *First name Joint applicants need to have a client record created online. To identify existing clients online, you can use all or part of the client name or client reference. *Surname For new clients only: * Date of birth *UK residence status (3) Resident *National Insurance (NI) Your client has never had an NI (3) * Relevant UK individual (3) *Individual status (3) Employed Pensioner Self-employed Caring for children under 16 Permanent UK residential address *Address *Town/City County *Postcode Caring for person aged 16 or over Full time education Other (please state) Home phone Work phone Mobile phone address Unemployed *Country Occupation Industry *Nationality(ies) * Country(ies) of Tax Residence * Tax Reference Number(s) * This is a mandatory field when creating a client online. YOUR ADVICE Registered individual/account to receive remuneration Have you given advice to the client in respect of this transaction? (3) Are you appropriately authorised to conduct this business? (3) On which basis are you acting for this transaction? (3) Independent Restricted 3 of 10

4 LIVES ASSURED DETAILS 1. Title (3) You may not need to capture all of the detail information if the client is to be a life assured. First name Surname Date of birth This form can be copied if there are more than four lives assured. The maximum allowed is ten. Relationship (3) Civil Partner Creditor/Debtor Daughter Dependant Employer/Employee Husband/Wife In Trust Nephew Niece Owner Parent Partner/Co-Director Son Spouse Other (please state) 2. Title (3) First name Surname Date of birth Relationship (3) Civil Partner Creditor/Debtor Daughter Dependant Employer/Employee Husband/Wife In Trust Nephew Niece Owner Parent Partner/Co-Director Son Spouse Other (please state) 3. Title (3) First name Surname Date of birth Relationship (3) Civil Partner Creditor/Debtor Daughter Dependant Employer/Employee Husband/Wife In Trust Nephew Niece Owner Parent Partner/Co-Director Son Spouse Other (please state) 4. Title (3) First name Surname Date of birth Relationship (3) Civil Partner Creditor/Debtor Daughter Dependant Employer/Employee Husband/Wife In Trust Nephew Niece Owner Parent Partner/Co-Director Son Spouse Other (please state) 4 of 10

5 INVESTMENT DETAILS Lump sum investment Lump sum amount Adviser Initial Fee (please complete if appropriate) Percentage fees must be entered in multiples of 0.05%.. % OR The minimum lump sum investment is 10,000 for a Collective Investment Bond. The adviser initial fee will be deducted before the investment is made into the bond. FUNDS Portfolio name (if applicable) Select funds Funds Inc/Acc % Please continue on a separate sheet if more funds are required. Key Investor Information Documents (KIIDs) or Key Information Documents (KIDs) are produced by fund managers and provide important information about their funds. It is not a mandatory requirement to provide fund KIIDs/ KIDs to Collective Investment Bond investors, but we recommend doing so. More information about KIIDs and KIDs is on our website: www. oldmutualwealth. co.uk/fund-info PHASING AND AUTOMATIC REBALANCING OPTIONS (not available with the wealthselect managed portfolio service) Phased investment required? (3) Phased investment over (3) 3 months 6 months 12 months Phased investment start date 0 1 (mm/yyyy) OR Automatic rebalancing option (3) Rebalancing frequency (3) Quarterly Half-yearly Yearly This will rebalance back to the fund allocation selected in the application. Rebalancing start date 1 5 (mm/yyyy) 5 of 10

6 APPLICATION OPTIONS Automatic withdrawal option (complete as appropriate) Fixed withdrawal of amount for each payment (minimum payment 25) Frequency withdrawal payments (3) Monthly OR Please select months required Jan Feb Mar Apr May Jun Jul Aug Sep Oct v Dec Payment start date 2 8 (mm/yyyy) Annual escalation basis (3) Nil RPI 5% Deduction preference for automatic withdrawals (3) the deduction will be made proportionally across all the life policies within your bond Largest fund Proportionally from all funds Proportionally from the following funds (3) Please list below: This is the only option available in conjunction with the WealthSelect Managed Portfolio Service. Bank details for income/withdrawal options Name of bank account holder Branch Branch sort code Bank/Building society Account Building society reference Death benefit option Capital Protected Death Benefit (3) With Without ADVISER FEES Adviser servicing fee % each year OR Percentage fees must be entered in multiples of 0.05%. Add VAT to the servicing fee? Frequency (3) each year Monthly Quarterly Half-yearly Yearly The Adviser Fee Authorisation form will be generated during the online process for you to print for your client to sign and return to us. Alternatively, you can download the form from our website www. oldmutualwealth. co.uk/adviser/ literature library/ Charge/fee deduction preference Same deduction preference as automatic withdrawals? (3) This applies to the Old Mutual Wealth Product Charge and Adviser servicing fee. 6 of 10

7 ADVISER FEES (continued) If select the following options for selling units to meet the Old Mutual Wealth Product Charge and any servicing fees. Largest fund Proportionally from all funds The deduction will be made proportionally across all the life policies within the bond. Proportionally from the following funds (3) Please list below: Proportionally is the only option available in conjunction with the WealthSelect Managed Portfolio Service. Adviser fund switch fee % OR from each switch Illustration options Consider additional accounts held on our platform by your client in this illustration? (3) This is the maximum switch fee you agree with your client. You will be able to stipulate the actual fee payable for each switch at the time the switch instruction is given. We calculate the Old Mutual Wealth Product Charge as the total value of all the client s accounts/ bonds on the Platform. Additional holdings amount The illustration will assume that this is the value of the client s other accounts on the Platform for the duration of the illustration. PAYMENT DETAILS Lump sum payment method (3) Cheque For cheques: Make cheques payable to Old Mutual Wealth Life & Pensions Limited. Debit card CHAPS Internet banking transfer For debit cards: Follow the instructions online. Your client must be with you when the debit card details are recorded online. For bank transfers: Bank must be provided with Old Mutual Wealth Life & Pensions Limited s bank details: Bank name: NatWest Bank plc Account name: Old Mutual Wealth Life & Pensions Sort code: Account : Reference: You will need to enter the cheque, account and sort code online. Then use the Print Cheque Confirmation option on the application summary screen once submitted, and attach the cheque to this when sending it to us. The reference is the application. It will be generated online during submission and can be input here for your records. ANTI-MONEY LAUNDERING As part of the online submission you will need to have verified the identity of the client under Money Laundering Regulations. 7 of 10

8 CLIENT SIGNATURE Please make sure that all of the information in this form is correct, before signing and dating below. Client signature Joint Applicant Signature (if applicable) Date Date This signature is for your own records. If Old Mutual Wealth does not already hold a signature for your client then the last page can be detached and sent to Old Mutual Wealth for this purpose. APPLICATION NUMBER This will be generated online during submission and can be input here for your records. This is not an application. It is solely for financial adviser records and will not be accepted if submitted. CLIENT DECLARATION As your financial adviser will be submitting the application electronically on your behalf, please see the Collective Investment Bond declaration below. Your adviser will be required to confirm that you have made this declaration. 1. On the basis of the details supplied in my application: a) I apply to invest in 1,000 unit-linked, whole of life assurance policies referred to collectively as the Collective Investment Bond. Alternatively, I apply to invest an additional amount into my existing Collective Investment Bond with that additional amount invested equally in each policy. b) I declare that: I am 18 years of age or over; I am resident in the United Kingdom and will inform Old Mutual Wealth Life & Pensions Limited if this changes in the future. c) I understand that Old Mutual Wealth Life & Pensions Limited will administer the Collective Investment Bond in accordance with UK tax legislation. d) I understand that incorrect information regarding lives assured may result in a reduced death benefit being paid. 2. I authorise Old Mutual Wealth Life & Pensions Limited: a) to hold interest distributions, dividends, rebates and any other rights or proceeds in respect of my investments in the Collective Investment Bond; and b) to sell units or shares in investments within my bond to meet any charges or fees for my financial adviser, in accordance with the Terms and Conditions; and c) to give effect to my instructions in accordance with the Terms and Conditions. 3. I understand that I will not receive confirmation relating to transactions involving the purchase or sale of investments which are carried out on a periodic basis in the manner agreed to in this application. Details of these transactions will be shown in the periodic statement which will be sent to me. In particular, such transactions include: phased investments automatic rebalances automatic withdrawals dividend and rebate reinvestments, and sales of units to meet Old Mutual Wealth Life & Pensions Limited charges and fees for my financial adviser (if applicable). 4. I have been given the opportunity to read and keep the following, and to have any questions concerning them answered to my satisfaction: a) Terms and Conditions, to which I agree b) Key Features Document c) Key Information Document about the Collective Investment Bond d) information including rebates, in respect of my chosen funds. 5. I consent to my personal data being used in accordance with the Personal Data Statement in the Terms and Conditions. 6. I declare that my application has been completed correctly and to the best of my knowledge and belief. 7. I confirm that I have obtained the consent of each life assured to use their personal data in accordance with the Personal Data Statement contained within the Terms and Conditions and am signing the application as his/her agent(s) as well as applicant(s)/trustee(s). 8. I understand that if I want Adviser fees to be deducted from my investment, I will need to sign and submit an Adviser Fee Authorisation form. 9. Tax information I understand that for regulatory purposes Old Mutual Wealth is required to obtain information concerning my taxation status. a) I declare that: i. I am resident for taxation in the country(ies) shown in this application and I am not resident for taxation elsewhere. ii. I am a national of the country(ies) shown in this application and I am not a national or citizen of any other country. iii. I will inform Old Mutual Wealth if this changes in the future. b) I understand that: i. Old Mutual Wealth may need to contact me for further information regarding tax information. ii. if I am resident for taxation outside of the UK, Old Mutual Wealth may need to share my information with the relevant tax authorities. 8 of 10

9 WEALTHSELECT MANAGED PORTFOLIO SERVICE DECLARATION Where you are using the WealthSelect Managed Portfolio Service in conjunction with a CIB, your financial adviser will be required to make you aware of the following declaration being made during the online application process. I have read and agreed to the following WealthSelect Managed Portfolio Service declaration. I confirm that I have explained the Managed Portfolio Service to my clients and I request on their behalf that you invest their bond into the Managed Portfolio I have selected. I confirm for each client: I have given advice in relation to the suitability of using the Managed Portfolio Service and to the Managed Portfolio to be selected here which meets my client s needs. I have provided the client with the factsheet for the relevant Managed Portfolio; I have given the client an opportunity to read it and they understand the investment risks relating to the Managed Portfolio Service in general and specifically to the relevant Managed Portfolio. I am responsible for ensuring that the Managed Portfolio selected is suitable currently and on an ongoing basis in accordance with my duties under the FCA rules. My client is aware that you, as the portfolio manager, will have complete discretion over the assets in each Managed Portfolio to buy, sell, retain, exchange or otherwise deal in assets, take all routine and day-to-day decisions about the asset allocation of the Managed Portfolios, and that neither 1, nor the client is permitted to provide such dealing instructions or modifications to the Managed Portfolio. My client accepts that the agreement to provide the Managed Portfolio Service is between you and them as detailed in the supplementary terms, and you are offering this service to them as part of your agreement with them on the condition that I am appointed as their financial adviser to offer advice in respect of the ongoing suitability of the Managed Portfolio for their needs. My client understands that where they have existing instructions to pay withdrawals or deduct the Product Charge (formerly known as platform charge) or adviser servicing fees from specific funds, these will automatically be changed to withdrawals or deductions taken proportionally across all funds. I have explained any potential tax implications of this change to my client and they accept these. My client has a copy of the Supplementary Terms and Conditions for Collective Investment Bonds on Charge Basis 3 to reflect the two investment ranges and the WealthSelect Managed Portfolio Service and they have had an opportunity to read and understand them before agreeing to the use of the Managed Portfolio Service. 9 of 10

10 INVESTOR SIGNATURE If Old Mutual Wealth does not already hold a specimen signature for your client then this page can be detached and sent to Old Mutual Wealth for this purpose. Old Mutual Wealth must hold a valid signature for all clients, to ensure any future instructions are not delayed whilst security checks are made. The application will be generated when the application is entered online Application Client reference The client reference will be generated when the client is created online. Once completed please send this page to: Freepost RSJX-XAJZ-BKKT Old Mutual Wealth Old Mutual House Portland Terrace Southampton SO14 7AY This freepost address is for specimen signatures only. Please do not use it for other correspondence as it will not be delivered to the correct area. First applicant Joint applicant (if applicable) Print name Signature* Date Date * if you are an attorney signing this on behalf of the investor please add as attorney after your signature and ensure our completed Power of Attorney form and documentary evidence accompany this specimen signature page. Please be aware that this form is not an application and will not be accepted if sent to us. **investor** SK6697/ /December of 10