INVESTMENT PORTFOLIO BOND APPLICATION FORM. Request to add to your Investment Portfolio Bond FOR INTERNAL USE ONLY. Proposal number.

Transcription

1 INVESTMENT PORTFOLIO BOND APPLICATION FORM Request to add to your Investment Portfolio Bond Proposal number FOR INTERNAL USE ONLY Policy number Special deal number

2 The Investment Portfolio Bond is provided by Clerical Medical. Clerical Medical is a trading name of Scottish Widows Limited. Please complete all details in CAPITAL LETTERS. Trustees should also complete the Supplementary Trustee form. 1. DETAILS OF APPLICANTS/TRUSTEES FIRST APPLICANT/TRUSTEE SECOND APPLICANT/TRUSTEE Title Mr Mrs Mr Mrs Miss Ms Miss Ms Other Other Sex Male Female Male Female First name(s) Last name Date of birth (DD MM YYYY) Current address Postcode Nationality Country of residence* (if other than the UK) Occupation Status (e.g. Limited Company, private individual, etc) Full name(s) of life (lives) assured if different from the applicant(s) Bond policy number(s) / Illustration reference number (if applicable) 1

3 2. PAYMENT AMOUNT If you have received advice, your adviser will have told you the cost of this advice and you will have paid for this separately. Please complete only one section below, depending on how you wish to add to your investment. Lump sum only I/we wish to make an additional lump sum payment of Lump sum and monthly payment I/we wish to make an additional lump sum payment of and increase my/our monthly payments to per month. Monthly payment only I/we wish to begin making monthly payments of per month. I/we wish to increase my/our monthly payments to per month. If you wish to make monthly payments, please ensure you complete the direct debit form at the end of this application. Cheques should be made payable to Scottish Widows Limited for a minimum of 1,000 in whole pounds only. To help prevent fraud, you should also add the policyholder name and/or the policy number. For example: Scottish Widows Limited A N Other, policy no You should also draw a line through any unused space on the cheque so that unauthorised people cannot add extra numbers or names. 3. SOURCE OF WEALTH FIRST APPLICANT i) What is your current employment? Employed Self-employed Retired Other (please specify) ii) What is your occupation? iii) What is your employer s name and address? iv) What is your current annual income? v) Please indicate where the Income from employment House sale Company sale money for this investment has come from: House sale Gift Divorce settlement Other (please specify) 2

4 3. SOURCE OF WEALTH (CONTINUED) SECOND APPLICANT i) What is your current employment? Employed Self-employed Retired Other (please specify) ii) What is your occupation? iii) What is your employer s name and address? iv) What is your current annual income? v) Please indicate where the Income from employment House sale Company sale money for this investment has come from: House sale Gift Divorce settlement Other (please specify) Clerical Medical reserves the right to request further documentary evidence of source of wealth should it be considered necessary. Please note that missing information may delay the processing of the application or settlement monies. 4. FUND CHOICE These funds are designed for you to place all of your investment into a single fund. However, you can invest in multiple funds if you wish. If you do wish to invest in more than one fund, please tick the relevant boxes and enter the percentage of your money to be invested in each fund. Please ensure that the total figure adds up to 100% in all cases. We will place your additional investment in the same fund(s) as the original unless you advise otherwise. Please note that if you are investing in an Income Distributing Fund below, you can only invest in that fund. Please also note that, for any new investments into an Income Distributing Fund, we will not make any income payments for at least 12 months. See the Key Information Document(s) (KIDs) and Additional Information Document (AID) for further details. Growth Funds SW Wealth Defensive Fund % SW Wealth Cautious Fund % SW Wealth Discovery Fund % Income Distributing Funds SW Wealth Higher Yield Balanced Fund Please note that Income Distributing Funds should not be selected if the bond is being held under trust. SW Wealth Balanced Fund % SW Wealth Progressive Fund % SW Wealth Dynamic Fund % SW Wealth Adventurous Fund % SW Wealth Liquidity Fund % 3

5 5. INCOME/REGULAR WITHDRAWALS Any existing income or regular withdrawal arrangements on your current Investment Portfolio Bond will continue unaltered as a result of this additional payment. If you wish to amend your income/ regular withdrawals, please also complete and return the Income/ Regular withdrawals instructions. Please note that you cannot make regular withdrawals if you are making monthly payments. If you top up your investment with a lump sum and had previously specified a regular withdrawal percentage this will increase proportionately with any increase in your contribution. 6. IMPORTANT NOTES FOR APPLICATIONS DATA PROTECTION ACT Your information will be held by Scottish Widows Limited which is part of the Lloyds Banking Group. More information on the Lloyds Banking Group can be found at We may ask you to provide physical forms of identity verification when you open your investment or plan. Alternatively, we may search credit reference agency files in assessing your application. The agency also gives us other details and information from the Electoral Register to verify your identity. The agency keeps a record of your ability to obtain credit. We will share your personal information from your application with fraud prevention agencies. If necessary a copy of the application form and any other supporting information may be given to a reassurance company who will share the risk with us. If false or inaccurate information is provided and fraud is identified, details of this fraud will be passed to these agencies to prevent fraud and money laundering. Further details explaining how information held by the fraud prevention agencies may be used can be obtained by reading the privacy notice at If you make a claim, any information you give to us, may be put onto a register of claims and shared with other insurers to prevent fraudulent claims. Your personal information will be shared within the Lloyds Banking Group so that we and any other companies in our Group can look after your relationship with us. By sharing this information it enables us to better understand your needs and provide products in the efficient way that you expect. Any information which you have provided relating to your health or lifestyle is required for underwriting purposes and is defined as sensitive data by the Data Protection Act This information will be held securely with access limited to those who need to see it. If you apply to us for insurance, a pension or life insurance, we may ask you for some sensitive details, for example your medical history. We will only use this information to provide the service you require and we will ask for your explicit consent. It is important that you understand how the personal information you give us will be used. Therefore, we strongly advise that you read our Privacy Statement, which you can find at or you can ask us for a copy. By signing this application/declaration you agree to your personal information being used in the ways we describe in our Privacy Statement. Please let us know if you have any questions about the use of your personal information. MONEY LAUNDERING REGULATIONS Under current regulations we are required to verify the identity of our customers. In order to meet this requirement and for the prevention and detection of fraud, we will access information from a credit reference agency* to confirm your identity. They will authenticate your name and address which involves checking the details you supply against those held on any databases that the company carrying out the checks on our behalf (or any similar company) has access to. This includes information from the Electoral Register. We will use scoring methods to authenticate your identity. Our search will not be used by lenders or insurers when assessing lending or insurance risks. We may also pass information to financial and other organisations involved in money laundering and fraud prevention to protect ourselves and our customers from theft and fraud. If you give us false or inaccurate information and we suspect fraud, we will record this and share this information with other organisations. If you provide us with information about another person, we will treat this as confirmation that they have appointed you to act for them to consent to the processing of their personal data. This means that you have informed them of our identity and the purpose for which their personal data will be processed, namely to verify their name and address. Where we receive notification affecting the legal ownership of the plan, or the appointment of an attorney under a Power of Attorney or other circumstances where there are new parties associated with the contract, the same process as set out above will apply. Please note that if we cannot confirm your name, address and date of birth by using a credit reference agency we may contact you to ask you to supply certain documents to verify this information. If you ask, we will tell you which credit reference agency we have used so you can get a copy of your details from them. * Please note we only use this agency to verify identity to fulfil antimoney laundering regulations and not to check credit worthiness. SUMMARY DETAILED GROUP CONFLICTS POLICY In accordance with financial services regulations, Clerical Medical, which is a member of the Lloyds Banking Group, has established and implemented a Conflicts Policy. The Conflicts Policy sets out how we must seek to identify and manage all material conflicts of interest. Such conflicts of interest can occur in our day to day business activities, for example, where one of our clients could make a gain at the direct expense of another client, or we might be faced with an opportunity to make a gain but this would be to the direct disadvantage of one or more of our clients. 4

6 6. IMPORTANT NOTES FOR APPLICATIONS (CONTINUED) SUMMARY DETAILED GROUP CONFLICTS POLICY (CONTINUED) Depending on the exact nature of the conflict of interest involved, we may take certain actions in accordance with the Conflicts Policy to lessen the potential impact of the conflict. Such actions may include putting in place controls between the opposing sides of the conflict, which may control or prevent the exchange of information, and/or involve the appropriate management of staff activities and segregation of duties. In instances where such controls would not be enough to eliminate the potential material risk of damage to clients from specific conflicts, we ll disclose the general nature and/or source of those conflicts of interest to you before we take on the relevant business. CATEGORISING YOUR BUSINESS We ll treat you as a retail client, unless we contact you to let you know otherwise. Retail clients are afforded the highest level of protection under the rules of the Financial Conduct Authority. You should be aware that other organisations, including the Financial Ombudsman Service (FOS) and Financial Services Compensation Scheme (FSCS), may classify you differently. If they do, they may afford you lesser rights than those which normally apply to retail clients. The Conflicts Policy may be revised and updated from time to time. If you d like more information on the Conflicts Policy, or on any specific conflict of interest that you think might affect you, please contact us. 7. DECLARATION I/We understand that Scottish Widows Limited reserves the right not to accept this application, in which case my/our investment will be returned. I enclose a cheque for the payment amount made payable to Scottish Widows Limited. I declare that: I am 18 years of age or over. I have received and read the Key Information Document(s) (KIDs) and Additional Information Document (AID) relating to this investment. I have seen the latest version of the Key Information Document(s) (KIDs), and I have a printed copy or I have saved an electronic version of the document. this application form has been fully and correctly completed to the best of my knowledge and belief. Before signing the application form, please make sure you have read the notes contained within Section 8 below entitled Important notes. If you need any help completing this application form, or if you have any questions, please contact us on or speak to your financial adviser. We may record and monitor calls to help improve our service. Lloyds Banking Group companies may use your information to contact you by mail, telephone, or text message about products and services that may be of interest to you. If you do not wish to receive this information please tick this box. Signature(s) of all applicant(s) Date (DD MM YYYY) 8. IMPORTANT NOTES 1. Copies of the completed application and the policy provisions are available on request from the address below. 2. The current minimum additional amount that can be invested is 1, The current minimum monthly premium is You must be aged 80 or less to add to your investment. 5. If you invest in an Income Distributing Fund, then the whole of your payment must be in that fund only. 6. Each policy is a legally separate entity and any income and withdrawals from each segment are treated as a return of capital. For example, income distributions or regular withdrawals exceeding 5% per annum of your total payment amount may give rise to a tax charge. Please see your Additional Information Document (AID) or contact your financial adviser for more information. The completed application and cheque made payable to Scottish Widows Limited should be sent to us at: PO Box 28117, 15 Dalkeith Road, Edinburgh EH16 9AN. 5

7 DIRECT DEBIT INSTRUCTION Please write and/or check your Bank/Building Society details in the boxes provided below. Originator s Identification Number A Direct Debit Instruction will be created to take payments from your account Account Name Account Number Sort Code Branch Name Please pay Scottish Widows Limited Direct Debits from the account detailed on this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that the instruction may remain with Scottish Widows Limited and, if so, details will be passed electronically to my bank/building society. Signature Date (DD MM YYYY) Signature Date (DD MM YYYY) 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 Scottish Widows Limited will notify you 14 working days in advance of your account being debited or as otherwise agreed. If you request Scottish Widows Limited 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 Scottish Widows Limited 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 Scottish Widows Limited 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. 1. This Direct Debit is solely for the purpose of this plan. 2. Banks and Building Societies may not accept Direct Debit Instructions for some types of account. 3. For joint or individual accounts, you must be the only person required to authorise debits from the account. 4. The Bank/Building Society Account holder and Applicant must be the same person (if a joint account is to be used the applicant must be one of those named as an account holder). 5. If your plan starts less than 14 days before the chosen payment date on your application, the first two monthly payments will be collected from your initial payment. Subsequent payments will then be the agreed monthly amount.

8 Scottish Widows Limited. Registered in England and Wales No Registered office in the United Kingdom at 25 Gresham Street, London EC2V 7HN. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services Register number /18