OFFSHORE BOND MANAGED PORTFOLIO SERVICE

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1 MANAGED PORTFOLIO SERVICE - FOR CLIENTS OF A FINANCIAL ADVISER 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 MPS is where your investment manager invests your portfolio in one of our predefined investment strategies and can undertake transactions without prior reference to you. Taking into account your investment objective, attitude to risk and other relevant information, your investments are managed in line with an MPS strategy to match your requirements. PART A: DETAILS Policyholder s name: Offshore life company: Offshore life company reference: Please indicate if the policy is written in trust or held personally; Trust Personal BOND VALUE What is the approximate amount being invested into this portfolio and what is the base currency? Value: Currency: EXPLANATION OF MANAGED PORTFOLIO SERVICE (MPS) 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. MPS Global Growth portfolio. The Quilter Cheviot MPS Global Growth Strategy is designed for an investor with a time horizon of more than 7 years, and a 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 MPS Global Growth Strategy is a diversified portfolio comprising predominantly international and domestic equity funds as well as some exposure to funds investing in alternative assets. This means there is limited scope for diversification across asset classes, although the investments will be spread across sectors. There may also be an allocation to funds investing into alternatives such as commercial property, private equity, commodities and absolute return strategies. The risk category for this strategy is considered higher risk. BOND TYPE The bond type will depend on the insurance Company product. If unsure, we will assume non-personalised. n Personalised Personalised Segregated MPS Growth portfolio as well as to generate some degree of income. The Quilter Cheviot MPS 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. 01 The Quilter Cheviot MPS Growth Strategy is a diversified portfolio comprising predominantly domestic and international equity funds with a small exposure to fixed interest funds. There may also be an allocation to funds investing into alternatives such as commercial property, private equity, commodities and absolute return strategies. The risk category for this strategy is considered medium-higher risk.

2 MPS Balanced portfolio as well as to generate some degree of income. The Quilter Cheviot MPS 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 MPS Balanced Strategy is a diversified portfolio comprising predominantly domestic and international equity funds as well as some exposure to fixed interest funds. There may also be an allocation to 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. MPS Global Income portfolio as well as to generate some degree of income. The Quilter Cheviot MPS Global 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 MPS Global Income Strategy is a diversified portfolio comprising predominantly international equity funds as well as some exposure to domestic equity and fixed interest funds. There may also be an allocation to 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. MPS Income portfolio as well as to generate some degree of income. The Quilter Cheviot MPS 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. MPS Conservative portfolio as well as to generate some degree of income. The Quilter Cheviot MPS 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 MPS Conservative Strategy is a diversified portfolio comprising predominantly fixed interest funds as well as some exposure to domestic and international equity funds. There may also be an allocation to 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. MPS Cautious The investment objective is to generate a return from the income from the portfolio. The Quilter Cheviot MPS Cautious Strategy is designed for an investor with a time horizon of more than 1 year, and a lower tolerance for risk that regardless of market conditions would only be comfortable with minimal variation or disruption to capital value or income. The Quilter Cheviot MPS Cautious Strategy is a diversified portfolio comprising predominantly fixed interest funds with a small exposure to domestic equity funds. There may also be an allocation to funds investing into alternatives such as commercial property, private equity, commodities and absolute return strategies. The risk category for this strategy is considered lower risk. The Quilter Cheviot MPS Income Strategy is a diversified portfolio comprising predominantly domestic and international equity funds as well as some exposure to fixed interest funds. There may also be an allocation to 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. 02

3 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. 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. ACCOUNT STRATEGY Please select your chosen strategy. Global Growth Growth Balanced Global Income Income Conservative Cautious 03

4 PART B: ACCOUNT SET-UP Policyholder 1/Trustee s Personal Details Title: Preferred correspondence address (if this is not the permanent residential address we are unable to accept a care of or post box): Surname: Forename(s): Date of birth: Preferred telephone numbers: Nationality: Country of birth: National Insurance number: 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. l / l l l l l / Or Local tax number for overseas residents (personal accounts only): 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* Are you a director or significant senior manager of a Public Limited Company? Yes If yes, which company(ies)? *If you have ticked yes, please provide details: CONTACT DETAILS Permanent residential address (we are unable to accept a care of or post box): 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 04

5 If yes, please state their position and/or association: 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* *If you have ticked yes, please provide details: Does your employer need to receive contract notes? Yes If yes, please provide details: CONTACT DETAILS Permanent residential address (we are unable to accept a care of or post box): REPORTING We provide a report that covers the investments that we hold. It will not give the full value of the bond as this is provided by the Bond Provider. This report will be sent to the first policyholder. Policyholder 2/Trustee s Personal Details Title: Preferred correspondence address (if this is not the permanent residential address we are unable to accept a care of or post box): Surname: Forename(s): Date of birth: Preferred telephone numbers: Nationality: Country of birth: 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. National Insurance number: l / l l l l l / Or Local tax number for overseas residents (personal accounts only): Are you a director or significant senior manager of a Public Limited Company? Yes 05

6 If yes, which company(ies)? Policyholder 3/Trustee s Personal Details Title: Surname: 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: Forename(s): Date of birth: Nationality: Country of birth: National Insurance number: l / l l l l l / Does your employer need to receive contract notes? Yes If yes, please provide details: Or Local tax number for overseas residents (personal accounts only): 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* *If you have ticked yes, please provide details REPORTING We provide a report that covers the investments that we hold. It will not give the full value of the bond as this is provided by the Bond Provider. This report will be sent to the first policyholder. Please indicate if you wish to receive a copy of the Quilter Cheviot investment report. CONTACT DETAILS Permanent residential address (we are unable to accept a care of or post box): 06

7 Preferred correspondence address (if this is not the permanent residential address we are unable to accept a care of or post box): Does your employer need to receive contract notes? Yes If yes, please provide details: Preferred telephone numbers: 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. REPORTING We provide a report that covers the investments that we hold. It will not give the full value of the bond as this is provided by the Bond Provider. This report will be sent to the first policyholder. Please indicate if you wish to receive a copy of the Quilter Cheviot investment report. If there are more than 3 policyholders, please provide names and details on page 9. Are you a director or significant senior manager of a Public Limited Company? Yes If yes, which company(ies)? 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: 07

8 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 any of the associated parties been an investor in financial markets for less than 5 years? Yes Do any of the associated parties have experience of managing investments and directing deals? Yes FINANCIAL ADVISER If you have a financial adviser, please give their details below. Name: Name of company: Address: Do any of the associated parties have experience of using derivatives (including options), warrants, leveraged or unregulated products? Yes Telephone number: Please indicate whether; We can share information relevant to your account with your appointed financial adviser Your appointed financial adviser can instruct us to make a payment to one of your nominated bank accounts (including HMRC), give investment instructions on your behalf and/or make changes to your investment strategy Please tick if you would like your financial adviser to receive the following: Investment report/valuations/transaction reports Online access Annual tax report 08

9 OTHER ADVISER If you would like us to provide information to another professional or individual, please enter their details here. Please note that if you want to authorise another individual to be able to give instruction on your account, please complete the authority as follows. Name: OTHER CONTACT DETAILS/ADDITIONAL TRUSTEES/ POLICY HOLDERS Please show below any other contact details we might need with a brief description of their relevance Name: Address: Name of company: Address: Relevance: Date of birth: Please tick if you would like your adviser to receive the following: Investment report/valuations/transaction reports Online access Annual tax report Name: Address: Relevance: Date of birth: INTERNET ACCESS Do you want to access and download valuations and transactions from our website? Yes Existing ID, if applicable: 9

10 DECLARATION (to be signed by the Policyholders) 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/We confirm that all the information in this form is accurate, complete, can be relied upon, and that my/our investment objectives are as set out in this application form. I/We confirm our acceptance of the fee arrangement agreed with Quilter Cheviot and the Bond Provider. If the Quilter Cheviot fee cannot be paid from the bond, I/We will be personally liable for such fees. I/We acknowledge receipt of a copy of the Quilter Cheviot terms and conditions and risk disclosures. I/We agree to the terms for online access as detailed in the Quilter Cheviot terms and conditions. Signatory 1: Date: Print name: Signatory 2: Date: Print name: I/We confirm receipt of the Quilter Cheviot Understanding Your Investment Portfolio document. Signatory 3: Date: Print name: Signatory 4: Date: Print name: Signatory 5: 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. 10