For lump sum investments covering two tax years: 2018/19 and 2019/20

ISA application For lump sum investments covering two tax years: 2018/19 and 2019/20 With this form you can: invest a lump sum into your ISA for one or both of the 2018/19 and 2019/20 tax years (cheque payments only). Did you know? Your financial adviser can apply for you online in which case we do not require a paper application as well because we will only use the information submitted online. It cannot be used for: our Managed Portfolio Service (MPS) this service is only available online through financial advisers. For new or top-up investments into the MPS, please speak to your financial adviser. the surviving spouse of a deceased ISA investor to subscribe an Additional Permitted Subscription (APS) there are separate forms relating to ISA APS investments, available from your financial adviser. phased investment, automatic rebalancing, automatic withdrawals or the income option. If you require any of these, you will need to complete our standard application form. Alternatively you may request these options at a later date. Subscriptions If applying for both tax years you must write two separate cheques, one for each tax year. The cheques must NOT be post-dated and BOTH will be banked immediately upon receipt. Cheques should be made payable to Old Mutual Wealth Limited. The money banked for the 2019/20 tax year will not be invested straight away, but will be held in a segregated non-interest bearing client money account, pending investment into an ISA in the new tax year. Subscriptions for the 2019/20 tax year can only be invested on the first business day AFTER 5 April 2019. Withdrawals Any money you later withdraw from your ISA cannot be reinvested into the ISA without counting as a new subscription. Power of Attorney If an attorney is applying on behalf of an investor, we will also need a completed Power of Attorney form.! IMPORTANT DOCUMENTS YOU NEED TO HAVE RECEIVED BEFORE PROCEEDING You need to have received several important documents about this product and the funds you choose, before you send us your application to invest in, or top up, an ISA. More information about these documents is in section 1. TAX INFORMATION Under Exchange of Information regulations we are required to obtain various details of our investors, including where they were born, their nationalities, countries of tax residence* and related tax identification numbers** - section 2 of this form is where you can provide this information. We also need to obtain `a self-certification that the information provided is true and complete - this is contained in the declaration in section 7. We may have to provide this information to HMRC who may share it with overseas tax authorities. We may contact you for further information if required. *Country of tax residence Normally you are resident for taxation in the country in which you spend the majority of your time each year. However, some countries (eg the United States) may also treat an individual as resident for taxation based on their nationality or citizenship. As tax residence is determined by the country in which tax is paid, it is possible to be tax resident in more than one country. **Tax identification number (TIN) If your country of tax residence is the UK or the Isle of Man your TIN is your National Insurance number. If it is Guernsey, Jersey or Gibraltar it is your Social Security Number. If you are a US national/tax resident it is your US Tax Identification Number. For help to work out where you are tax resident, or if you are unsure about your TIN, please consult a financial adviser or the information at www.oecd.org/tax/automatic-exchange. If you are unsure what information to include, please consult a financial adviser. 1 of 6

Please tick/complete this form, as applicable, using BLOCK CAPITALS and blue or black ink. ucomplete the form carefully; errors or omissions by you or your financial adviser will not be corrected retrospectively 1 FINANCIAL ADVICE In most cases, we only accept business for investors who have received financial advice. This is because financial advisers can recommend investments that are most suitable for investors financial circumstances. Old Mutual Wealth cannot provide such advice. However, in exceptional circumstances we can accept applications on an execution only (without advice) basis, provided we ensure you have been given appropriate information and you complete some additional paperwork, see 1.2. Tick 1.1 or 1.2 as applicable 1.1 I have received financial advice in respect of this application On what basis was the advice given? (your financial adviser will help you answer this) Restricted Independent IMPORTANT DOCUMENTS YOU NEED TO HAVE RECEIVED BEFORE APPLYING Your financial adviser will have provided you with the following: A Key Features Document and Terms & Conditions for the Individual Savings Account (ISA) Information about the funds chosen for your investment: a Key Investor Information Document (KIID) or a Key Information Document (KID) for each fund the rebates applicable to your fund choice A Cost and Charges Statement, contained in the illustration or projection for your investment Our Privacy Notice concerning use of your personal data. In section 7, the declaration you sign will include your confirmation that you have received and read these documents. 1.2 I have NOT received financial advice in respect of this application Please contact us on 0808 171 2626 or by email at ask@omwealth.com. We can then assess whether we can accept your application on an execution only basis, and provide you with the additional Execution Only Declaration for you to sign and attach to your application. Tick here, if you have already contacted us, and your signed Execution Only Declaration is attached to this application. 2 YOUR DETAILS Type of investment New account Top-up into this account number Your client reference number u if known Title Mr Mrs Miss Other (please specify) Surname Full forename(s) Date of birth (dd/mm/yyyy) National Insurance number Permanent UK residential address Correspondence address (if different from residential address) Crown employees Telephone number (in case of query) Tick here if you are a Crown employee, or the spouse/civil partner* of a Crown employee *as defined by the Civil Partnership Act 2004 (see Declaration point 1b in section 7) E-mail address If you have never been issued with a National Insurance number, tick here Postcode Postcode Nationality(ies) Country(ies) of tax residence Tax identification number(s) (TIN) Reason for no TIN (if applicable) 2 of 6 PDF5846/219-0005/January 2019 (ISA app dual TY)

3 Subscription and fund choice Initial fees agreed with your financial adviser can be added on top of your ISA subscription so that you can invest the maximum allowed. Your adviser can tell you the lump sum amount you need to send us to maximise your ISA allowance by using our calculator on www.oldmutualwealth.co.uk/isagutool Please complete the boxes below as required. TAX YEAR ENDING 05/04/2019 TAX YEAR ENDING 05/04/2020 Lump sum amount:. Lump sum amount:. Maximum investment: 20,000 + initial fees for your financial adviser. Cheque number: Maximum investment: 20,000 + initial fees for your financial adviser. Cheque number: Date on cheque: If you are applying for two tax years you MUST write two separate cheques, one for each tax year. Date on cheque: Do NOT post date this cheque Tick one of the following to indicate which investment range* your fund choice is from, then list the funds below: WealthSelect SelfSelect Bundled funds u SelfSelect only Where both bundled funds (full Annual Management Charge (AMC) with rebates) and unbundled funds (lower AMC with reduced rebates) are available, we will automatically default to unbundled funds even if you currently hold the bundled version in your account. Tick here if you wish us to use the bundled version of the funds selected (where available) *If you are topping up and have chosen a different investment range from that which you currently hold, we will automatically swap all of the funds in your account and replace them with the funds listed below before carrying out your top-up. However, we will not automatically apply a switch fee as part of the swap process. Full name of fund or portfolio u the funds must all be from the same investment range, not a mixture from both Unit/Share type ie Inc/Acc Investment % An investment choice continuation sheet is available on request. TOTAL 1 0 0 If no unit/share type (ie Inc/Acc) is stated, accumulation units (where available) will automatically be applied. Where accumulation units have been selected and they are not available, income units will be automatically applied or vice versa. For more information on income and accumulation units/shares, refer to our Funds List. % If the fund choice you give is: missing, illegible or otherwise invalid, or from an investment range that is not available for your contribution type, or available through financial advisers only, but yours is an execution only application we will place the investment into Cash Deposit, after which you or your adviser can switch* into a revised fund choice. * Remember: if you have automatic rebalancing on your account, switches will cause it to be cancelled and you will need to provide us with a new rebalancing instruction for it to continue. PDF5846/219-0005/January 2019 (ISA app dual TY) 3 of 6

4 Third-party payer details This section must be completed with details of any third party paying for your lump sum investment. If there is more than one third-party payer please photocopy and complete this for each one and attach to this application. Surname/Company name Full forename(s) u if applicable Full residential/registered office address Postcode Date of birth u dd mm yyyy Company registration number u UK companies only / / u the payer must be at least 18 years of age 5 PAYMENTS TO YOUR FINANCIAL ADVISER u to be completed with your financial adviser where applicable Complete this section if you wish us to deduct fees for your financial adviser from your account. Percentage fees must be entered in multiples of 0.05%. If you wish to cancel an existing fee instruction using this form, enter 0 or 0% in the boxes for the fee in question. It will be cancelled for the whole account, not just the investment in this application. Any Servicing or Switch Fees you authorise here will apply to the entire account, and will override any existing Servicing or Switch Fee instructions on your account. initial fee required: % from your lump sum payments switch fee: up to OR % from each switch The amount you authorise using this form is the maximum fund switch fee payable to your financial adviser. You or your adviser will need to stipulate the actual fee payable for each switch up to this limit, at the time the switch instruction is given. servicing fee: OR % each year Tick the frequency required Add VAT on top of the servicing fee? Monthly Quarterly Half-yearly Yes Yearly If you leave the frequency blank, we will assume monthly. The fee is an annual amount which will be divided by the payment frequency selected and paid to your adviser accordingly. If VAT applies to this fee, your financial adviser can either include VAT within the fee or add it on top. If you tick yes, VAT will be added to the amount shown above. Where a percentage fee amount is agreed, the fee paid to your financial adviser may go up or down depending on the value of your account on the date the fee is calculated. We will only pay an ongoing adviser fee to your authorised financial adviser. If you are receiving discretionary fund management services from a third party, your adviser may pay all or a proportion of the fee to the third party as payment for these services, and where relevant, to cover any associated VAT. 6 OLD MUTUAL WEALTH SERVICE CHARGE & ADVISER SERVICING FEE DEDUCTIONS u where applicable You can choose which funds are sold to meet the Service Charge and adviser servicing fee, as applicable; the option selected will apply to both of these payments. Select one of the following options: Largest fund OR All funds OR The following fund(s) If you do not specify a preference, and in the absence of any existing instructions, we will deduct the payments from the largest fund in your account. More information about charges and fees is in the document Making the cost of investment clear 4 of 6 PDF5846/219-0005/January 2019 (ISA app dual TY)

7 Declaration and signature(s) Please read this section carefully it is important that you read and understand the Terms & Conditions as well as this declaration. You should ask questions if there is anything you do not understand before you sign and date below. The total amount you subscribe in a tax year to a stocks and shares ISA must not exceed the maximum ISA allowance, plus initial charges or fees as agreed with your financial adviser (you may only subscribe to one stocks and shares ISA in any one tax year). 1. a) I apply to subscribe for a stocks and shares ISA for the tax year indicated on this form and each subsequent year until further notice. b) I declare that: all subscriptions made, and to be made, belong to me; I am 18 years of age or over; where I am applying for a 2018/19 ISA, except where I am transferring a current tax year ISA, I have not subscribed and will not subscribe to another stocks and shares ISA in the same tax year that I subscribe to this stocks and shares ISA, and where I am applying for a 2019/20 ISA, I have not subscribed and will not subscribe to another stocks and shares ISA in the same tax year that I subscribe to this stocks and shares ISA, and I have not subscribed and will not subscribe more than the overall subscription limit in total to any combination of permitted ISAs in the same tax year. I am resident in the United Kingdom for tax purposes or, if not so resident, either perform duties which, by virtue of Section 28 of Income Tax (Earnings & Pensions) Act 2003 (Crown employees serving overseas), are treated as being performed in the United Kingdom, or I am married to, or in a civil partnership* with, a person who performs such duties. I will inform Old Mutual Wealth Limited if I cease to be so resident to perform such duties or be married to, or in a civil partnership* with, a person who performs such duties. c) I understand that any money withdrawn from my ISA cannot be reinvested in the ISA without counting as a new subscription. 2. I authorise Old Mutual Wealth Limited a) to hold my cash subscription and ISA investments, interest distributions, dividends and any other rights or proceeds in respect of those investments and any other cash; and b) to make any claims to relief from tax in respect of ISA investments on my behalf; and c) to sell units or shares in investments within my account to meet any charges or fees for my financial adviser, in accordance with the Terms and Conditions; and d) to give effect to my instructions in accordance with the Terms and Conditions. 3. I understand that I will not receive contract s relating to transactions involving the purchase or sale of investments which are carried out on a periodic basis in the manner agreed to in this application. Details of these transactions will be shown in the periodic statement which will be sent to me. In particular, such transactions include: regular investments payable by direct debit; phased investments; automatic rebalances; automatic withdrawals; dividend and rebate reinvestments; and sales of units to meet Old Mutual Wealth Limited charges and fees for my financial adviser (if applicable). 4. I have been given the opportunity to read and keep the following, and to have any questions concerning them answered to my satisfaction: Applicant s signature a) Terms and Conditions, to which I agree b) Key Features Document c) Costs and Charges Statement, included in an illustration or projection regarding my investment d) all available Key Investor Information Documents, Key Information Documents and information about rebates, in respect of my chosen funds. 5. Personal information I confirm that I have been shown and have read Old Mutual Wealth s privacy notice concerning use of my personal information, available at www.oldmutualwealth.co.uk/privacy 6. I declare that this application has been completed correctly and to the best of my knowledge and belief. 7. If I have completed section 5 of this form: a) I authorise Old Mutual Wealth to deduct any fees detailed in section 5 from my investment and pay them to my financial adviser. b) I understand that: i) the fees agreed will be met as follows (as applicable): Initial fee by deduction from my payment before the balance is invested into my choice of funds Fund switch fee by deduction from the sale proceeds of the switch, before they are invested into my new choice of funds Servicing fee by selling units as instructed in section 6 ii) if I have ticked Yes in section 5 to add VAT to any servicing fees, the amount of the agreed fee will be increased to include VAT at the rate prevailing when the fee is deducted iii) if I select a percentage amount servicing or switch fee, the fee to be paid to my financial adviser may go up or down depending on the value of my account on the date the fee is calculated iv) I will need to reauthorise any increases to fees that have been previously agreed c) I confirm that: i) I have completed and agreed section 5 with my financial adviser ii) my financial adviser has explained the effect that selling units to pay Adviser Charges from my investment will have on its future value iii) Old Mutual Wealth has brought to my attention the importance of reading and discussing section 5 of this form with my financial adviser before signing below d) I understand that: i) I can cancel an adviser servicing fee at least 10 working days before it is deducted, by contacting Old Mutual Wealth ii) I cannot cancel a fee once it has been deducted, instead I would need to contact my financial adviser to discuss whether a refund is payable 8. Tax information I understand that for regulatory purposes Old Mutual Wealth is required to obtain information concerning my taxation status. a) I declare that: i) I am resident for taxation in the country(ies) shown in section 2 of this application and I am not resident for taxation elsewhere. ii) I am a national of the country(ies) shown in section 2 of this application and I am not a national or a citizen of any other country. iii) I will inform Old Mutual Wealth if this changes in the future. iv) the information in section 2 and the statements made in this declaration are correct and complete, to the best of my knowledge and belief. b) I understand that: i) Old Mutual Wealth may need to contact me for further information regarding tax information. ii) if I am resident for taxation outside of the UK and/or a US citizen, Old Mutual Wealth may need to share my information with the relevant tax authorities. * as defined in the Civil Partnership Act 2004 Date u dd mm yyyy / / 2 0 PDF5846/219-0005/January 2019 (ISA app dual TY) 5 of 6

8 Financial adviser s declaration u to be completed by your financial adviser 1. I understand that adviser fees will be paid subject to the limits outlined in Old Mutual Wealth s Remuneration Guide. 2. I confirm that: (a) I have verified the identity of all relevant parties referred to in this application (b) the information in this form was obtained by me in respect of the relevant parties (c) the evidence I have obtained to verify the identity of the relevant parties can be produced on demand and meets the standard of evidence set out within the guidance for the UK Financial Sector issued by the Joint Money Laundering Steering Group (JMLSG) (d) if any individual referred to in this application has changed address within the last three months, I can provide evidence on demand (e) I have not verified the identity of the following parties referred to in this application because they are exempt from verification under Money Laundering Regulations (f) this section is signed below by the person who has seen the documentary evidence (which may include an electronic identity check). 3. Tax information Based on the knowledge I have gained of the relevant parties, I have no reason to believe that the tax residency self-certification in section 7 of this form (point 8) requires any follow-up action from me. Financial adviser s signature Date (dd/mm/yyyy) 2 0 Print name Financial Services number Full name of regulated firm (or sole trader) Position Contact number Send the completed form and cheque(s) to: Old Mutual Wealth Old Mutual House Portland Terrace Southampton SO14 7AY Tel: Customer Contact Centre 0808 171 2626 CHECKLIST Once you have signed the application, please check that you have completed all applicable sections and enclosed the following: Execution Only Declaration (if applicable, see section 1.2) Signed cheque - one for each tax year - for the amount(s) shown in section 3. www.oldmutualwealth.co.uk Please be aware that calls and electronic communications may be recorded for monitoring, regulatory and training purposes and records are available for at least five years. Old Mutual Wealth is the trading name of Old Mutual Wealth Limited which provides an Individual Savings Account (ISA) and Collective Investment Account (CIA) and Old Mutual Wealth Life & Pensions Limited which provides a Collective Retirement Account (CRA) and Collective Investment Bond (CIB). Old Mutual Wealth Limited and Old Mutual Wealth Life & Pensions Limited are registered in England and Wales under numbers 1680071 and 4163431 respectively. Registered Office at Old Mutual House, Portland Terrace, Southampton SO14 7EJ, United Kingdom. Old Mutual Wealth Limited is authorised and regulated by the Financial Conduct Authority. Old Mutual Wealth Life & Pensions Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Their Financial Services register numbers are 165359 and 207977 respectively. VAT number 386 1301 59. 6 of 6 PDF5846/219-0005/January 2019 (ISA app dual TY)