ITC BUY OUT BOND APPLICATION PACK www.independent-trustee.com
ITC Buy Out Bond Application Checklist Please return the following documents to ensure the successful acceptance of your application. 1. Proof of ID (One of the following) Check a. Current (i.e. in date) and valid passport. Or b. Current, full and valid Driving Licence Must be certified as a true copy of the original and dated by an Accountant, Solicitor, Garda or Regulated entity based in Ireland. 2. Address Verification (One of the following & less than 3 months old from the issue date) Check a. Residential Utility Bill for the client s home address (electricity, gas, water, home phone or home broadband) Or b. Personal Bank / Building society / financial institution statement (must be a full page statement and show activity on the account) Must be certified as a true copy of the original and dated by an Accountant, Solicitor, Garda or Regulated entity based in Ireland. 3. Confirmation of PPS number Copy of one of the following: P60 P45 Tax-credit Certificate Payslip Must be certified as a true copy of the original and dated by an Accountant, Solicitor, Garda or Regulated entity based in Ireland. Page 2 of 12
Application Investor Details Title First Name Gender Surname Address Email Address Home Tel Work Tel Mobile Date of Birth / / You must notify ITC in writing of any future change in the address stated above. Marital Status Married Single Widow(er) Separated Divorced Civil Partnership PPS Number Normal Retirement Age Spouse s Name Spouse s Date of Birth / / Date Employment Commenced / / Date Employment Ended / / (a) Salary at date of leaving (b) Other earnings in last three years before leaving employment (eg bonuses) (c) (20% directors only) Total earnings for each of the last three years before ceasing employment Asset Transfer Scheme Provider NRA Policy Number Transfer Value Early Retirement option (age 50-59) Yes Yes Yes Yes No No No No Do any of the benefits being transferred contain assets transferring in-specie? Yes If so, please enclose a copy of the latest scheme report. No Revenue Details This information is required in order to calculate the Revenue Commissioner s maximum limits. Failure to provide this information is a breach of Revenue rules and could result in Revenue taking action regarding member s benefits under this Buy Out Bond (the Bond ). Page 3 of 12
Please tick the appropriate box for each of the following- if neither box is ticked, we will assume the answer is no. If you answer yes to any of the questions, please give details in the notes section at the end of this application form. Are you entitled to benefits from another pension scheme? Have you previously received any pension benefits (including a tax free lump sum payments or a refund of previous contributions)? Do you and/or your dependent(s) hold 20% or more of the shares/equity and/or the voting control of the employer company? Have you irrevocably surrendered your right to take a tax free lump sum in respect of some or all of your pension? Does any of the transfer relate to benefits from more than one previous pension scheme? If yes, please fill in details relating to each transfer in the table below Is there a Pension Adjustment Order in place against any of your pension benefits? If so, please provide a copy of the Pension Adjustment Order. Advisor Details Yes No First Name Firm Surname Fax Address Email Telephone Advisor fee Initial Set Up Fee AMC % The Advisor fee will be charged in addition to ITC s annual management fee (as per the fee schedule). Advisor Minimum Fee Signature of Advisor: Date: Special Instructions & Additional Information Representations and Warranties of the Investor 1. I instruct ITC to invest in this Bond. I understand that this investment will be used to purchase units in a unit trust and such investment will be subject to the terms of the trust deed and supplemental declaration of trust of the unit trust. I authorise ITC to subscribe for units in the unit trust on behalf of my Bond. I acknowledge and understand that ITC will be trustee of the unit trust. Page 4 of 12
2. I confirm that I am 18 years of age or over. 3. I confirm that having received, read and considered a copy of the Application Form and General Conditions relating to this investment (the Documents ), my application regarding the investment is based solely on the Documents and I am not relying on any other information or representation. I understand and agree to the terms and conditions stated in the Documents. 4. I declare that I am fully aware of the risks and the costs relating to my Bond. I understand that the value of my Bond can rise as well as fall. I also understand that if my Bond includes assets which are leveraged, there may be higher risks involved regarding the investment performance of my Bond. Regarding the Bond, I acknowledge and understand that ITC shall not be responsible for any loss or damage, whatsoever or howsoever occurring, or for any depreciation in value howsoever arising by reason of the exercise or nonexercise of the powers hereby imposed on or undertaken by ITC or any diminution in the value of assets or any part thereof or by reason of the assets or any part thereof failing to appreciate in value or failing to produce any return on the capital invested, save for any loss or damage resulting directly from ITC s fraud, wilful default or negligence. 5. I have been provided with a copy of the fee schedule and all fees relating to this Bond have been explained to me, and I understand and agree to those fees. 6. I understand that ITC operates liquidity requirements depending on the investment mix of this Bond and I agree to adhere to same. 7. I agree that all representations, warranties and declarations which I make or give here will apply with respect to my future investments pursuant to the Bond, as if repeated in full at the time of the future investment. 8. I acknowledge the right of ITC to compulsorily redeem my Bond in the event that the representations or warranties set out herein above are not accurate. 9. I acknowledge the right of ITC to compulsorily redeem my Bond if any governmental authority requires ITC to do so. 10. I shall provide ITC with any additional information which it may require in connection with my tax status and authorise ITC to disclose such information relating to this application to such Revenue authorities as ITC considers appropriate. 11. I acknowledge that pursuant to the anti-money laundering requirements of the Criminal Justice (Money Laundering and Terrorist Financing) Act 2010 (as amended), that proof of my identity will be required by ITC before this Application Form can be processed. 12. I confirm, represent and warrant that I have taken my own investment advice in relation to the Bond and acknowledge that ITC, its employees, officers and agents have not made any representation or warranty to me in relation to the Bond and that I have not received or relied on any advice from ITC and its employees, officers or agents in relation to the Bond. I acknowledge that ITC and its employees, officers or agents have no liability to me in relation to my decision to make this investment, or any losses which I may incur in relation to the Bond. 13. I have read the Data Protection Notice below and I agree that my personal information may be used for the purposes described in that Notice. I hereby consent to ITC and any of its delegates and duly authorised agents and any of their respective related, associated or affiliated companies obtaining, holding, using, disclosing and processing my data: (i) to manage and administer my investment and any related accounts on an on-going basis; (ii) for any other specific purposes where I have given specific consent to do so; (iii) to comply with legal or regulatory requirements applicable to the Bond or me; or (iv) for disclosure to the tax authorities. I hereby acknowledge my right of access to and the right to amend and rectify my personal data, as provided herein. ITC will hold any personal information provided by me in confidence and in accordance with the Data Protection Act 1988 as amended by the Data Protection (Amendment) Act 2003. Page 5 of 12
14. I declare that the information provided in this application form and other related forms (if any) is true and complete to the best of my knowledge and belief whether in my handwriting or not and that this application and declaration shall form the basis of my contract with ITC which relates to the Bond. 15. I acknowledge that the terms and conditions of my investment shall be governed by and construed in accordance with the laws of Ireland. Data Protection and Notices and Consents Consent to Marketing Communications: From time to time, we may wish to use the information you have provided for the purposes of providing you with additional information relating to the goods and services of ITC, its associated companies and / or carefully selected third parties. If you consent to our use of your data in these ways, please indicate by ticking this box: WARNING: If you propose to take out this Bond in complete or partial replacement of any existing policy, please take special care to satisfy yourself that this Bond meets your needs. In particular, please make sure that you are aware of the financial consequences of replacing your existing plan. If you are in doubt about this, please contact your current provider or financial advisor. WARNING: Please note that the provision of this product or service does not require licensing, authorisation, or registration with the Central Bank of Ireland and, as a result, it is not covered by the Central Bank s requirements designed to protect consumers or by a statutory compensation scheme. WARNING: This document is based on our understanding of current Revenue Law and Practice which is subject to change without notice. Client Portal - Consent Access to the ITC Client Portal can be gained from the website, www.independent-trustee.com or by downloading the app to phone or tablet from the App Store. I confim that I do not wish to receive reports, statements or projections as hard copy (by post) I wish to gain access to the ITC Client Portal and consent to receiving relevant scheme documentation, reports, statements and projections via my ITC Client Portal. Signature of Bondholder: Date: Page 6 of 12
QROPS (complete if benefits are to be transferred from UK-based pension schemes) Member Personal Details Name Address UK Employer (if applicable) Employer Name Employer Address Employee ID (if any) UK Pension Scheme Name Scheme Ref. Trustee Trustee Address Scheme Manager Scheme Manager Address ITC QROPS (name of the receiving scheme) I authorise Independent Trustee Company (ITC) to make such enquiries as are necessary to facilitate the transfer of this UK pension to my new scheme with ITC. I understand that a future transfer from the ITC QROPS may be restricted. I enclose HM Revenue & Customs form APSS263 (Available on the QROPS section of the ITC Website). Member Signature Date Due to circumstances beyond our control, transfers from the UK may take significantly longer than transfers from Irish providers. Page 7 of 12
Purchasing Scheme - To be completed by Trustees or Existing Provider Name of Pension Scheme Revenue Reference Number Pensions Board Reference Number Normal Retirement Age Total value of AVCs paid to the scheme: Is the scheme a preserved benefit? Name(s) of Trustee(s) Name of Employer Is the transferring scheme? Defined Benefit / Defined Contribution (delete as appropriate) We hereby enclose with this application, a copy of the rules of the Purchasing Scheme as at the date of the investor s withdrawal from service of the Employer as specified in this application form. We declare, represent and warrant that the information given by us in connection with this application is accurate and complete to the best of our knowledge and belief. We confirm that this application is to be the basis for the benefits to be provided under this Bond. We confirm that no pension adjustment order has been served on the trustees in respect of this member. Trustee / Provider Signature: Date: I authorise the Trustees of the above scheme to transfer to the Bond the amount which in the opinion of the Trustees represents the value of my benefits on withdrawal under the pension scheme. In consideration of the payment of such transfer value to the Bond, I hereby release the Trustees from all liability to me and my dependents in respect of all benefits under the pension scheme with effect from the date of such transfer. Signature of Bondholder: Date: Page 8 of 12
Custody Trust Subscription (Application for Units) This application form relates to all initial and subsequent subscriptions for Units in the Custody Trust made by me on behalf of the Pension Investor as evidenced by the transfer of subscription monies into the appropriate Sub-fund account. Applicant Information Name of applicant(s): Address: To be completed by ITC Trust Reference: To be completed by ITC The Pension Investor: Representations and Warranties The capitalised words and expressions used in this application form shall have the meaning ascribed to them in the Custody Trust Declaration of Trust dated 25th April 2014, available to view on the ITC website at www.independent-trustee.com/downloads 1. I confirm that having considered the Declaration of Trust and a specimen Supplemental Declaration of Trust in relation to the Sub-fund, this application is based solely on the Declaration of Trust and the Supplemental Declaration of Trust and I am not relying on any other information or representation. 2. I agree that all representations, warranties and declarations which I make or give here will apply with respect to future acquisitions of Units in the Custody Trust as if repeated in full at the time of the future acquisition. 3. I hereby acknowledge and agree that the Trustee reserves the right at its sole discretion to accept or reject in whole or in part my application. 4. I acknowledge the right of the Trustee in its capacity as trustee of the Custody Trust to issue such number of Units to the Pension Investor upon the transfer of initial or subsequent subscription monies into the account of the Sub-fund as the Trustee may in its sole discretion determine in accordance with the provision of the Declaration of Trust. I further acknowledge and agree that the transfer of monies by me into the account of the Sub-fund will be deemed to be an irrevocable subscription for Units on behalf of the Pension Investor in the Custody Trust. 5. I acknowledge the right of the Trustee in its capacity as trustee of the Custody Trust, to redeem the Units in the event that the representations or warranties set out herein above are no longer accurate. Page 9 of 12
1. I acknowledge the right of the Trustee in its capacity as trustee of the Custody Trust to compulsory redeem Units in the event that the Pension Investor (i) hold such Units in breach of any law or requirement of any country or governmental authority; (ii) hold such Units in circumstances which in the opinion of the Trustee might result in the Trust incurring any liability for taxation or suffering any legal, pecuniary, regulatory or material administrative disadvantage which the Trust might not otherwise have incurred or suffered; or (iii) are not or cease to be a Pension Investor (as defined in the Declaration of Trust); or (iv) hold such Units in circumstances in the opinion of the Trustee might result in the Series Trust or Trust being deemed to be a unit trust scheme as defined in Section 1(1) of the Unit Trusts Act, 1990; (v) hold such units in the circumstances in the opinion of the Trustee might result in the Sub-fund or Trust being deemed to be an Alternative Investment Fund (as defined in the European Union (Alternative Investment Fund Managers) Regulations 2013). 2. I understand that during the Term of the Sub-fund, the redemption of Units shall be subject to restrictions which may adversely affect the ability to redeem Units. 3. I shall provide the Trustee with any additional information which it may require in connection with my tax status and authorise them to disclose such information relating to this application to such persons as it may be required for taxation, legal or regulatory purposes. 4. I acknowledge that it is envisaged that additional subscriptions for Units in the Custody Trust shall be made in such an amount as shall be determined by me. Where additional subscriptions are not made and where, as a result, there may not be sufficient assets within the Series Trust to discharge its liabilities from time to time I acknowledge that this may result in the Trustee being obliged to sell or otherwise dispose of some or all of the assets of the relevant Series Trust. 5. I have consulted to the extent I have determined appropriate with my own advisers as to the financial, tax, legal and related matters concerning an investment in the Custody Trust and on that basis believe that an investment in the Custody Trust is suitable and appropriate. Acknowledged and agreed by; Applicant (Investor) / / Date: Page 10 of 12
ITC Fee Schedule for Buy Out Bonds Initial Charge ITC will not apply a set up charge on establishment of the Buy Out Bond. No contribution charge will apply to transfers received from other pension schemes. Management Charge The management charge is based on the Net Asset Value of the assets held as follows; Type 1 e.g. cash, portfolio of shares held by stockbroker, tracker funds, life bond Type 2 e.g. property 0.25% NAV 0.50% NAV Minimum management charge 900 Additional Information 1. ITC will apply the management charge on an annual basis. 2. The management charge will be deducted from the funds in the Buy Out Bond. 3. Furthers charges may be applied in respect of particular investments made within your Buy Out Bond. You will be notified of these charges at the time of investing by the promoter/asset manager of the investment. 4. Any annual fees charged in excess of the amounts above will be paid to your advisor. Propertyline There is a once-off legal and administrative fee for property purchases that will be outlined in advance of the purchase process proceeding. Page 11 of 12
Independent Trustee Company Limited Harmony Court Harmony Row Dublin 2 Tel: (01) 661 1022 Fax: (01) 661 1024 Email: info@independent-trustee.com BO 101.1.6 Effective from November 2018 www.independent-trustee.com Independent Trustee Company Limited, part of the ITC Group, is regulated by the Central Bank of Ireland. Please note that the provision of this product or service does not require licensing, authorisation, or registration with the Central Bank of Ireland and, as a result, it is not covered by the Central Bank s requirements designed to protect consumers or by a statutory compensation scheme.