Close Inheritance Tax Service (CITS) Application form

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Close Inheritance Tax Service (CITS) Application form 1. Your details Title First name(s) Surname Date of birth Country of birth City/town of birth National Insurance number 1 Tax residency 2 Please tick this box if you are only UK resident for tax purposes, if not, please complete the table below detailing all countries where you are liable to pay tax. Country of tax residency Tax Identification Number (TIN) No TIN 3 Please complete in BLOCK capitals using black ink. Please note any sections that are not completed correctly may incur delays or may have to be returned to you ( the Client ). This form should only be completed once the CITS Client Agreement has been considered by you and after you have taken advice from your financial adviser on the suitability of CITS. The declarations at the end of the form, one for you and one for your financial adviser, must be completed and signed in order for your application to be processed. 1 Please tick this box if you have not been issued with a National Insurance number. 2 Please indicate ALL countries other than the UK in which you are resident for the purposes of that country s tax. Permanent residential address 4 Are you a US resident 5 Previous residential address (if at current address less than three years) Preferred telephone number Email address 6 2. Is this part of a joint application? Please note that an ISA cannot be held in joint names. Any instruction regarding joint ownership will only apply to a CITS Main account. If you are a US citizen, US Green Card holder, or US resident, you must include United States in this table along with your US Tax Identification Number. 3 If no TIN, please tick the box. 4 We ( Close Brothers Asset Management ) cannot accept Care of and PO Box addresses. Only UK addresses are acceptable. 5 If you are a US Resident, we may not be able to progress with your application. If you have any queries please contact us on 020 7426 4179. 6 Please include your email address to enable you to use the Close Brothers Asset Management (CBAM) online service. We will only post contract notes online. However, if you want to receive paper copies, please tick this box. Yes No If Yes, are these assets to be held as Name of the Joint Applicant 8 Joint Tenants or Tenants in Common 7 7 For Tenants in Common, we will assume 50/50 ownership unless you inform us otherwise. 8 Please note that the joint applicant will need to complete a separate application form.

3. Financial Adviser details Name of Intermediary 9 FCA number (Individual) Name of Intermediary Company FCA number (Company) Address 9 Please ensure that the Financial Adviser named in Section 3 is also the signatory in Section 7. 10 Please include an email address to enable your Financial Adviser to use the CBAM online service. 11 A contract note is generated for each purchase or sale made on the account. These are also collated and reported in both the half yearly valuations and the consolidated tax pack. Email address 10 Telephone number 4. Tax Adviser details (if applicable) 12 This is a valuation and trading summary of your account(s) for the six months ending 30 June or the 31 December respectively. 13 This is a valuation, trading summary, income summary and capital gain summary for the tax year ending 5 April. These are not supplied for ISA portfolios. Name of Adviser Name of Firm Address Email address Telephone number 5. Mailing instructions Please indicate below who you would like to receive a copy of your correspondance. We will only post documents to the relevant adviser s online acount. Please only tick one box per row. Financial Adviser Tax Adviser Contract Notes 11 Half Yearly Valuation Pack 12 Annual Consolidated Tax Pack 13 and / or and / or and / or

6. Declaration (by applicant) For your own benefit and protection, please carefully read the Close Inheritance Tax Service s Client Agreement (including the Brochure), which includes our risk warnings, upon which we intend to rely. If you do not understand any point please ask your Financial Adviser for further information. I confirm the following: (i) That the details contained in this form are true and accurate; (ii) I have read the Client Agreement for the Close Inheritance Tax Service in conjunction with the Brochure and hereby agree to the terms and conditions and risk warnings as set out in them; (ii) That the person(s) named as my Adviser(s) on this application form are authorised by me to access my portfolio details through the Close Brothers Asset Management online service; (iv) I will notify CBAM if the Adviser(s) named on this application no longer act for me. Main (v) I wish to invest 14 (complete as appropriate) Please tick method of payment Cheque 15 BACS 16 Signature - Client/POA/Trustee 17 (please delete as appropriate) Print name (BLOCK CAPITALS) ISA (approximately) 14 Please note that the minimum investment value is 50,000 in either a CITS Main Investment or ISA account, or combination of both. Please note that the minimum level of investement in the ISA account is one full years subscription. 15 Cheques should be made payable to CAM Client Monies Account. 16 If you prefer to fund your investment through a BACS transfer then please tick the box and submit the fully completed application form. Once the application form has been successfully received we will contact your adviser with the relevant payment details. 17 If you are signing the application form under Power of Attorney (POA), please also send: an original or certified copy of the POA; and money laundering documentation on the signing POA documents. 18 If the estate has gone to the Court or Protection, please ensure the POA s authority in respect of financial matters is included as well. Date We are only able to accept an application signed by a Power of Attorney if: 7. Declaration (by Financial Adviser) I hereby acknowledge and declare that: (i) I am authorised and regulated by the Financial Conduct Authority to advise on and transact in investments in the UK. (ii) I have discussed the investment in the Close Inheritance Tax Service with the above named client, including both the risks and benefits associated with such investment and I am satisfied as to its suitability / appropriateness (as applicable) for the client s investment objectives and personal circumstances. (iii) I will ensure that the investment continues to be suitable / appropriate (as applicable) for the client s investment objectives and personal circumstances throughout the investment period so long as I remain as an appointed advisor to the client. (iv) I will inform CBAM if I no longer act for the Client. (v) The evidence I/we have obtained to verify the identity of the applicant: a) meets the standard set out within the guidance for the UK Financial Services Sector issued by the Joint Money Laundering Steering Group (JMLSG) OR b) is included as an original or certified copy along with this application form 18 Signature Print name (BLOCK CAPITALS) Date a) they hold a Lasting Power of Attorney which has been registered with the Public Guardians Office and which give the Attorney the power to make decisions on financial matters; or b) they hold an Enduring Power of Attorney made and signed before October 2007 that has been registered with the Public Guardians Office; or c) the application is made by a parent, guardian, spouse, civil partner, son or daughter of an individual who lacks mental capacity. In this instance we would also require documentation proving the client lacks mental capacity and stating the relationship between the client and signatory. 18 Acceptable Money Laundering is an original or certified copy of: a) passport (with photo) or driving license (with photo) and b) utility bill less than 3 months old (not a mobile phone bill). OR A Confirmation of Verification of Identity is also acceptable.

ISA Application Only complete if applicable 1. Amount to be invested Please complete as relevant. Option A - New ISA Application 1 Stocks & Shares ISA subscription for the tax year 2 0 Y Y / 2 0 Y Y and for each subsequent tax year, where the ISA automatic funding facility section below is completed Single investment amount for the tax year specified above Please tick method of payment Cheque 2 BACS 3 Option B - ISA Transfer-in Estimated re-registration amount 4 from existing ISA Plan Manager(s) Number of ISA transfers to be made 2. ISA automatic funding facility Please only complete this section if you wish to fund your ISA account in future years. I would like CBAM to fully fund my ISA directly on an annual basis from: 5 my CITS Main Investment Account (only select this if you have applied for both a CITS Main Investment Account and ISA) Please complete in BLOCK capitals using black ink. Please note any sections that are not completed correctly may incur delays or may have to be returned to you. 1 Please note that you cannot invest more than the current annual ISA limit. 2 Cheques should be made payable to CAM Client Monies Account. 3 If you prefer to fund your investment through a BACS transfer then please tick the box and submit the fully completed application form. Once the application form has been successfully received we will contact your adviser with the relevant payments details. 4 Please complete Section 3 with your transfer instruction details. 5 Until you inform us otherwise, we will automatically fund the annual ISA subscription limit by selling shares up to the permitted annual ISA subscription limit from your holdings in your CITS Main Investment Account and reinvesting the proceeds in your CITS ISA Account. The sale of shares within your Investment Account will be made without reference to your Capital Gains Tax (CGT) position and could give rise to a CGT liability. You will receive notification of both the sale and reinvestment of your holdings. Your money will not be invested in the markets during this reinvestment period. This application will cover the first tax year in which you subscribe and all subsequent tax years provided you continue to subscribe to your ISA Account. This means that in subsequent years you will not need to submit a further application form.

3. ISA Plan Manager details (existing) Transfer request 6 If you have completed section 1B then please provide details of the existing ISA you wish to transfer in to your CITS Stocks and Shares ISA. If you need to notify us about additional ISA providers, please copy this page, complete it and return it with the rest of this application. 6 Please note that since the 1 July 2014 it has been possible to transfer a Stocks & Shares ISA into a Cash ISA. 7 Please check that your ISA provider is willing to make partial transfers. Name of existing ISA Plan Manager Address Please indicate below what type of ISA you are transferring and also include the account number Account number Stocks & Shares ISA Cash ISA I wish to transfer my ISA in full in part 7 If in part, please indicate the amount I would like any investments held within my ISA that are not listed on the Alternative Investment Market or ICAP Securities & Derivatives Exchange to be sold. I would then like any remaining investments and cash (including the sale proceeds) held in my ISA to be transferred (in specie where applicable) to Close Asset Management Limited within 30 days of the date of receipt of this authority. If I have requested a partial transfer please apply this proportionately. Signature Account holder Print name (BLOCK CAPITALS) Date

4. ISA Declaration For your own benefit and protection, please carefully read the Close Inheritance Tax Service s Client Agreement (including the Brochure), which include our risk warnings, upon which we intend to rely. If you do not understand any point please ask your Financial Adviser for further information. 8 Close Asset Management Limited (CAML) is the principal operating company of Close Brothers Asset Management I am applying to subscribe to an ISA and declare that: all subscriptions made, and to be made, belong to me; I am 18 years of age or over; I have not subscribed, and will not subscribe, more than the overall subscription limit in total to a Cash ISA and a Stocks and Shares ISA, and an innovative finance ISA in the same tax year; 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 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 Close Asset Management Limited (CAML) 8 if I cease to be so resident or to perform such duties or be married to, or in a civil partnership with, a person who performs such duties. I understand that where I am transferring a Cash ISA, it will be transferred into a Stocks and Shares ISA. I authorise CAML: to hold my cash subscription, ISA investments, interest, dividends and any other rights or proceeds in respect of those investments and any other cash; to make on my behalf any claims to relief and tax in respect of ISA investments and any other cash; on my written request to transfer or pay to me, as the case may be, my ISA investments, interest, dividends, rights or other proceeds in respect of such investments or any cash; and to manage this and any subsequent ISA subscriptions in line with the Close Inheritance Tax Service s objectives as set out in the Client Agreement (including the Brochure) or as directed from time to time. I am applying to subscribe to an ISA and declare that: the information given is correct to the best of my knowledge and belief; I will inform CAML of any changes to the information given on this form; and I have read and understood the Close Inheritance Tax Service Client Agreement (including the ISA Terms and Conditions) which together with the Brochure and this Application Form shall constitute my agreement with CAML for the management of the ISA.

4. ISA Declaration (continued) Where I have applied to automatically fund my ISA, I declare that: I wish to subscribe to an ISA, starting the tax year after CAML accepts this form, and in each subsequent tax year, and invest the permitted maximum amount; I understand that if I have requested future subscriptions be transferred from an existing CITS Investment Account that I will be subscribing the maximum Stocks and Shares ISA contribution or the remaining balance of said account (whichever is less) to the Stocks and Shares ISA detailed above, starting the tax year after CAML accepts this form; I understand that each annual ISA contribution will be invested in line with the CITS objectives as set out in the Close Inheritance Tax Service s Client Agreement (including the Brochure). I understand that I must notify CAML in writing to cancel this instruction, and that this cancellation notice must be received by CAML at least 14 days before the end of a tax year. In order to confirm these declarations and authorisation, to accept these terms and to clarify that certain powers are being conferred on CAML, please sign below. Signature - Client/POA (please delete as appropriate) Print name (BLOCK CAPITALS) Date

Adviser Charging Agreement For clients of Intermediaries 1. Initial fee details 1 I/we hereby authorise CBAM to make payment of my Financial Adviser s fees as shown below: A fixed fee of OR Is VAT applicable to this fee? Is the VAT amount included in the amount shown above? 2 2. Ongoing fee details 3 I/we hereby authorise CBAM to make payment of my Financial Adviser s fees as shown below: Is VAT applicable to this fee? Is the VAT amount included in the amount shown above? 2 3. Declaration and signature I/we authorise the facilitation of adviser charging on my/our account(s) as detailed above. I/we understand that Close Brothers Asset Management will not be liable for refunding any Adviser Charges to a Client that it has facilitated on the Intermediary s behalf. I/we understand that it shall be the sole responsibility of the Intermediary to refund any Adviser Charges owing to me/us and the Intermediary will indemnify Close Brothers Asset Management against any loss, cost, damage or expense incurred as a result of the Intermediary s failure to refund such Adviser Charges. I/we acknowledge that this Agreement will remain in place until I/we notify you in writing that I/we wish to amend or cancel/terminate it in line with the Client Agreement. Signature - Client/POA/Trustee (please delete as appropriate) of the investment/transfer value % which equates to a fee of based on your proposed investment of Net investment after charge of the net investment/transfer 4 % value which equates to a fee of per year based on your net proposed investment Yes Yes Yes Yes No No No No Please complete in BLOCK capitals using black ink. Please note any sections that are not completed correctly may incur delays or may have to be returned to you ( the Client ). Close Brothers Asset Management (CBAM) does not act as an agent of financial intermediaries and is authorised by you, the Client, to facilitate fees to your Intermediary for financial advice as detailed below. This document is supplemental to the CBAM Intermediary Terms of Business. 1 CBAM will facilitate the collection of a client approved adviser charge. 2 If No the fee will be increased to include VAT. 3 Important: If there is insufficient cash within the portfolio, CAML may either accrue fees, charges and other costs, or sell assets to settle such liabilities. You should be aware that the sale of investments for these purposes may occur at a disadvatageous time or may result in a tax charge, where this occurs outside of a Tax Wrapper, for which we shall not be liable. You may need to take this into consideration when calculating and capital gains tax liability. 4 The ongoing fee will be calculated and deducted twice yearly in arrears, based on the investment balance at the end of June and December. Please note that fees will be applied on a pro rata basis during the period in which your portfolio is opened. As the ongoing charge is applied to the value of investments as above, the amount you pay will move up and down in line with investment values. Print name (BLOCK CAPITALS) Date

CITS Fees and charges schedule 1 Terms applying to the Close Inheritance Tax Service (CITS) 1.1 Fees and charges become due and payable once calculated. This schedule sets out our current and maximum fees and charges and should be read in conjunction with your Client Agreement. Other taxes or costs may exist that are not paid through Close Asset Management Limited (CAML) 1 or imposed by it. 1.2 These charges cover all normal custody and administration costs within the account, although the Client will be responsible for the payment of all other costs, transfer fees, registration fees, taxes and similar liabilities, payable or incurred by CAML under this agreement. 2 Management fees and other charges Client charges Up front Annually Dealing fee One off Administration charge of 250 plus VAT Management Fee of 1.25% plus VAT e.g. ( 1,250+VAT for 100,000) 1% on the value of each transaction 2 Annual Management Fees are charged half yearly in arrears and are taken from the cash balance of the portfolio. The fee is based on the closing value of the portfolio on the final business day of the reporting period and so will go up and down in line with investment values. If there is insufficient cash within the portfolio, CAML may either accrue fees, charges and other costs, or sell assets to settle such liabilities. You should be aware that the sale of investments for these purposes may occur at a disadvantageous time or may result in a tax charge, where this occurs outside of a Tax Wrapper, for which we shall not be liable. You may need to take this into consideration when calculating any capital gains tax liability. Adviser charges These are subject to receipt of a signed adviser fee charging agreement. CAML will facilitate the collection of a client approved adviser charge half yearly in arrears. Transfer charges When assets are transferred intact to the Client or a Third Party i.e. a new Fund Manager, rather than being encashed, the Client continues to have beneficial ownership of the stocks, shares, bonds, etc. CAML is entitled to charge 20 per item transferred (monies and shares). Amendment charges CAML is entitled to charge a processing fee of 5 (plus VAT) per line item amended in respect of ownership/internal transfers including where joint portfolios are split into individual names or when there is a change in management style involving an internal transfer from one Close Portfolio to another. More complex transfers may incur additional charges. 3 Interest on Capital and Income Interest on Capital and Income Account Balances (Sterling) will be paid at: Bank of England Base Rate less 1.0% on cash balances below 250,000; and Bank of England Base Rate less 0.5% on cash balances of 250,000 and above. The rate paid cannot go below zero. The interest we pay the Client may be less than the interest we receive. 4 Withdrawals For any telegraphic transfer of cash, CAML will be entitled to pass on the bank charges to the Client. 5 Other matters CAML will not normally accept commission payable by issuers of securities or investment intermediaries. However, on rare occasions, CAML may accept such commissions, in lieu of fees or part thereof, where it is in the Client s interest to do so. CAML will not normally benefit directly from any commission paid, as such commission will normally be applied for the benefit of the Client by reinvestment or enhanced allocation, according to the rules of the organisation concerned. With this service, the client s money is segregated and managed as an individual portfolio. 1 Close Asset Management Limited is the principal operating company of Close Brothers Asset Management 2 Certain transaction taxes may also apply. These include: Stamp Duty of 0.5% of the value of any purchase where applicable. From the 28 April 2014, purchases of certain AIM and ISDX listed shares granted exemption by HMRC will not be liable to Stamp Duty. The Panel on Takeover and Mergers will charge a levy of 1 per transaction, if the transaction is in excess of 10,000 VAT is not currently chargeable on dealing fees.

Confirmation of Verification of Identity Only complete if applicable 1. Power of Attorney/Trustee Title First name(s) If you need to provide money laundering documents on more than one Power of Attorney/ Trustee, then please copy and complete this page and return it with the rest of the application form. All sections must be completed. Please send the completed form to: Surname Date of birth Permanent residential address CITS Administration Team Close Brothers Asset Management 10 Exchange Square Primrose Street London EC2A 2BY For any queries, please contact: Telephone: 020 7426 4343 Email: citsenquiries@closebrothers.com Previous residential address (if current address less than three years) Acceptable Money Laundering is an original or certified copy of: a) passport (with photo) or driving license (with photo) and b) utility bill less than 3 months old (not a mobile phone bill). 2. Confirmation by Authorised Adviser I/We confirm that: The evidence I/We have obtained to verify the identity of the individual named above, meets the standard set out within the guidance for the UK Financial Services Sector issued by JMLSG Name of Intermediary FCA number (Individual) Name of Intermediary Company FCA number (Company) Position Signature Print name (BLOCK CAPITALS) Date

Completion check list Your Close Inheritance Tax Service application form is now completed. Please return this application form along with: The adviser charging agreement Any relevant original or certified copies of the requisite Money Laundering documentation. Any relevant original or certified copies of the Power of Attorney documents or Trust Deeds. Please include a certified copy of the applicant s passport. We require this to minimise any witholding taxes on dividends received from non UK domiciled companies. If your Intermediary Company has not submitted business to Close Brothers Asset Management previously, please call 020 7426 4179 to obtain a terms of business document. This is also available online at www.closebrothersam.com/sharedpages/index?page=2082 To: CITS Administration Team Close Brothers Asset Management 10 Exchange Square Primrose Street London EC2A 2BY For any queries, please contact: Telephone: 020 7426 4343 Email: citsenquiries@closebrothers.com

Close Brothers Asset Management is a trading name of Close Asset Management Limited (Registered number: 01644127) and Close Asset Management (UK) Limited (Registered number: 02998803). Both companies are part of Close Brothers Group plc, are registered in England and Wales and are authorised and regulated by the Financial Conduct Authority. Registered office: 10 Crown Place, London EC2A 4FT. VAT registration number: 245 5013 86.