Immediate Life Annuity

Transcription

1 Immediate Life Annuity Appication Return address Aviva New Business Immediate Life Annuity, PO Box 520, Norwich, NR1 3WG For adviser use ony Preferred method of contact (*) Your name Your teephone number Your emai address Your fax number Your Aviva Account code 0 for exampe ABC0123 Name of person to be contacted if different from above printed at the bottom of each page of the iustration. *Pease note, if we are unabe to reach you via your preferred method we wi try aternatives. It is an FCA requirement that we provide data as to whether advice was given on the sae of this product. Was financia advice given? YES NO (Tick one) We ony faciitate the payment of an adviser charge (Section 8 beow) where you confirm that advice has been given. Pease read these notes before competing your appication. We ve prepared these notes to hep you compete this appication form. It s important that you answer a the questions accuratey to the best of your knowedge. Pease make sure that you: - answer a questions fuy - do not use dashes to skip questions - tick the appropriate box when asked. First annuitant If you are appying for this annuity for yoursef, pease compete sections 1, 5, 6, 9 and 10. If you are appying for this annuity for someone ese, pease compete sections 1, 3, 4, 5, 6, 9 and 10. Two annuitants If you are appying for this annuity for yourseves, pease compete sections 1, 2, 3, 5, 6, 9 and 10. If you are appying for this annuity for other peope, pease compete a the sections. Section 5 tes us what type of annuity pan you woud ike. Pease make sure that you compete this section carefuy. If you are in any doubt, pease discuss this with your financia adviser. Before the poicy starts, we require a PLA6 tax form to assess the tax treatment of your annuity, this can downoaded from the HMRC website: Tax Residence Sef-Certification Tax reguations require us to coect certain information about each poicyhoder s tax status, and in certain circumstances we may be obiged to share this information with the reevant tax authorities. Any poicyhoders wi need to compete Section 9. Evidence we need to set up this pan We need to verify the name and age of each annuitant. We wi accept one of the foowing documents as proof for each annuitant (If this is a joint ife or married femae appication form where the name on the birth certificate is different to their current name, and a photocopy of a vaid passport is not being used as evidence, we need both an origina birth and marriage certificate): Certified copy of vaid passport Certified copy of vaid photo driving icence Origina birth certificate Origina marriage certificate/civi partnership certificate and origina decree absoute (We ony need these documents when the annuitant has changed their name). Every person invoved in this appication must compete a money aundering verification form. This incudes the annuitant(s), poicyhoder(s) and trustees (if the funds are being drawn on the trustees account). If the money is coming from a wi, trust or settement, we wi need a copy of that part of the wi, trust or settement document that confirms the name of the beneficiary and the amount of the settement.

2 1 Persona detais of singe/first annuitant Surname Mr/Mrs/Miss/Ms/other Forename(s) Permanent residence address Postcode Daytime teephone number Date of birth Nationa Insurance number 2 Persona detais of second annuitant Surname Mr/Mrs/Miss/Ms/other Forename(s) Permanent residence address Postcode Daytime teephone number Date of birth Nationa Insurance number 3 Poicyhoder detais Singe poicyhoders If you take out an annuity as a singe poicyhoder on the ife of someone ese or on joint ives with you and another person, you shoud consider these points: 1. Ony you as the poicyhoder wi have any rights under this contract. 2. If you are the poicyhoder but not the annuitant (or ony annuitant) and you die but an annuitant survives you we wi keep the annuity payments unti we receive your grant of ega representation. Once we have that, we wi pay the money to your ega persona representative(s). A grant of ega representation is an officia document that proves your ega persona representatives have the authority to dea with your estate after your death. If you haven t chosen a persona representative, you wi be assigned one by the court. With this in mind, you shoud consider: a. making provision in your wi asking us to pay the money to another person (such as the surviving annuitant) after your death b. the effects of any deay in annuity payments after you die if you use the money to fund premiums under a ife insurance poicy. Pease tak to your financia adviser if you woud ike more advice on these points. Who wi be the poicyhoder? First annuitant? Second annuitant? Joint ife? Other? (Pease compete section 4) A poicyhoders wi need to sign the appication.

3 4 Persona detais of poicyhoder(s) ony compete this if the poicyhoder is not one of the annuitants Surname Mr/Mrs/Miss/Ms/other Forename(s) Surname Mr/Mrs/Miss/Ms/other Forename(s) Permanent residence address Postcode Daytime teephone number 5 Detais of annuity required The minimum investment into this annuity is: - 7,500 after deduction of any adviser charge, if bought with your own money - 100,000 after deduction of any adviser charge, if bought by the trustees of a wi, trust or settement. You can use the tax-free cash from your pension fund to buy this annuity, but not the pension fund itsef. You can aso buy this annuity with money from your savings, investments or an inheritance. 1 Purchase price Pease make your cheque payabe to Aviva. Uness the money is from a wi, trust or settement, it must be cear that the money comes from the persona account of either the annuitant(s) or the poicyhoder. Pease give us the quote ID printed at the bottom of each page of your iustration. This tes us what options you woud ike us to set up for this annuity. 2 Do you pay income tax? Yes No If no, we need you to send us an R86 or R89 tax form with this appication. You can downoad the R86 form from the HMRC website at The R89 form is avaiabe to compete onine through the HMRC website. Pease cick on this ink to go directy to the form. Aternativey, you can access the form from the HMRC home page by searching for R89. 3 Are you buying this annuity with money from a wi, trust or settement? Yes No If yes, pease give detais 6 Payments of annuity Fu name and posta address of your bank/buiding society The manager Postcode Branch sort code number Name of account hoder Bank/buiding society account number

4 7 Financia Crime To verify your identity and prevent financia crime, your information may be used by any company within the Aviva group and may be shared with third parties who provide services to us, as we as other organisations where required to by aw and reguatory requirements. A record may be kept of any searches carried out and any suspicions of financia crime and reated detais may be retained and used to assist other companies for verification and identification purposes. The search is not a credit check and your credit rating shoud not be affected. 8 Adviser Charge Agreement This section ony appies if you have received advice from any adviser other than an Aviva adviser and you wish Aviva to faciitate an Adviser Charge to such an adviser. The terms and conditions as set out beow are important and you shoud take time to read them before you compete the Decaration. If you are uncertain about the nature of this Agreement or how to compete it, you shoud discuss this with your Financia Adviser or any other professiona adviser acting on your behaf. In this Adviser Charge Agreement, the foowing terms wi have the foowing meanings; Aviva, we, us or our means Aviva Life & Pensions UK Limited; Aviva Poicy Financia Adviser you or your Adviser Charge means the Aviva Annuity for which you are appying. This Agreement does not appy in reation to any other poicies or investments that you may have with Aviva; means the Firm identified in this appication form who is providing you with financia advice in respect of your annuity appication; means the Poicyhoder identified in this appication form; means the payment you have agreed to pay your Financia Adviser for the initia advice and services provided to you. 1. Payment of an Adviser Charges 1.1 We wi pay to your Financia Adviser the Adviser Charge in accordance with your instructions. 1.2 The Adviser Charge that you have agreed to pay your Financia Adviser is a matter between you and your Financia Adviser. We do not assess the suitabiity or amount of the Adviser Charge you have agreed to pay. 1.3 When we pay an Adviser Charge to your Financia Adviser, this is a payment we are making at your direction and on your behaf. The Adviser Charge is not a payment made by us to your Financia Adviser. 1.4 The payment of an Adviser Charge is separate to any charges that you may be required to pay Aviva in respect of your Aviva Poicy 1.5 We wi ony credit an Adviser Charge to your Financia Adviser s firm account or as otherwise directed by your Financia Adviser. We wi not pay an Adviser Charge to you. 1.6 We wi not pay interest to you or your Financia Adviser for the non payment or ate payment of an Adviser Charge. 1.7 No Adviser Charge wi be payabe in respect of monies subsequenty received by us after your Aviva Poicy has been set up. 1.8 Any queries regarding your Adviser Charge, incuding entitement to a refund, shoud be referred to your Financia Adviser. 2. Canceing your Aviva Poicy 2.1 If you decide to cance your Aviva Poicy, the Adviser Charge wi be credited back to you uness it has aready been paid by us to your Financia Adviser. 3. Stopping Payment of Your Adviser Charge 3.1 Once we have received your instruction to pay an Adviser Charge, we may not be abe to stop such payment if you subsequenty ask us to do so. 3.2 In exceptiona circumstances, we may stop the payment of an Adviser Charge and we wi endeavour to notify you as soon as possibe of the action we have taken. These circumstances incude if we reasonaby beieve; (a) that the payment of the Adviser Charge woud be in breach of any reevant aws or reguations or your Financia Adviser was not appropriatey authorised by the Financia Conduct Authority or any repacement reguator at the time of providing you with advice or services in reation to your Aviva Poicy; or (b) your Financia Adviser is no onger in business or may be insovent. 4. Keeping you and your Financia Adviser informed 4.1 We wi notify you if your Financia Adviser instructs us to reduce or stop the payment of an Adviser Charge. 4.2 We wi aso notify your Financia Adviser if you instruct us to stop the payment of the Adviser Charge. 5. Outstanding Responsibiity 5.1 If, subject to the terms of this Agreement, an Adviser Charge is stopped, unpaid or is re-credited to your Aviva Poicy, you may remain iabe to reimburse your Financia Adviser, You shoud check the terms of your arrangement with your Financia Adviser. 6. Vaue Added Tax 6.1 We expect that most Adviser Charges reating to Aviva products wi not be subject to VAT. However, certain services provided to you by your Financia Adviser, incuding those paid for by Adviser Charges reating to Aviva products, may not be exempt from VAT. You shoud discuss this with your Financia Adviser who wi be responsibe for accounting for VAT where appicabe.

5 8 Adviser Charge Agreement (continued) 7. Misceaneous 7.1 This Agreement does not give any rights to any person other than you and us. No other person sha have any rights under the Contracts (Rights of Third Parties) Act 1999 to rey on any terms under this Agreement 7.2 This Agreement is to be governed by and interpreted in accordance with the aws of Engand and Waes. The courts of Engand and Waes wi have excusive jurisdiction over any dispute arising from this Agreement. 9 Tax Residence Sef-Certification You need to compete this section. If you don t we have to report detais of your annuity to Her Majesty s Revenue and Customs (HMRC). If you have any question about how to compete this form pease contact your professiona adviser. First poicyhoder Your fu name Your date of birth Your account number 1. Are you a resident for TAX PURPOSES anywhere other than the United Kingdom (UK)? Yes No Notes (i) UK is Engand, Northern Ireand, Scotand and Waes. (ii) If you are a US citizen or hod a US passport or green card, you wi aso be considered tax resident in the US even if you ive outside the US so you must answer Yes. 2. If you answered Yes to question 1, pease ist beow the country or countries you are resident in for tax purposes, aong with any Tax Reference number(s)/tax Identification Numbers(s) (TIN), if reevant. Country/Countries of tax residency Tax Identification Number/Reference Number/Nationa Insurance Number or equivaent If you don t have a Tax Identification Number or equivaent, pease te us why in the box beow. Second poicyhoder Your fu name Your date of birth Your account number 1. Are you a resident for TAX PURPOSES anywhere other than the United Kingdom (UK)? Yes No Notes (i) UK is Engand, Northern Ireand, Scotand and Waes. (ii) If you are a US citizen or hod a US passport or green card, you wi aso be considered tax resident in the US even if you ive outside the US so you must answer Yes. 2. If you answered Yes to question 1, pease ist beow the country or countries you are resident in for tax purposes, aong with any Tax Reference number(s)/tax Identification Numbers(s) (TIN), if reevant. Country/Countries of tax residency Tax Identification Number/Reference Number/Nationa Insurance Number or equivaent

6 If you don t have a Tax Identification Number or equivaent, pease te us why in the box beow. Important Information The UK Government has and wi be entering into a number of inter-governmenta agreements to share tax information, where appicabe, with the tax authorities in other territories. The requirement to coect information about each customer s tax residence is part of UK egisation and as a financia services company we are egay obiged to coect it. We are asking for your tax residency and Tax Identification Number (where appicabe) and wi record this on our records. Your tax residence generay is the country in which you ive for more than haf a year. Specia circumstances (such as studying abroad, working overseas, or extended trave) may cause you to be resident esewhere or resident in more than one country at the same time (dua residency). The country/countries in which you pay income tax are ikey to be your country/countries of tax residence. If you are unsure about your tax residence in a territory you shoud speak to your financia adviser or visit the tax authority website for that territory. If you are tax resident in a territory other than the UK then we wi report the information isted beow to Her Majesty s Revenue & Customs (HMRC) and they may transfer that information to the government of that other territory in accordance with the reevant agreement. The information is as foows: Your name, address, jurisdiction of tax residence, Tax Identification Number (TIN) and date of birth. Your account/poicy number and that the account/poicy is with Aviva. The baance or vaue of your account/poicy at the end of the year or at the date it was cosed. The gross amount of interest, dividends, proceeds from sae or redemption or other amounts paid or credited to you or your account/poicy during the year. In accordance with those agreements, UK Government wi aso begin to receive information from Governments of other territories about non- UK accounts hed by UK tax residents.

7 10 Decaration A the poicyhoders must sign this decaration. To Aviva Life & Pensions UK Limited I decare that the answers given to the questions on the appication are true and compete to the best of my knowedge and beief. I agree that this annuity contract wi start when Aviva Life & Pensions UK Limited has accepted this appication and received payment of the purchase price. I confirm that I have read the Can I change my mind? section of the Key Features Document and understand my canceation rights. I understand the annuity is payabe for the ifetime of the annuitant(s) and I can t cash it in or change it once it has started. I understand that you may undertake a search with third party companies, who provide identity verification services, for the purposes of verifying my identity and the detais I have submitted as part of this appication. To do so, the third party companies may check the detais I suppy against any particuars on any database (pubic or otherwise) to which they have access. They may aso use my detais in the future to assist other companies for verification purposes. I understand that Aviva and the third party wi keep a record of the search. Where I have received financia advice in connection with this appication from a financia adviser I instruct you to pay the adviser charge shown in the quotation for my annuity to my financia adviser. I understand and agree that the terms of the Adviser Charge Agreement set out in Section 8 of this appication wi appy in respect of this payment. Persona Information We coect and use persona information about you so that we can provide you with a poicy that suits your insurance needs. This notice expains the most important aspects of how we use your information but you can get more information about the terms we use and view our fu privacy poicy at or request a copy by writing to us at: Aviva, Freepost, Maiing Excusion Team, Unit 5, Wanip Road Ind Est, Syston, Leicester, LE7 1PD The data controer responsibe for this persona information is Aviva Life & Pensions UK Ltd as the provider of the product. Additiona controers incude any appicabe reinsurers. Persona information we coect and how we use it We wi use persona information coected from you and obtained from other sources: To provide you with your annuity poicy: we need this to decide what terms we can offer and aso to administer your poicy; To support egitimate interests that we have as a business: We need this to detect and prevent fraud We aso use persona information about you to hep us better understand our customers and improve our customer engagement. This incudes profiing and customer anaytics which aows us to make certain predictions and assumptions about your interests, make correations about our customers to improve our products and to suggest other products which may be reevant or of interest to customers, which incudes marketing products and services to you To meet any appicabe ega or reguatory obigations: we need this to meet compiance requirements with our reguators (e.g. Financia Conduct Authority), to compy with aw enforcement and to manage ega caims; and To carry out other activities that are in the pubic interest: for exampe we may need to use persona information to carry out anti-money aundering checks. As we as coecting persona information about you, we may aso use persona information about other peope, for exampe famiy members you wish to insure on a poicy. If you are providing information about another person we expect you to ensure that they know you are doing so and are content with their information being provided to us. You might find it hepfu to show them this privacy notice and if they have any concerns pease contact us in one of the ways described beow. The persona information we coect and use wi incude name, address, date of birth and financia information. We may aso need to ask for detais reating to the heath of you or somebody ese covered under your poicy. We recognise that information about heath is particuary sensitive information. Where appropriate, we wi ask for consent to coect and use this information. If we need consent to use persona information for a specific reason, we wi make this cear to you when you compete an appication. If you give us consent to using persona information, you are free to withdraw this at any time by contacting us. Pease note that if consent to use this information is withdrawn we wi not be abe to continue to process the information you gave us for this purpose. This woud not affect our use of the information where consent is not required. Of course, you don t have to provide us with any persona information, but if you don t provide the information we need we may not be abe to proceed with your appication. Some of the information we coect as part of this appication may be provided to us by a third party. This may incude information aready hed about you and your dependant within the Aviva group, incuding detais from previous quotes and caims, information we obtain from pubicy avaiabe records, our trusted third parties and from industry databases, incuding fraud prevention agencies and databases. How we share your persona information with others We may share your persona information: With the Aviva group, our agents and third parties who provide services to us, and other insurers to hep us administer our products and services; With reguatory bodies and aw enforcement bodies, incuding the poice, e.g. if we are required to do so to compy with a reevant ega or reguatory obigation; With other organisations incuding insurers, pubic bodies and the poice (either directy or using shared databases) for fraud prevention and detection purposes; With reinsurers who provide reinsurance services to Aviva and for each other. Reinsurers wi use your data to decide whether to provide reinsurance cover, assess and dea with reinsurance caims and to meet ega obigations. They wi keep your data for the period necessary for these purposes and may need to discose it to other companies within their group, their agents and third party service providers, aw enforcement and reguatory bodies Some of the organisations we share information with may be ocated outside of the European Economic Area ( EEA ). We aways take steps to ensure that any transfer of information outside of Europe is carefuy managed to protect your privacy rights. For more information on this pease see our privacy poicy or contact us.

8 10 Decaration (continued) Marketing We aso use persona information we hod about you across the Aviva Group to hep us identify and taior products and services that may be of interest to you. We wi ony communicate with you in accordance with any marketing preferences you have provided to us. We wi continue to do this after your poicy has ended. If you wish to amend your marketing preferences, change how you woud ike us to communicate with you, or te us to stop marketing to you, you can do so in the foowing ways: Update in MyAviva By phone: By emai: By Post: Aviva, Freepost, Maiing Excusion Team, Unit 5, Wanip Road Ind Est, Syston, Leicester, LE7 1PD To see how you can change your preferences in MyAviva or view your choices for onine advertising visit our fu privacy poicy at How ong we keep your persona information for We maintain a retention poicy to ensure we ony keep persona information for as ong as we reasonaby need it for the purposes expained in this notice. We need to keep information for the period necessary to administer your insurance and dea with caims and queries on your poicy. We may aso need to keep information after our reationship with you has ended, for exampe to ensure we have an accurate record in the event of any compaints or chaenges, carry out reevant fraud checks, or where we are required to do so for ega, reguatory or tax purposes. We wi aso use this information for marketing purposes. Your rights You have various rights in reation to your persona information, incuding the right to request access to your persona information, correct any mistakes on our records, erase or restrict records where they are no onger required, object to use of persona information where this use is based on our egitimate business interests, incuding for profiing and marketing ask not to be subject to automated decision making if the decision produces ega or other significant effects on you, and data portabiity. For more detais in reation to your rights, incuding how to exercise them, pease see our fu privacy poicy or contact us. Contacting us If you have any questions about how we use persona information, or if you want to exercise your rights stated above, pease contact our Data Protection Officer by writing to them at Data Protection Officer, Aviva, Leve 4, Pitheavis, Perth, PH2 0NH. If you have a compaint or concern about how we use your persona information, pease contact us in the first instance and we wi attempt to resove the issue as soon as possibe. You aso have the right to odge a compaint with the Information Commissioners Office at any time. The Aviva group and its agents woud ike to contact you from time to time to provide you with updates and offers for Aviva s products and services taiored to you by direct marketing by post, phone, e-mai or text. Te us if you do not want to hear from us How we keep you informed You can te us beow if you woud prefer not to hear about Aviva products, services, and promotions. You can aways te us if you change your mind. Post Emai Teephone SMS/Text You have 30 days to change your mind from the date that you receive confirmation that your annuity pan has started. Pease refer to your Key Features Document for further information. Signature singe/ first poicyhoder Signature second poicyhoder Date Country Pease contact us if you woud ike a copy of your appication form. Aviva Life & Pensions UK Limited. Registered in Engand No Registered Office: Aviva, Weington Row, York YO90 1WR. Authorised by the Prudentia Reguation Authority and reguated by the Financia Conduct Authority and the Prudentia Reguation Authority. Firm Reference Number aviva.co.uk AN /2018 Aviva pc