APPLICATION FORM MANAGED PORTFOLIO SERVICE

Transcription

1 APPLICATION FORM MANAGED PORTFOLIO SERVICE Please help us by providing as much information as you can. The more information you are able to share, the more we will be able to match our investment service to your requirements. Managed Portfolio Service (MPS) Our Managed Portfolio Service (MPS) offers you the choice of predefined investment strategies that are selected based on your investment objective, attitude to risk and other relevant information. We undertake the investment transactions within these strategies without prior reference to you and the strategies are managed to meet the strategy objectives. The member (and pension adviser where applicable) should complete pages 1 to 6 of this form and sign page 11. The scheme administrator and trustee should complete page 9. SIPP PROVIDER PART A: MEMBER S PERSONAL DETAILS PERSONAL DETAILS Title: Surname: Forename(s): Date of birth: Nationality: MEMBER S NAME Title: Country of birth: Surname: Forename(s): CONTACT DETAILS Permanent residential address (we are unable to accept a care of or post box): PROVIDER REFERENCE Preferred correspondence address (if this is not the permanent residential address we are unable to accept a care of or post box): Preferred telephone numbers: 01

2 We will send you an investment report that includes a valuation, performance summary, transaction schedule, capital and income statements. In addition an annual tax report. If you require further reporting, please indicate below: Online access EMPLOYMENT AND BUSINESS INTERESTS What is your current occupation or your previous occupation if you have retired? Please state if you have not been employed previously. Are you an individual, in the UK or abroad, who has held a prominent public function (for example senior politician, senior government, judicial or military official, senior executive of state owned corporation, important political party official). Or have you ever been connected, directly or indirectly (for example by blood, marriage or business/financial link) to such an individual? Yes If yes, please state their position and/or association: Are you a director or significant senior manager of a Public Limited Company? Yes Does your employer need to receive contract notes? Yes If yes, please provide details: If yes, which company(ies)? Are you or have you ever been employed in the financial services industry? Yes If yes, please provide details: INVESTMENT EXPERIENCE Your answers to these questions will enable us to determine your familiarity with particular types of services and investments. Please refer to the risk warnings outlined in Annex 1 of our Terms and Conditions booklet. Please indicate the level of experience and understanding you have of investment matters by providing the following information: (i) Relevant Experience If relevant, please indicate for how long you have previously held an investment portfolio and whether this was discretionary, advisory or execution only: Are you accustomed to making your own investment decisions without relying on professional advice? Yes If yes, have you ever dealt on an execution-only basis? Yes 02

3 Please tick a box below to indicate the average value of your transactions: Value Under 1,000 1,000-9,999 10,000-49,999 50,000 and over Please indicate in the boxes below the frequency and approximate number of transactions: Weekly YOUR PENSION ADVISER Contact name: Name of company: FCA reference number (if applicable): Address: Monthly Annually Do you have experience of using derivatives (including options), equities, warrants, leveraged or unregulated products? Yes If yes, please indicate below details of the average value and frequency of individual transactions carried out on your instructions: Telephone: Can we take investment instructions from your pension adviser? Yes (ii) Relevant Investments Please tick which of the following investments you consider yourself to be familiar with from your previous investment experience: Investment type Government/Corporate bonds Equities Unit trusts/open Ended Investment Companies Hedge funds Venture capital/private equity Structured products Warrants/Futures/Options Unquoted investments Property funds Unregulated investments 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 existing schemes Savings previously held outside of pension scheme Inherited capital Existing fund Additional contributions Other sources If other, please provide details; 03

4 YOUR FINANCIAL DETAILS ASSETS Beneficial ownership Applicant 1 Joint Total value of assets Main residence Y / N Other property Y / N Pension funds Investments Stocks & shares ISAs Cash ISAs Cash/term deposits Other* Total LIABILITIES Total Amount Mortgage(s) Method of repayment Repayment date YYYY Other loans* Method of repayment Repayment date YYYY GROSS INCOME PER ANNUM Applicant 1 Employment Pensions Savings Other* Total *If other, please give details: 04

5 PART B: DETAILS OF YOUR PENSION FUND(S) This section can be answered by your pension adviser Please indicate the amount being invested into the SIPP with Quilter Cheviot: Take regular withdrawals to include tax free cash Take irregular withdrawals to include tax free cash (please give as much detail as possible in the box below) What is this SIPP s annual reporting date? If in pension withdrawal, when is the next formal review of the pension? Additional information: Are you making or do you plan to make additional contributions into this fund? Yes If yes, how much each year? What is the approximate combined value of your invested pension funds? If you are a member of a defined benefits scheme, please give the estimated value of your pension at retirement: If known, what is the anticipated annual pension withdrawal? or % Are there any other considerations we should be aware of relative to managing this SIPP? What percentage of your overall retirement income do you expect this SIPP to provide? % If you have not yet taken any benefits from your pension, when do you intend to take the pension commencement payment? How do you anticipate taking income from this fund? (please tick all that apply) Buying an annuity/secured income When are you likely to buy an annuity? YYYY Do you have other investments? Yes, managed by Quilter Cheviot Yes, not managed by Quilter Cheviot. Please give approximate value. Take a tax free sum, then regular income drawdown Take a tax free sum, then irregular income drawdown (please give as much detail as possible in the box below) 05

6 FUTURE CIRCUMSTANCES Do you foresee any changes to your circumstances in the future? If so, please give details below: Personal: Financial: The possibility that your investments do not meet your objective, such as a targeted future expenditure The chance of irregular or unusual investment returns, particularly in times of financial crisis The likelihood of temporary or permanent loss of capital or income The possible lack of liquidity, meaning that in certain market circumstances, it might not be possible to sell a particular investment. Completing the information and questions in this section will help us assess your risk profile. We have divided the questions into two parts: Your ability to bear loss this is sometimes referred to as your Risk Capacity and is a function of your broader financial circumstances. Willingness to accept risk in the portfolio this is sometimes called your Risk Tolerance Health. If in poor health please give details: YOUR ABILITY TO BEAR LOSS Here, we are trying to ascertain your ability to bear investment losses, in the broader context of your overall current financial situation and standard of living. Please select one of the following which most closely matches your circumstances: PART C: INVESTMENT STRATEGY A good starting point for any investment portfolio is a clear definition of the aims, objectives, constraints and risk tolerance as well as the anticipated time horizon. The following questions will help us recommend and implement a suitable long-term investment strategy. It is important that you keep us informed of any changes to your circumstances or objectives so we can review the strategy. YOUR INVESTMENT OBJECTIVE Please select one of the following as your main objective: Capital Growth the principal objective is to grow the capital value of the portfolio. Capital Growth and Income the objective is to grow the capital value of the portfolio, as well as generating some degree of income from the portfolio. Income the principal objective is to generate income from the portfolio. UNDERSTANDING RISK Obtaining an investment return higher than cash deposits will involve taking risk. To meet your longer-term objectives, you may have to be prepared to take on a higher level of risk than you have historically. Risk associated with investments can take many different forms, including: The sensitivity of your investments to various market events or economic factors, including changes to interest rates and inflation I/we have NO ability to bear investment losses. Any losses to the value of the portfolio would have an unacceptable impact on my/our overall financial position and standard of living. I/we have a LOW ability to bear investment losses. In extreme circumstances, falls in the value of the portfolio of up to 20% would not have a material impact on my/our overall financial position and standard of living. I/we have a MODERATE ability to bear investment losses. In extreme circumstances, falls in the value of the portfolio of up to 35% would not have a material impact on my/our overall financial position and standard of living. I/we have a SIGNIFICANT ability to bear investment losses. In extreme circumstances, falls in the value of the portfolio in excess of 35% would not have a material impact on my/our overall financial position and standard of living. INVESTMENT RESTRICTIONS Do you wish to exclude certain investments and/or asset classes for ethical reasons from your portfolio? Yes If yes, please contact us for our Investment Restrictions supplement. 06

7 YOUR WILLINGNESS TO ACCEPT RISK The Quilter Cheviot Understanding Your Investment Portfolio document must be read for further guidance. Please select the risk category that most closely matches your tolerance to risk and minimum time period for the investment portfolio we will be managing for you. Please tick one box only. The tables below provide guidance on the level of equities that would be involved and the range of returns that can be experienced in each of the risk categories. 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 TICK Typical equity weighting up to 25% Suggested minimum investment period 1 year or more Estimated range of annualised return* +8% Estimated peak to trough decline across investment period* -2% -15% Lower to Medium TICK 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 Typical equity weighting up to 50% Suggested minimum investment period 3 years or more Estimated range of annualised return* +15% -3% Estimated peak to trough decline across investment period* -20% 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 TICK Typical equity weighting up to 75% Suggested minimum investment period 5 years or more Estimated range of annualised return* +20% -6% Estimated peak to trough decline across investment period* -35% Medium to Higher TICK 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 Typical equity weighting up to 100% Suggested minimum investment period 5 years or more Estimated range of annualised return* +25% -10% Estimated peak to trough decline across investment period* -45% 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 TICK Typical equity weighting up to 100% Suggested minimum investment period 7 years or more Special situations apply to specialist mandates where the types and concentration of riskier assets could be significant Estimated peak to trough decline across investment period* >-45% * Source: Quilter Cheviot. These figures are for illustrative purposes and represent estimated pattern of return for each risk profile. Past performance is not indicative of future performance and actual performance may vary. 07

8 REPORTING Our investment summaries, 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. Correspondence Comprehensive investment report Member Adviser INTERNET ACCESS Do you want to access and download valuations and transactions from our website? Yes If yes and you already have an internet account with us, please enter your user ID. Member: 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: Or Driving licence number: l l l l / l l l l l / l l / l Date of expiry photocard: Adviser: TAX INFORMATION National Insurance number: l / l l l l l / 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 clients, 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. MEMBER S DETAILS Previous surname if changed in the last 5 years: and/or other country(ies) of tax residence: Country: Tax identification number: Are you a US citizen, a US resident, the holder of a US passport, Green Card, or US bank account? Yes* * If you have ticked yes, you will need to complete an IRS (Internal Revenue Service) form W9 which your investment manager can provide on request. Are you an Irish resident? Previous residential address, if less than 1 year at current address (we are unable to accept a care of or post box): Yes* *If you have ticked yes, please refer to the Euro Managed Portfolio Service Application Form. 08

9 The following should be completed by the scheme administrator and trustee. TRUSTEES DETAILS Pension trustee(s) name: SCHEME ADMINISTRATOR Full name of pension administrator: Contact name: Contact name: Full postal address: Full postal address: Telephone: Telephone: Fax: Fax: Member trustee name (where applicable): SIPP BANK ACCOUNT AND INCOME INSTRUCTIONS Account name: HMRC approval number: Sort code: l / l / l Account number: Reference: 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: 09

10 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: Name capacity/position: Signatory 2: Date: 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 8. 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. 10

11 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. Please tick here to confirm you have received the Quilter Cheviot Understanding Your Investment Portfolio document. If you are a trustee of this fund, please also sign the trustee declaration. Signed: Date: 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. 11 QW532 (08/2015)