International Pension Plan

Transcription

1 International Pension Plan APPLICATION FORM THIS FORM IS NOT APPLICABLE TO PERSONS RESIDENT IN HONG KONG This Form should be read in conjunction with the current International Pension Plan principal Brochure which, together with the Policy Document, sets out the terms and conditions of the contract, and the current Fund Prices leaflet.

2 Application Form To be completed by each Investor who is the current legal owner of the premium(s) Please use BLOCK CAPITALS *Delete as applicable FIRST APPLICANT Last Name SECOND APPLICANT Last Name Forename(s) Forename(s) Title (please tick) Mr Mrs Miss Other Marital Status Title (please tick) Mr Mrs Miss Other Marital Status of Birth Country of Residence of Birth Country of Residence Residence Address Residence Address Telephone Number Telephone Number Fax Number Fax Number Address Address How long have you lived at this address? How long have you lived at this address? Years Months Years Months Correspondence Address (if different to Residence Address) Correspondence Address (if different to Residence Address) Please tick if you wish all correspondence/statements to be sent direct to the Applicant(s). (If the box is not ticked, all correspondence will be sent to the introducing intermediary.) Please tick if you wish all correspondence/statements to be sent direct to the Applicant(s). (If the box is not ticked, all correspondence will be sent to the introducing intermediary.) Nationality Nationality Passport or ID Number Passport or ID Number Country of Issue Country of Issue

3 Occupation (a) Name and Address of Employer Occupation (a) Name and Address of Employer (b) Nature of Business (b) Nature of Business (c) Job Title (c) Job Title (d) How long have you followed this occupation? (d) How long have you followed this occupation? Years Months Years Months Are you in good health? Are you in good health? Yes No If NO, please give details on a separate piece of paper. Are you to be a Life Assured? Yes No Are you to be a Policyholder? Yes No Yes No If NO, please give details on a separate piece of paper. Are you to be a Life Assured? Yes No Are you to be a Policyholder? (jointly with First Applicant)? Yes No If the Applicants are not to be the Lives Assured, the relevant section of the Supplementary Forms must be completed. If the Proposed Policyholder is a Company or a Trust, full details must be given in Part A of the Supplementary Forms. All Applicants are potentially eligible to be considered for Additional Life Assurance Cover. CONTRIBUTIONS /US$/ /HK$* Lump Sum (Minimum 10,000/US$20,000/ 14,000/HK$150,000) /US$/ /HK$* Monthly Contributions (Minimum 200/US$300/ 280/HK$3,000) /US$/ /HK$* Annual Contributions (Minimum 2,000/US$3,000/ 2,800/HK$30,000) Plus any premium for Additional Life Assurance Cover Please note that if the contribution is in excess of 200,000/US$330,000/ 350,000/HK$2,500,000 lump sum or 42,000/US$70,000/ 75,000/HK$500,000 per annum, you must complete the Financial Questionnaire in the Supplementary Forms. VALUATION CURRENCY Please select the currency in which you wish to receive valuations of your Plan. A full list of the available currencies is given in the principal Brochure. (If no selection is made, valuations will be produced in the currency in which Contributions are paid.) Sterling ( ) US dollars (US$) HK dollars (HK$) Other* * If other, please complete the Supplementary Forms

4 SOURCE OF FUNDS (e.g. savings over a period of X years from an annual income of Y or sale of X shares in Y Co. Ltd. at a price of Z) PAYMENT METHODS Please tick the relevant box BY CHEQUE. Please make cheques payable to Royal & Sun Alliance International Financial Services Limited BY BANKER S DRAFT/TELEGRAPHIC TRANSFER. Please complete the Bank Instruction Letter BY STANDING ORDER. Please complete the Banker s Standing Order and enclose a cheque for the first premium BY CREDIT CARD. Please complete a Credit Card Charge Authority (available on request) and enclose a cheque for the first premium RETIREMENT DATE The maximum retirement age is 70 The Retirement must be not less than 5 years and not more than 50 years from inception of the Plan. If you require more than one Retirement, please give details. Minimum investment per Retirement : Lump Sum: 1,000 / US$2,000 / 1,400 / HK$15,000 Monthly Contributions: 20 / US$30 / 28 / HK$300 Annual Contributions: 200 / US$300 / 280 / HK$3,000 CHOICE OF FUNDS Please indicate the funds in which you wish your Plan to invest, up to a maximum of 10, showing the percentage of each investible premium you wish to be invested in each fund. Fund Code Fund % of Contribution Total 100%

5 IMPORTANT NOTES 1. A specimen policy document and / or copy of this completed form are available on request. 2. You are advised to satisfy yourself / selves that, under any taxation, exchange control or insurance legislation to which you may be subject, you are permitted to effect the policy. 3. You should seek guidance from your usual Financial Adviser as to the suitability of the Plan to your own particular circumstances. 4. Information which you provide in connection with this Application and any subsequent Policy will be held (whether stored electronically or otherwise), used or disclosed by Royal & Sun Alliance International Financial Services Limited or any associated company that exists from time to time. You have the right to obtain access to and to request a correction of any personal information about you. Requests can be made to the Compliance Officer at Royal Court, Castletown, Isle of Man, British Isles IM9 1RA or the General Manager, Two Pacific Place, 88 Queensway, Hong Kong. 5. Each policy is governed by and shall be construed in accordance with the law of the Isle of Man. Attention is drawn to the following Declarations. If the Application Form requests information which has to be assessed by the Company before acceptance, then: You must disclose all facts which are material. Such facts are those which an insurer would regard as likely to influence the assessment and acceptance of a proposal. If you are in doubt as to the relevance of any particular information you should disclose it, as failure to do so could result in you being quoted the wrong terms, a claim being rejected or reduced, or the policy being invalid. DECLARATIONS 1. I/we* declare that this Application was signed in (Country) and that, to the best of my/our* knowledge and belief, all the above statements are true. I/we* agree that they, together with any other statements made to a medical examiner in the event of a medical examination or to the Company, now or in the future, shall form the basis of the contract under the law of the Isle of Man. I/we* have read and understood all the printed materials relevant to this contract and I/we* have acquainted myself/ourselves* with the management charges made by Royal & Sun Alliance International Financial Services Limited. I/we* understand that I / we* may choose the investments to which my/our* International Pension Plan Policies are to be linked. Consequently, Royal & Sun Alliance International Financial Services Limited shall not be responsible for the investment performance or for any loss or liability arising from my/our* choice of investment, however arising. I/we* understand that this application can only be accepted by employees of Royal & Sun Alliance International Financial Services Limited situated at the Company s Head Office in the Isle of Man and that no other employees or third parties have the necessary authority to create a binding contract. 2. DATA PROTECTION I/we* consent that any personal information collected or held by Royal & Sun Alliance International Financial Services Limited (whether contained in this Application or obtained otherwise) is provided and may be held (whether stored electronically or otherwise), used or disclosed to enable Royal & Sun Alliance International Financial Services Limited to: (i) transfer the information between its offices wherever they are situated; and (ii) provide me/us* with information about other products or services which it believes may be of interest to me/us*; and (iii) communicate with me/us* whether directly or indirectly for any purpose. SIGNATURE(S) Applicant Second Applicant

6 Royal & Sun Alliance International Financial Services Limited Royal Court, Castletown, Isle of Man, British Isles, IM9 1RA Telephone: Facsimile: Registered No: Isle of Man Regulated by the Personal Investment Authority for UK investment business Member of the Association of International Life Offices The appointed representative of the Company in Hong Kong is Royal & Sun Alliance International Financial Services Limited s branch office: Royal & Sun Alliance International Financial Services Limited Two Pacific Place, 88 Queensway, Hong Kong Telephone: Facsimile: servicing.hongkong@rsaifs.com Visit our website at NAME OF CLIENT S FINANCIAL ADVISER Lanson Financial Ltd TO ENSURE THE SMOOTH PROCESSING OF THE APPLICATION, PLEASE CHECK THE FOLLOWING For completion by the Client s Financial Adviser required Please supply Proof of Identity of each Applicant (i.e. a certified copy of the Applicant s passport or ID Card) and/or IFA Certificate for each Applicant Required/Completed/Enclosed Not Payment method detailed Financial Questionnaire (if contribution is in excess of 200,000/US$330,000/ 350,000/HK$2,500,000 lump sum or 42,000/US$70,000/ 75,000/HK$500,000 per annum) Supplementary Form (Corporate/Trust/Additional Applicants /Alternative Currencies) IPP 1/2000-6

7 VERIFICATION OF CUSTOMER IDENTITY IFA Certificate Individual Applicant This document should be completed by the introducing Intermediary and should accompany the completed Application Form. (Where there is more than one individual Applicant a separate form for each additional Applicant should be completed.) Full Name of Customer EVIDENCE OBTAINED TO VERIFY NAME This section should be completed to indicate the documentation you have obtained so that the identity of the customer can be verified. Certified copies of this documentation should be attached. Identity should be verified by obtaining: I of either item from Group A or 2 items from Group B Please indicate the documents and enter relevant details. (Such as reference numbers, issuing authority details, etc.) GROUP A PASSPORT NATIONAL IDENTITY CARD Issuing Office Issuing Office Country Country GROUP B FULL NATIONAL DRIVING LICENCE ARMED FORCES ID CARD SIGNED ID CARD OF EMPLOYER KNOWN TO YOU Employer Name and Address MORTGAGE STATEMENT Lender BANK/BUILDING SOCIETY/CREDIT CARD STATEMENT Issuer

8 DECLARATION I/We being the person(s) introducing the above customer hereby give assurance that: (a) evidence of the identity of the customer has been obtained and has been and will continue to be recorded by me/us in accordance with: (i) (ii) (iii) any requirements of Royal & Sun Alliance International Financial Services Limited from time to time notified to me/us. The Isle of Man Insurance and Pensions Authority Common Trading Practices for Isle of Man Insurers Guidance Notes on the Prevention of Money Laundering (and all legislation, regulations, and guidance issued in substitution thereof and in addition thereto, where applicable). the requirements of any other regulatory body of any jurisdiction applicable to the business submitted. (b) I confirm that I have seen the original documents specified above and have checked the name and identity of the individual(s) and attach a certified copy for your records. Signed Full Name (Sole Trader/Partner/Director or other duly authorized signatory please delete as applicable) For and on behalf of Lanson Financial Ltd (Full name of Intermediary firm) Address of Intermediary firm

9 VERIFICATION OF CUSTOMER IDENTITY IFA Certificate Individual Applicant This document should be completed by the introducing Intermediary and should accompany the completed Application Form. (Where there is more than one individual Applicant a separate form for each additional Applicant should be completed.) Full Name of Customer EVIDENCE OBTAINED TO VERIFY NAME This section should be completed to indicate the documentation you have obtained so that the identity of the customer can be verified. Certified copies of this documentation should be attached. Identity should be verified by obtaining: I of either item from Group A or 2 items from Group B Please indicate the documents and enter relevant details. (Such as reference numbers, issuing authority details, etc.) GROUP A PASSPORT NATIONAL IDENTITY CARD Issuing Office Issuing Office Country Country GROUP B FULL NATIONAL DRIVING LICENCE ARMED FORCES ID CARD SIGNED ID CARD OF EMPLOYER KNOWN TO YOU Employer Name and Address MORTGAGE STATEMENT Lender BANK/BUILDING SOCIETY/CREDIT CARD STATEMENT Issuer

10 DECLARATION I/We being the person(s) introducing the above customer hereby give assurance that: (a) evidence of the identity of the customer has been obtained and has been and will continue to be recorded by me/us in accordance with: (i) (ii) (iii) any requirements of Royal & Sun Alliance International Financial Services Limited from time to time notified to me/us. The Isle of Man Insurance and Pensions Authority Common Trading Practices for Isle of Man Insurers Guidance Notes on the Prevention of Money Laundering (and all legislation, regulations, and guidance issued in substitution thereof and in addition thereto, where applicable). the requirements of any other regulatory body of any jurisdiction applicable to the business submitted. (b) I confirm that I have seen the original documents specified above and have checked the name and identity of the individual(s) and attach a certified copy for your records. Signed Full Name (Sole Trader/Partner/Director or other duly authorized signatory please delete as applicable) For and on behalf of Lanson Financial Ltd (Full name of Intermediary firm) Address of Intermediary firm

11 Bank Instruction APPLICANTS WITH BANK ACCOUNTS IN THE FAR EAST SHOULD COMPLETE OVERLEAF This letter should be returned with your Application Form. Please use BLOCK CAPITALS *Delete as applicable To: The Manager, Name of Bank Full postal address of Bank Account holders name Account Number Dear Sir, On my/our* behalf would you please prepare a Telegraphic Transfer (see Section A) or a Draft (see Section B) and carry out the transaction indicated within 48 hours of you receiving this instruction. SECTION A - TELEGRAPHIC TRANSFERS Please remit SWIFT Payment Order to National Westminster Bank, London, SWIFT Code NWBKGB2L, quoting the receiving branch as Isle of Man Bank, East Region, Sort Code If remitting sterling from a UK/Channel Island bank account, send by CHAPS direct to the Isle of Man Bank. The beneficiary account name is Royal & Sun Alliance International Financial Services Limited, and the beneficiary account number is shown below. Sterling Transfers Sub Account Number US dollar Transfers Sub Account Number Euro Transfers Sub Account Number The reference number below (see Section C) must be quoted by the Bank on all advices. /US$/ * (figures) /US$/ * Please charge the amount of the payment together with any bank and agent bank s charges to my/our* account. (words) SECTION B - DRAFTS On receipt of this letter please prepare a (tick one box only) Sterling draft (drawn on a bank in the United Kingdom) US dollar draft (drawn on a bank in New York) Euro draft payable to Royal & Sun Alliance International Financial Services Limited, quoting the reference given below, for exactly /US$/ * (figures) /US$/ * After preparation of the draft please airmail it at my/our* own cost, together with a copy of this instruction, immediately to; Royal & Sun Alliance International Financial Services Limited, Royal Court, Castletown, Isle of Man IM9 1RA (words) Yours faithfully, Signature(s) My/Our* Address SECTION C This must be quoted by the Bank on all advices (to be completed by Royal & Sun Alliance International Financial Services Limited) Royal & Sun Alliance International Financial Services Limited Royal Court, Castletown, Isle of Man, British Isles, IM9 1RA Telephone: Facsimile: servicedesk@rsaifs.com website: Registered No: Isle of Man Regulated by the Personal Investment Authority for UK investment business Member of the Association of International Life Offices

12 Bank Instruction ONLY APPLICABLE CLIENTS WITH BANK ACCOUNTS IN THE FAR EAST NOT FOR USE BY APPLICANTS WITH HANG SENG BANK ACCOUNTS This letter should be returned with your Application Form. Please use BLOCK CAPITALS *Delete as applicable To: The Manager, Name of Bank Full postal address of Bank Account holders name Account Number Dear Sir, On my/our* behalf would you please prepare a Telegraphic Transfer (see Section A) or a Draft (see Section B) and carry out the transaction indicated within 48 hours of you receiving this instruction. SECTION A - TELEGRAPHIC TRANSFERS Please remit to the Hong Kong & Shanghai Banking Corporation Limited, Main Office, 1 Queen s Road, Central, Hong Kong for credit to Royal & Sun Alliance International Financial Services Limited, and the beneficiary account number is shown below. Sterling Transfers Account Number US dollar Transfers Account Number Hong Kong dollar Transfers Account Number The reference number below (see Section C) must be quoted by the Bank on all advices. /US$/HK$* (figures) /US$/HK$* Please charge the amount of the payment together with any bank and agent bank s charges to my/our* account. (words) SECTION B - DRAFTS On receipt of this letter please prepare a (tick one box only) Sterling draft (drawn on a bank in the United Kingdom) US dollar draft (drawn on a bank in New York) Hong Kong dollar draft (drawn on a bank in Hong Kong) payable to Royal & Sun Alliance International Financial Services Limited, quoting the reference given below, for exactly /US$/HK$* (figures) /US$/HK$* After preparation of the draft please airmail it at my/our* own cost, together with a copy of this instruction, immediately to; Royal & Sun Alliance International Financial Services Limited, Two Pacific Place, 88 Queensway, Hong Kong. (words) Yours faithfully, Signature(s) My/Our* Address SECTION C This must be quoted by the Bank on all advices (to be completed by Royal & Sun Alliance International Financial Services Limited) Royal & Sun Alliance International Financial Services Limited Royal Court, Castletown, Isle of Man, British Isles, IM9 1RA Telephone: Facsimile: servicedesk@rsaifs.com website: Registered No: Isle of Man Regulated by the Personal Investment Authority for UK investment business Member of the Association of International Life Offices

13 Banker s Standing Order FOR ANNUAL OR MONTHLY PAYMENTS APPLICANTS WITH BANK ACCOUNTS IN THE FAR EAST SHOULD COMPLETE OVERLEAF This letter should be returned with your Application Form. Please use BLOCK CAPITALS *Delete as applicable To: The Manager, Name of Bank Full postal address of Bank Account holders name Account Number Dear Sir, On my/our* behalf would you please pay by Bankers remittance to: Isle of Man Bank, (sort code ) East Region, PO Box 13, Douglas, Isle of Man, British Isles, IM99 1AN, carrying out the transaction indicated within 48 hours, the sum of /US$/ * (figures) /US$/ * (words) for credit to Royal & Sun Alliance International Financial Services Limited, Account Number (tick one box only) Sterling US dollars Euros on the day of and on the same day monthly yearly quoting the reference number below (see Section A) until this order is cancelled in writing. Please charge the amount of the payment together with any bank and agent bank s charges to my/our* account. Yours faithfully, Signature(s) My/Our* Address SECTION A This must be quoted by the Bank on all advices (to be completed by Royal & Sun Alliance International Financial Services Limited) Royal & Sun Alliance International Financial Services Limited Royal Court, Castletown, Isle of Man, British Isles, IM9 1RA Telephone: Facsimile: servicedesk@rsaifs.com website: Registered No: Isle of Man Regulated by the Personal Investment Authority for UK investment business Member of the Association of International Life Offices

14 Banker s Standing Order FOR ANNUAL OR MONTHLY PAYMENTS ONLY APPLICABLE TO CLIENTS WITH BANK ACCOUNTS IN THE FAR EAST NOT FOR USE BY APPLICANTS WITH HANG SENG BANK ACCOUNTS This letter should be returned with your Application Form. Please use BLOCK CAPITALS *Delete as applicable To: The Manager, Name of Bank Full postal address of Bank Account holders name Account Number Dear Sir, On my/our* behalf would you please pay by Bankers remittance to: Hong Kong & Shanghai Banking Corporation Limited, Main Office, 1 Queen s Road, Central, Hong Kong, carrying out the transaction indicated within 48 hours, the sum of /US$/HK$* (figures) /US$/HK$* (words) for credit to Royal & Sun Alliance International Financial Services Limited, Account Number (tick one box only) Sterling US dollars Hong Kong Dollars on the day of and on the same day monthly yearly quoting the reference number below (see Section A) until this order is cancelled in writing. Please charge the amount of the payment together with any bank and agent bank s charges to my/our* account. Yours faithfully, Signature(s) My/Our* Address SECTION A This must be quoted by the Bank on all advices (to be completed by Royal & Sun Alliance International Financial Services Limited) Royal & Sun Alliance International Financial Services Limited Royal Court, Castletown, Isle of Man, British Isles, IM9 1RA Telephone: Facsimile: servicedesk@rsaifs.com website: Registered No: Isle of Man Regulated by the Personal Investment Authority for UK investment business Member of the Association of International Life Offices

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