HomeInvestor Application for additional cover under mortgage options Important notes This application relates to the mortgage options which are available under, and governed by, the HomeInvestor Provisions (the Provisions ). These options are available where mortgage options are shown in your HomeInvestor Policy Certificate. This application will be used to assess whether the conditions for exercise of the mortgage options in section 13 of the Provisions have been met. This application for additional cover must be in connection with a mortgage increase for either house purchase or house improvements. Your answers to the questions on this form will be used to assess the application and you must, therefore, answer them fully to the best of your knowledge and belief. You must give us any information which might be relevant and which could influence our decision. If you are unsure whether a particular fact is relevant, you should disclose it. Before any plan comes into force, any changes in the facts contained in the answers given in this application must be notified to Clerical Medical in writing. Clerical Medical reserves the right to amend the terms on which your application may have been accepted or to withdraw acceptance in any event of such change. Part or all of the plan benefits might be forfeited if the requirements of the above paragraphs are not complied with. It is important that you read this section if you have ever had a genetic test. We comply with the Association of British Insurers policy on genetics and insurance. We ll never ask you to take a genetic test. You don t have to tell us about any genetic test result you ve had if: i) you re applying for Life Cover and the total amount of that benefit, added to any existing life insurance policies you have, is less than 500,000; ii) iii) you re applying for Critical Illness Cover and the total amount of that benefit, added to any existing critical illness policies you have, is less than 300,000; you re applying for Income Protection and the total amount of that benefit, added to any existing income protection policies you have, is less than 30,000 a year. You may need to tell us if your benefit amount goes over these limits. The Government s Genetics and Insurance Committee has agreed that certain genetic test results can be used for insurance and we will only use these ones. Please ask us if you think this may apply to you or go to www.abi.org.uk/insurance-and-savings/topics-and-issues/genetics However, you must always tell us about any genetically inherited condition which your family has a history of, or which you have symptoms of or are being treated for. If you want, you can tell us about any negative genetic test results to show you have not inherited a genetic disorder and we ll take this into account. Insurers pass information on claims concerning income protection insurance, critical illness insurance and waiver of premium benefits to the Income Protection Claims Register, run by the Association of British Insurers (ABI). The aim is to prevent duplicate fraudulent claims. When you make a claim, we will notify the register of that event. You can ask us for more information about this. The mortgage options expire on the life assured s 55th birthday and are not available in respect of plans that mature after the life assured s 70th birthday. The mortgage options can only be used on a maximum of three separate occasions and each occasion should be at least twelve months apart. You should remember that any person who is advising you regarding the plan(s), policy(ies) or contract(s) for which you are applying, is acting for you and not on behalf of Clerical Medical. Plan benefits will not commence until Clerical Medical has issued a Letter of Acceptance and all conditions contained therein have been complied with. Copies of the completed application and the plan provisions are available on request. The phrase Clerical Medical is used in this form to refer to Scottish Widows Limited. Defined terms used in this application have the same meaning as in the Provisions. 1
Please answer questions in CAPITAL LETTERS, and give careful consideration to any declaration before signing it. A. Details of the life (lives) to be assured First life Sex Male Female Mr/Mrs/Miss/Ms or other title Surname Full forename(s) Address Second life Sex Male Female Mr/Mrs/Miss/Ms or other title Surname Full forename(s) Address Phone number E-mail address Phone number E-mail address Marital Status single Marital Status single married married divorced divorced separated separated widowed widowed Date of birth (DD MM YYYY) Date of birth (DD MM YYYY) Place of birth Place of birth For tax purposes are you resident in the UK? Yes No For tax purposes are you resident in the UK? Yes No Length of residence in the UK Years Months Length of residence in the UK Years Months Country of residence (if other than UK) Country of residence (if other than UK) Nationality (list all if more than one) Nationality (list all if more than one) Occupation Occupation B. Plan details Fund Choice Please state the investment funds used in your illustration for premiums to be allocated to. Please give whole percentages only and the total must equal 100%. For the choice of funds available, please speak to your financial adviser. We may change the selection of funds that we make available. Fund name % Assumed rate of growth on investment funds Growth Rate % Please state the assumed growth rate used in your illustration % 2
B. Plan details (continued) Options Waiver of Premium Available only if you have this benefit under your existing plan and the life (lives) assured is (are) aged 59 or under and in full-time employment. If you do not require Waiver of Premium benefit on the increased cover, your existing Waiver of Premium benefit will remain unaltered. Do you wish to extend your existing Waiver of Premium benefit? First Life Yes No Second Life Yes No Critical Illness Cover If your original plan included Critical Illness Cover, then providing that this application for additional cover is accepted, your Critical Illness Cover will increase in the same proportion as the Sum Assured. C. Mortgage details Loan amount (new total sum assured) Address of property being mortgaged Term Years Months Name and address of lender Date of move (if applicable) Name of solicitor I/We confirm that the increase in cover is in connection with a mortgage increase for either house purchase or house improvements. Please tick Please note: Where an extra premium is being/has been charged on the original plan (policy), you should also complete a full application form. Please remember to sign the Declaration at the back of this form. 3
Declaration I/We declare that the option is being effected with a view to the proceeds being used to repay a mortgage on my/our main residence. I/We acknowledge that the plan may be rendered void if it is established that the option was not being effected for the purpose stated above. I/We consent to Clerical Medical seeking information about my/our loan from the lender and authorise the giving of such information. I/We also consent to Clerical Medical giving information about my/our plan to the lender. I/We declare that I/we have read and understood the important notes on the cover of this application and that all statements made are true and complete to the best of my/our knowledge and belief. I/We understand that you will pass the information about any claim concerning income protection insurance, critical illness insurance and waiver of premium benefits to the ABI so that they can make it available to other insurers. I/We also understand that, in response to any searches you may make in connection with this claim, the ABI may pass you information it has received from other insurers. I/We have read any answers completed other than in my/our own handwriting and confirm that they are correct. Data Privacy Notice Your personal information will be held by Scottish Widows Ltd which is part of the Lloyds Banking Group. More information on the Group can be found at www.lloydsbankinggroup.com This privacy notice contains key information about how we will use and share your personal information and the rights you have in relation to this. If you want to know more please access our full privacy notice at www.scottishwidows.co.uk/legalprivacy or ask us for a copy. We will use your personal information: to provide products and services, manage your relationship with us and comply with any laws or regulations we are subject to (for example the laws that prevent financial crime or the regulatory requirements governing the products we offer). for other purposes including improving our services, exercising our rights in relation to agreements and contracts and identifying products and services that may be of interest. To support us with the above we analyse information we know about you and how you use our products and services, including some automated decision making. You can find out more about how we do this, and in what circumstances you can ask us to stop, in our full privacy notice. Your personal information will be shared within Lloyds Banking Group and other companies that provide services to you or us, so that we and any other companies in our Group can look after your relationship with us. By sharing this information it enables us to better understand our customer s needs, run accounts and policies, and provide products and services efficiently. This processing may include activities which take place outside of the European Economic Area. If this is the case we will ensure appropriate safeguards are in place to protect your personal information. You can find out more about how we share your personal information with credit reference agencies below and can access more information about how else we share your information in our full privacy notice. We will collect personal information about you from a number of sources including: information given to us on application forms, when you talk to us in branch, over the phone or through the device you use and when new services are requested. from analysis of how you operate our products and services, including the frequency, nature, location, origin and recipients of any payments. from or through other organisations (for example card associations, credit reference agencies, insurance companies, retailers, comparison websites, social media and fraud prevention agencies). in certain circumstances we may also use information about health or criminal convictions but we will only do this where allowed by law or if you give us your consent. You can find out more about where we collect personal information about you from in our full privacy notice. 4
We may be required by law, or as a consequence of any contractual relationship we have, to collect certain personal information. Failure to provide this information may prevent or delay us fulfilling these obligations or performing services. The law gives you a number of rights in relation to your personal information including: the right to access the personal information we have about you. This includes information from application forms, statements, correspondence and call recordings. the right to get us to correct personal information that is wrong or incomplete. in certain circumstances, the right to ask us to stop using or delete your personal information. from 25th May 2018 you will have the right to receive any personal information we have collected from you in an easily re-usable format when it s processed on certain grounds, such as consent or for contractual reasons. You can also ask us to pass this information on to another organisation. You can find out more about these rights and how you can exercise them in our full privacy notice. We may also collect personal information about other individuals who you have a financial link with. This may include people who you have joint accounts or policies with such as your partner/spouse, dependents, beneficiaries or people you have commercial links to, for example other directors or officers of your company. We will collect this information to assess any applications, provide the services requested and to carry out credit reference and fraud prevention checks. You can find out more about how we process personal information about individuals with whom you have a financial link in our full privacy notice. In order to process your application we may supply your personal information to credit reference agencies (CRAs) including how you use our products and services and they will give us information about you, such as about your financial history. We do this to assess credit worthiness and product suitability, check your identity, manage your account, trace and recover debts and prevent criminal activity. We may also continue to exchange information about you with CRAs on an ongoing basis, including about your settled accounts and any debts not fully repaid on time, information on funds going into the account, the balance on the account and, if you borrow, details of your repayments or whether you repay in full and on time. CRAs will share your information with other organisations, for example other organisations you ask to provide you with products and services. Your data will also be linked to the data of any joint applicants or other financial associates as explained above. You can find out more about the identities of the CRAs, and the ways in which they use and share personal information, in our full privacy notice. The personal information we have collected from you and anyone you have a financial link with may be shared with fraud prevention agencies who will use it to prevent fraud and money laundering and to verify your identity. If fraud is detected, you could be refused certain services, finance or employment. Further details of how your information will be used by us and these fraud prevention agencies, and your data protection rights, can be found in our full privacy notice. If you apply to us for insurance, we may pass your details to the relevant insurer and their agents. If a claim is made, any personal information given to us, or to the insurer, may be put onto a register of claims and shared with other insurers to prevent fraudulent claims. It is important that you understand how the personal information you give us will be used. Therefore, we strongly advise that you read our full privacy notice, which you can find at www.scottishwidows.co.uk/legalprivacy or you can ask us for a copy. If you have any questions or require more information about how we use your personal information please contact us using https://www.scottishwidows.co.uk/secure/forms/contact_us/individual_customers/policy-enquiries You can also call us on 0345 300 2244. If you feel we have not answered your question Lloyds Banking Group has a Group Data Privacy Officer, who you can contact on 0345 300 2244 and tell us you want to speak to our Data Privacy Officer. 5
First life Marketing choices We would like to keep you up to date on products and offers that may be of interest to you. Please select how you would like to hear from us below. These choices won t affect any necessary information we need to send you such as statements and, don t worry, you can change your mind and update your preferences at any time. SCOTTISH WIDOWS WEBSITES You may see relevant messages when you log in to our online services. If you choose no, you may still see messages, but they will not be tailored to you. Yes No EMAIL Yes No POST Yes No DEVICE NOTIFICATIONS As we develop mobile applications you ll receive relevant notifications to your mobile device Yes No TEXT MESSAGES Yes No PHONE Yes No By saying yes, you are giving consent for Scottish Widows to use your personal information to send you relevant offers and information about our products. Scottish Widows includes the following legal entities: Scottish Widows Ltd, Scottish Widows Unit Trust Managers Limited, Scottish Widows Administration Services Limited and HBOS Investment Fund Managers Limited. Occasionally we will send you selected offers from other companies within Lloyds Banking Group that may be relevant to you. Signature Date (DD MM YYYY) Name in CAPITAL LETTERS Second life Marketing choices We would like to keep you up to date on products and offers that may be of interest to you. Please select how you would like to hear from us below. These choices won t affect any necessary information we need to send you such as statements and, don t worry, you can change your mind and update your preferences at any time. SCOTTISH WIDOWS WEBSITES You may see relevant messages when you log in to our online services. If you choose no, you may still see messages, but they will not be tailored to you. Yes No EMAIL Yes No POST Yes No DEVICE NOTIFICATIONS As we develop mobile applications you ll receive relevant notifications to your mobile device Yes No TEXT MESSAGES Yes No PHONE Yes No By saying yes, you are giving consent for Scottish Widows to use your personal information to send you relevant offers and information about our products. Scottish Widows includes the following legal entities: Scottish Widows Ltd, Scottish Widows Unit Trust Managers Limited, Scottish Widows Administration Services Limited and HBOS Investment Fund Managers Limited. Occasionally we will send you selected offers from other companies within Lloyds Banking Group that may be relevant to you. Signature Date (DD MM YYYY) Name in CAPITAL LETTERS Please note: Please complete and sign the Direct Debit Instruction if your bank details have altered and return it with your application. 6
Instruction to your bank or building society to pay Direct Debits Please complete the whole of this form and send it to: Originator s Identification Number Clerical Medical, PO Box 28121, 15 Dalkeith Road, Edinburgh EH16 9AS. 9 5 8 9 4 4 Bank or building society branch full postal address and account details Name(s) of Account Holder(s) For Clerical Medical official use only. This is not part of the instruction to your bank or building society. Bank or building society account number Branch sort code To: The Manager Bank/Building society Address Instruction to your bank or building society Please pay Clerical Medical Direct Debits from the account detailed on this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that the instruction may remain with Clerical Medical and, if so, details will be passed electronically to my bank/building society. Signature(s) Clerical Medical reference number Date (DD MM YYYY) Banks and Building Societies may not accept Direct Debit Instructions for some types of account. Please detach this guarantee and keep it for your future reference. The Direct Debit Guarantee This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits. If there are any changes to the amount, date or frequency of your Direct Debit Clerical Medical will notify you ten working days in advance of your account being debited or as otherwise agreed. If you request Clerical Medical to collect a payment, confirmation of the amount and date will be given to you at the time of the request If an error is made in the payment of your Direct Debit, by Clerical Medical or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society If you receive a refund you are not entitled to, you must pay it back when Clerical Medical asks you to You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us. www.clericalmedical.co.uk Clerical Medical is a trading name of Scottish Widows Limited. Scottish Widows Limited is registered in England and Wales No. 3196171. Registered office in the United Kingdom at 25 Gresham Street, London EC2V 7HN. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services Register number 181655.
www.clericalmedical.co.uk Clerical Medical is a trading name of Scottish Widows Limited. Scottish Widows Limited is registered in England and Wales No. 3196171. Registered office in the United Kingdom at 25 Gresham Street, London EC2V 7HN. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services Register number 181655. G907/0418