APPLICATION FORM SELF INVESTED PERSONAL PENSION (SIPP)

Transcription

1 APPLICATION FORM MANAGED PORTFOLIO SERVICE INDEX STRATEGIES This form should be used for a Self Invested Personal Pension (SIPP) to be managed by Quilter Cheviot. 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. The member (and pension adviser where applicable) should complete pages 1 to 6 of this form and sign page 7. The scheme administrator and trustee should complete pages 6 and 7. SIPP PROVIDER National Insurance Number l / l l l l l / Or Local tax number for overseas residents MEMBER S NAME 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? *Yes No *If you have ticked yes, please provide details PROVIDER REFERENCE Member s Personal Details Title Surname Forename(s) CONTACT DETAILS Permanent residential address Number of dependants Date of birth (DD/MM/YYYY) Nationality Preferred correspondence address (if this is not the permanent residential address) Country of birth Country of tax residence, if not UK Country of domicile, if not UK 01

2 Preferred telephone number EMPLOYMENT/OUTSIDE BUSINESS INTERESTS Are you a director or significant senior manager of a Plc? * *If yes, which company(ies)? Fax number 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). What is your current occupation, or your previous job if you have retired? Please state if you have not had a job previously. *If other, please specify. Does your employer need to receive contract notes? * *If yes, please provide details 02

3 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? YOUR PENSION ADVISER Contact name SOURCE OF FUNDS Please tick the applicable sources of how you fund your pensions; Surplus earned income Employee share (or share option) sales or sale of business Transfer from/consolidation of other schemes Savings previously held outside of the pension scheme Inherited capital Other source(s) Existing fund If other, please provide details; Additional contributions Name of company FCA reference number (if applicable) Existing fund Address Additional contributions DETAILS OF YOUR PENSION FUND(S) This section can be answered by your pension adviser. Telephone We will share information relevant to your account with your appointed financial adviser. If you do not consent, please tick this box. Can we take investment instructions from your pension adviser? Please indicate the amount being invested into this SIPP If in pension withdrawal, when is the next 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? 03

4 What is the approximate asset allocation of your pension funds not managed by Quilter Cheviot? Cash and bonds UK equities % % 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 SIPP to provide? % Do you or will you have a secured annual pension income of over 20,000 and qualify for the Minimum Income Requirement? If known, what is the anticipated annual pension withdrawal from this SIPP? or % Are there any other considerations we should be aware of in respect of managing this SIPP? Quilter Cheviot IDX Growth The investment objective is to grow the capital value of the portfolio as well as to generate some degree of income. The Quilter Cheviot IDX Growth Strategy is designed for an investor with a time horizon of more than 5 years, and a medium to higher tolerance for risk that can accept significant variation or disruption to capital value or current income in order to achieve their longer-term objective. The Quilter Cheviot IDX Growth Strategy is a diversified portfolio comprising predominantly domestic and international equity index-tracking funds with a small exposure to fixed interest index-tracking funds. There may also be exposure to exchange-traded products (ETPs) and funds investing into alternatives such as commercial property, private equity, commodities and absolute return strategies. The risk category for this strategy is considered mediumhigher risk. Quilter Cheviot IDX Balanced The investment objective is to grow the capital value of the portfolio as well as to generate some degree of income. The Quilter Cheviot IDX Balanced Strategy is designed for an investor with a time horizon of more than 5 years, and a medium tolerance for risk that can accept moderate variation or disruption to capital value or current income in order to achieve their longer-term objective. The Quilter Cheviot IDX Balanced Strategy is a diversified portfolio comprising predominantly domestic and international equity index-tracking funds as well as some exposure to fixed interest index-tracking funds. There may also be exposure to exchange-traded products (ETPs) and funds investing into alternatives such as commercial property, private equity, commodities and absolute return strategies. Does Quilter Cheviot manage any of your other investments? Yes No No other investments EXPLANATION OF MANAGED PORTFOLIO SERVICE (MPS) INDEX STRATEGIES Please note, the MPS does not take unrealised capital gains into account when changes are made to the portfolios. This means there may be occasions when realised gains are in excess of the Annual Exemption. Your financial adviser is responsible for selecting a suitable MPS Strategy to meet your individual circumstances and objectives. Please note that whilst Quilter Cheviot is responsible for managing your chosen MPS Strategy in accordance with the investment objectives and risk definitions as described below, your financial adviser will have an ongoing responsibility to ensure the Strategy continues to meet your individual circumstances and objectives. 04 The risk category for this strategy is considered medium risk. Quilter Cheviot IDX Income The investment objective is to grow the capital value of the portfolio as well as to generate some degree of income. The Quilter Cheviot IDX Income Strategy is designed for an investor with a time horizon of more than 5 years, and a medium tolerance for risk that can accept moderate variation or disruption to capital value or current income in order to achieve their longer-term objective. The Quilter Cheviot IDX Income Strategy is a diversified portfolio comprising predominantly domestic and international equity index-tracking funds as well as some exposure to fixed interest index-tracking funds. There may also be exposure to exchange-traded products (ETPs) and funds investing into alternatives such as commercial property, private equity, commodities and absolute return strategies. The risk category for this strategy is considered medium risk.

5 Quilter Cheviot IDX Conservative The investment objective is to grow the capital value of the portfolio as well as to generate some degree of income. The Quilter Cheviot IDX Conservative Strategy is designed for an investor with a time horizon of more than 3 years, and a lower to medium tolerance for risk that can only accept moderate variation or disruption to capital value or current income. The Quilter Cheviot IDX Conservative Strategy is a diversified portfolio comprising predominantly fixed interest index-tracking funds as well as some exposure to domestic and international equity index-tracking funds. There may also be exposure to exchange-traded products (ETPs) and funds investing into alternatives such as commercial property, private equity, commodities and absolute return strategies. The risk category for this strategy is considered lowermedium risk. RISK DEFINITIONS Your overall financial circumstances will principally determine your capacity for risk and you may have to accept more risk than you initially anticipate in order to achieve your long-term objective. Your capacity for risk means your ability to absorb falls in the value of your investments. All investments involve an element of risk to capital and/or income and there will also be periods when the short-term return differs from the long-term objective. Lower I/we have a low tolerance for risk and regardless of market circumstances, I/we would only be comfortable with minimal variation or disruption to capital value or current income. Lower to Medium I/we have a lower to medium tolerance for risk, I/we would only be comfortable with moderate variation or disruption to capital value or current income. Medium I/we have a medium tolerance for risk and can accept moderate variation or disruption to capital value or current income in order to meet my/our longer-term objectives. Medium to Higher I/we have a medium to high tolerance for risk and can accept significant variation or disruption to capital value or current income in order to meet my/our longer-term objectives. ACCOUNT STRATEGY Please select your chosen strategy having reviewed the options outlined on this page. IDX Growth IDX Balanced IDX Income IDX Conservative REPORTING Our half yearly summaries, the annual tax summary and valuations as requested will be sent to the SIPP administrator. Please enter what you and/or your adviser would like to receive. Member Adviser Correspondence Copy contract notes Comprehensive half yearly summary INTERNET ACCESS Do you want to access and download valuations and transactions from our website? Yes No If yes and you already have an internet account with us, please enter your user ID. Member Advisor ANTI-MONEY LAUNDERING VERIFICATION REQUIREMENTS We are required to verify the identity of all potential clients and their beneficial owners (where applicable). We cannot conduct business with you until this process is complete. For UK and Jersey resident individuals, 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 changed in the last 5 years Higher I/we have a high tolerance for risk and can accept significant variation or disruption to capital value or current income in order to meet my/our longer-term objectives. 05

6 Previous residential address, if less than 1 year at current address (a care of or post box is not acceptable) Telephone Fax Either 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 l l l l l / l Date of expiry (DD/MM/YYYY) Member trustee name (where applicable) HMRC approval number SCHEME ADMINISTRATOR Full name of pension administrator Contact name Or Driving licence number Full postal address l l l l / l l l l l / l l / l Date of expiry photocard (DD/MM/YYYY) Please sign the Declaration on page 7. The following should be completed by the scheme administrator and trustee. TRUSTEES DETAILS Pension trustee(s) name Telephone Fax Contact name Full postal address SIPP BANK ACCOUNT AND INCOME INSTRUCTIONS Account name Sort code l / l / l Account number Reference 06

7 For accounts not in drawdown, the portfolio income is transferred to the capital account for re-investment on a monthly basis. Where income is to be paid to the above bank or building society account, please confirm amount of standing order. Monthly standing order of or quarterly standing order of DECLARATION (to be signed by the trustee) 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 may be) 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) provide you on an ongoing basis with information regarding his/her personal details and relevant outside interests; (b) agree the investment objective, risk preference and any investment restrictions applicable to the management of the investments; DECLARATION ON BEHALF OF TRUSTEE(S)/ INSURANCE COMPANY Signatory 1 Date (DD/MM/YYYY) Name capacity/position Signatory 2 Date (DD/MM/YYYY) Name capacity/position Signatory 3 Date (DD/MM/YYYY) Name capacity/position (c) give instructions provided that these instructions are consistent with the investment guidelines that we have prescribed in relation to the SIPP ; and (d) elect to receive internet access and various reports for either him or herself and/or his/her adviser, as noted on page 5. Subject to the above, we specifically agree that in the event of any inconsistency between the information or instructions provided by us and by the member, the information or instructions provided by the member shall prevail. To the best of our knowledge the information provided in this form by the member and his/her adviser is true and accurate in all respects. 07

8 MEMBER S DECLARATION (to be signed by the member) The below confirmations are, what we call in legal terminology, representations and warranties. This means that we are entitled to rely on these confirmations without the need to check whether they are correct, and will have legal rights against you if the confirmation is not correct. I confirm that all the information in this form is accurate, complete, can be relied upon, and that my investment objectives are as set out in this application form. I confirm my acceptance of the Quilter Cheviot fee arrangement. If the Quilter Cheviot fee cannot be paid from the SIPP, I will be personally liable for such fees. I acknowledge receipt of a copy of the Quilter Cheviot Terms and Conditions and risk disclosures. I agree to the terms for online access as detailed in the Quilter Cheviot Terms and Conditions I authorise Quilter Cheviot to obtain relevant financial details from my pension adviser. If you are a trustee of this fund, please also sign the trustee declaration. Signed Date (DD/MM/YYYY) Print name QUILTER CHEVIOT One Kingsway London WC2B 6AN t: +44 (0) w: quiltercheviot.com Quilter Cheviot Limited is registered in England with number , registered office at One Kingsway, London WC2B 6AN. Quilter Cheviot is a member of the London Stock Exchange and authorised and regulated by the UK Financial Conduct Authority. 08