financial and fund adviser fees authorisation

Transcription

1 Financial adviser details Old Mutual International Name of financial adviser Company name financial and fund adviser fees authorisation Address Telephone number Fax number address Old Mutual International Isle of Man and Old Mutual International Ireland only accept business introduced by companies which have Terms of Business with us. This form should only be used where your financial adviser is completing and submitting to Old Mutual International an online application on behalf of the applicants. Only for use in the UK This document was last reviewed in January Please confirm with your financial adviser that this is the most up-to-date document for your product or servicing needs. Please use only blue or black ink and block capitals. You should use this form to authorise Old Mutual International to pay the fees you have agreed with your financial adviser and/or fund adviser from the products listed below. All references to Old Mutual International in this form refer to Old Mutual International Isle of Man Limited or Old Mutual International Ireland dac, where you have applied for one of the Portfolio Bond products listed below: Old Mutual International Isle of Man Limited International Portfolio Bond Redemption International Portfolio Bond Life International Select Bond Redemption International Select Bond Life Old Mutual International Ireland dac European Portfolio Bond Life European Wealth Bond European Select Bond Please complete the Adviser fees for the Loan Trust form if you wish to pay fees to your financial adviser from your Loan Trust. Your financial adviser will be able to provide you with this form. It is important that you discuss the content of this form with your financial adviser. This form does not cover the charges to Old Mutual International. Details of these will be provided by your financial adviser. The fees documented in this form relate to the Portfolio Bond you are applying for: Initial advice and ongoing services provided by your financial adviser; and/or Ongoing services provided by your fund adviser. Each applicant must check that this form is completed correctly and sign to authorise the payment(s) to the financial adviser and/or fund adviser. Any errors or omissions may delay the implementation of your instructions. Where applicable, we will send the lead policyholder confirmation of the fees we have set up. These details should be checked to ensure the adviser fee payment(s) details are correct. If the details are incorrect, the lead policyholder should contact Old Mutual International immediately using the contact details provided at that time. Once completed, your financial adviser will upload this document along with your Portfolio Bond application and send these electronically to Old Mutual International. We will send you confirmation that we have set up the fee instructions given on this form. More information about fees and how they are deducted from your investment can be found in our Explaining your Portfolio Bond fees and charges document. Please ask your financial adviser for a copy. The notes on page 6 will help you complete this form. 1 of 6

2 Details of all individual applicant(s) Applicant 1 Applicant 2 (if any) Customer ID (if you have one ask your financial adviser) Full forename(s) Surname If there are any further applicants, please photocopy this page, attach the details with this application form and tick here (3) If additional pages are added, each separate page must be dated and initialled by all applicants. Portfolio Bond Please provide the following details Type of Portfolio Bond (3) Old Mutual International Isle of Man International Portfolio Bond Redemption International Portfolio Bond Life International Select Bond Redemption Old Mutual International Ireland European Portfolio Bond Life European Wealth Bond European Select Bond International Select Bond Life Please state the currency in which the premium is to be paid $ Other Premium paid to Old Mutual International (state currency) Other currencies are not permitted on the International Select Bond - Life or Redemption, or the European Select Bond. Financial Adviser Financial Adviser Fee details Please enter details of the fees that you have agreed with your financial adviser or tick the No fee payable boxes where Old Mutual International is not to pay fees to your financial adviser. Initial Fee Please note: A monetary amount must be a whole amount All amounts must be inclusive of any VAT Percentage amounts must be to two decimal places the fee to be deducted cannot be more than the premium paid in that currency Please enter the Initial Fee you authorise us to pay to your financial adviser no Initial Fee payable Do you want us to pay this fee? (3) before investment in your Portfolio Bond. We deduct the fee from your lump sum premium before the remainder is invested in your Portfolio Bond. after investment in your Portfolio Bond. We pay this fee by making a one-off withdrawal (part surrender) of this amount from your policy after your lump sum premium has been invested. Please note there may be tax implications depending on the choice made. We suggest that you discuss the above with your financial adviser before selecting your option. continued 2 of 6

3 Financial Adviser (continued) Ongoing Service Fee Please note: Ongoing Service Fees are paid quarterly by a regular withdrawal from your policy A monetary amount must be a whole amount Percentage fees will be calculated using the portfolio fund value at the Quarterly Date. Your financial adviser can explain how this is calculated The Ongoing Service Fee must be paid in the Portfolio Bond currency All amounts must be inclusive of any VAT Please enter the Ongoing Service Fee amount you authorise us to pay to your financial adviser each year. each year or % each year or no Ongoing Service Fee payable Fund Adviser (NOT APPLICABLE TO EUROPEAN WEALTH BOND) Fund Adviser Fee details Where you have appointed a fund adviser, please enter the name of your fund adviser and details of the fees that you have agreed will be deducted from your Portfolio Bond. Tick the No fee payable box where Old Mutual International is not to pay fees to your fund adviser from your Portfolio Bond. Fund Adviser details Please enter your fund adviser s company name Fund adviser company name Fund Adviser Fee Please note Fund Adviser Fees are paid quarterly by a regular withdrawal from your policy A monetary amount must be a whole amount Percentage fees will be calculated using the portfolio fund value at the Quarterly Date. Your financial adviser can explain how this is calculated The Fund Adviser Fee must be paid in the Portfolio Bond currency All amounts must be inclusive of any VAT Please enter the Fund Adviser Fee amount you authorise us to pay to your fund adviser each year each year or. % each year or no Ongoing Fund Adviser Fee payable 3 of 6

4 Declaration and authorisation this declaration is made by each applicant/trustee who signs below and, where a trustee, all trustees have agreed jointly to this declaration: 1. I/We instruct Old Mutual International to deduct the fees detailed in this form from the Portfolio Bond which my financial adviser is submitting on my behalf. 2. I/We understand that the fee(s) stated in this form will be met as follows: i. Initial Fee by deduction from the amount paid to Old Mutual International before investment into the Portfolio Bond or after the investment is made by part surrender from my/our Portfolio Bond in accordance with the instruction given in this form. ii. Ongoing Service Fee by a quarterly Regular Withdrawal from my/our Portfolio Bond. iii. Fund Adviser Fee by a quarterly Regular Withdrawal from my/our Portfolio Bond. 3. I/We confirm that Old Mutual International has brought to my/our attention the importance of discussing the content of this form with my/our financial adviser and/or fund adviser before signing below. 4. I/We confirm that my/our financial adviser has explained the effect that deducting fees from my/our Portfolio Bond will have on the future value of my bond. In particular that there may be tax implications in agreeing to pay fees from my/our Portfolio Bond 5. I/We have the authority to approve these instructions. 6. I/We understand that I/we can amend an Ongoing Service Fee or Fund Adviser Fee facilitated by Old Mutual International by giving notice to Old Mutual International. 7. I/We confirm Old Mutual International cannot refund a fee once it has been deducted from my/our Portfolio Bond. Instead, I/we would need to contact my/our financial adviser and/or fund adviser to discuss a refund and that any such payment would be paid to me/us by my/our financial adviser and/or fund adviser. If there are any further applicants, please photocopy this page, attach the details with this application form and tick here (3) If additional pages are added, each separate page must be dated and initialled by all applicants. Applicant 1 Applicant 2 (if any) Name (Please PRINT) Signature Date D D M M Y Y Y Y D D M M Y Y Y Y 4 of 6

5 Financial Adviser s declaration 1. I confirm that I have agreed the fee(s) authorised in this form with my client(s), for services provided or to be provided. 2. I understand that i. Old Mutual International will send my client(s) confirmation of these instructions and that they have been implemented. ii. if there is any missing or incomplete information on this form it may result in a delay in implementing these instructions. iii. All fees will be paid directly to the firm authorised under the terms of business. iv. Any fee paid is assumed to include VAT where this would apply at the rate then prevailing. Financial Adviser s name (Please PRINT) Signature Company Name Date D D M M Y Y Y Y Fund Adviser s declaration (not applicable to European Wealth Bond) 1. I confirm that I have agreed the fee(s) authorised in this form with my client(s), for services provided or to be provided. 2. I understand that i. Old Mutual International will send my client(s) confirmation of these instructions and that they have been implemented. ii. if there is any missing or incomplete information on this form it may result in a delay in implementing these instructions. iii. All fees will be paid directly to the firm authorised under the terms of business. iv. Any fee paid is assumed to include VAT where this would apply at the rate then prevailing. Fund Adviser s name (Please PRINT) Signature Company Name Date D D M M Y Y Y Y 5 of 6

6 Notes: Completing the financial and fund adviser Fees Authorisation form Details of all individual applicant(s): is for the name and signature of all applicants to the Portfolio Bond being submitted by your financial adviser. If known then please enter your Old Mutual International customer ID, your financial adviser will be able to tell you this, if you have one. Portfolio Bond: is for you to confirm the product name for the Portfolio Bond that has been applied for and the amount you are paying to Old Mutual International. Financial Adviser Fee details: is for details of the fees you have agreed with your financial adviser and which will be deducted from your Portfolio Bond. Initial Fee you can state this as a monetary amount or as a percentage of the amount being invested. We will deduct the fee either before your Portfolio Bond has been set up and invest the balance or we will invest the full amount paid to us and deduct the fee from the Portfolio Bond as a one off withdrawal or payment. Please note there may be tax implications depending on the choice made. We suggest that you discuss this with your financial adviser before selecting your option. Ongoing Service Fee state this as a monetary amount or as a percentage of the portfolio fund value. Please note there may be tax implications in paying an Ongoing Service Fee from your Portfolio Bond. We suggest that you discuss the above with your financial adviser before selecting your option. Fund Adviser Fee details: is for you to enter the name of your fund adviser and details of the fees you have agreed will be deducted from your Portfolio Bond (not applicable to European Wealth Bond). Fund Adviser Fee you can state this as a monetary amount or as a percentage of the portfolio fund value. Please note there may be tax implications in paying a Fund Adviser Fee from your Portfolio Bond. We suggest that you discuss the above with your financial adviser before selecting your option (not applicable to European Wealth Bond). Declaration and authorisation: is where you sign to authorise payment of the fee(s). All applicants/trustees/authorised signatories must sign. You should discuss and agree the fee(s) with your financial adviser and/or fund adviser before signing. Financial adviser s declaration: is for your financial adviser to sign. Fund adviser s declaration: is for your fund adviser to sign (not applicable to European Wealth Bond). Calls may be monitored and recorded for training purposes and to avoid misunderstandings. Old Mutual International Isle of Man Limited is registered in the Isle of Man under number 24916C. Registered and Head Office: King Edward Bay House, King Edward Road, Onchan, Isle of Man, IM99 1NU, British Isles. Phone: +44 (0) Fax: +44 (0) Licensed by the Isle of Man Financial Services Authority. Old Mutual International Isle of Man Limited is a member of the Association of International Life Offices. Old Mutual International is registered in the Isle of Man as a business name of Old Mutual International Isle of Man Limited. Old Mutual International Ireland dac is regulated by the Central Bank of Ireland. Registered No Administration Centre for correspondence: King Edward Bay House, King Edward Road, Onchan, Isle of Man, IM99 1NU. Tel: +353(0) Fax: +353(0) Head Office Address: Hambleden House,19-26 Lower Pembroke Street, Dublin 2, Ireland. VAT number for Old Mutual International Ireland dac is S. Registered Office: Arthur Cox Building, Earlsfort Terrace, Dublin 2, Ireland. Old Mutual International is registered in Ireland as a business name of Old Mutual International Ireland dac. SK8861/INT /January of 6