Agent Offshore Bond Account Opening Form

Agent Offshore Bond Account Opening Form

HELPING US DELIVER THE BEST POSSIBLE SERVICE Before providing this service for your client(s), we need an understanding of their investment experience, attitude to risk and objectives. This form has been designed to provide us with this background information and, as a consequence, will help us deliver the best possible service in aiming to meet the requirements of your client(s). Thank you for taking the time to complete and return it to us. If you have any questions while completing the form your Account Executive will be pleased to help. If you would prefer to complete the form in large print please ask your Investment Manager for a copy. Name of Investment Manager Name of Business Development Manager

SECTION 1: PROVIDER AND AGENT S REGISTRATION DETAILS Please print in capitals throughout this form and mark boxes with an X. Offshore Bond Policy Number Account Title Brewin Dolphin: Agent Offshore Bond Account Opening Form Provider s Address Company Name Number Street City County Postcode Country Regulatory Authorisation Number VAT Registration Number (Provider) Email Agent s Details Agent s Name(s) Agent s Address Agent s Email VAT Registration Number (Agent) Agent s Contact Number FCA Authorisation Number The following documents will automatically be sent to the Provider: Original Valuations Original Statements Original Consolidated Tax Vouchers SECTION 2: WHO IS THIS ACCOUNT FOR? First Policyholder The First Policyholder (if applicable) will be the main correspondent for all Policyholder s. Mr Mrs Miss Ms Other If Other, please state below Other First Name(s) Surname of Birth Place of Birth 1

SECTION 2: WHO IS THIS ACCOUNT FOR? (CONTINUED) What is the Policyholder s Residential Address? House Name House Number Street City County Postcode Country Care Of/Hold Mail address Additional Details Nationality Country of Birth Residency for Tax Purposes Domicile National Insurance Number Tax Reference What are the Policyholder s Contact Details? Home Telephone Number Other Telephone Number Email Second Policyholder (if applicable) Mr Mrs Miss Ms Other If Other, please state below Other First Name(s) Surname of Birth Place of Birth What is the Second Policyholder s Residential Address? House Name House Number Street City County Postcode Country Care Of/Hold Mail address 2

SECTION 2: WHO IS THIS ACCOUNT FOR? (CONTINUED) Additional Details Nationality Country of Birth Residency for Tax Purposes Domicile National Insurance Number Tax Reference What are the Second Policyholder s Contact Details? Brewin Dolphin: Agent Offshore Bond Account Opening Form Home Telephone Number Other Telephone Number Email Third Policyholder (if applicable) Mr Mrs Miss Ms Other If Other, please state below Other First Name(s) Surname of Birth Place of Birth What is the Third Policyholder s Residential Address? House Name House Number Street City County Postcode Country Care Of/Hold Mail address Additional Details Nationality Country of Birth Residency for Tax Purposes Domicile National Insurance Number Tax Reference What are the Third Policyholder s Contact Details? Home Telephone Number Other Telephone Number Email 3

SECTION 2: WHO IS THIS ACCOUNT FOR? (CONTINUED) Fourth Policyholder (if applicable) Mr Mrs Miss Ms Other If Other, please state below Other First Name(s) Surname of Birth Place of Birth What is the Fourth Policyholder s Residential Address? House Name House Number Street City County Postcode Country Care Of/Hold Mail address Additional Details Nationality Country of Birth Residency for Tax Purposes Domicile National Insurance Number Tax Reference What are the Fourth Policyholder s Contact Details? Home Telephone Number Other Telephone Number Email Please provide an email address if the Director wishes to access our online valuation system. SECTION 3: HOW CAN WE HELP THE POLICYHOLDER? 3.1 How much capital does the Policyholder have available for investment? 3.2 Type of Service Discretionary The service you are selecting on behalf of your Client is Discretionary Fund Management. 3.3 Please indicate below which Risk Category the Policyholder has agreed to for this account. 1. Risk Category 1 - Cautious with Lower Risk 2. Risk Category 2 - Cautious with Risk 3. Risk Category 3 - Diversified Risk 4. Risk Category 4 - Progressive Risk 5. Risk Category 5 - High Risk Please refer to Brewin Dolphin s Retail Terms and Conditions for the Clients of Financial Advisers and the associated Risk Guide for further information. 4

SECTION 3: HOW CAN WE HELP THE POLICYHOLDER? (CONTINUED) 3.4 Benchmarks Brewin Dolphin: Agent Offshore Bond Account Opening Form Please refer to our Risk Guide for Financial Advisers for further information on the default benchmark that corresponds with the selection in section 3. Please advise us if you would like the portfolio to be assessed against an alternative benchmark. 3.5 Is an income required from the Policyholder s investments? Yes No If yes, please state the gross amount the Policyholder would like them to produce each year. This is an indication of what the Policyholder would like the portfolio to achieve. This is not a guarantee of what the portfolio can or will achieve. 3.6 What is the Policyholder s investment time horizon? 1-3 years 3-5 years 5-10 years 10+ years 3.7 Does the Policyholder s have any preferences or restrictions on where the Policyholder s money is invested? If yes, please provide details. Yes No We may not be able to accommodate your investment restrictions due to the nature of the Offshore Bond product. Please discuss with your Investment Manager. SECTION 4: CORRESPONDENCE AND ADMINISTRATION 4.1 Information for Professional Advisers and Third Parties If the Policyholder would like us to send copies of periodic account information to their other professional advisers or other third parties, please provide the details below and indicate which documents they would like us to send. Do you want us to provide information on the Policyholder s portfolio to third parties? Yes No If yes, please indicate below: Adviser Company Tax Adviser Solicitor Other General Correspondence Valuation*/Depreciation Report Invoices Contract Notes Year End Tax Report (one copy only) Statements Quarterly Custody Statement (Execution Only accounts) * maximum of 4 Please provide contact details (if applicable) Contact Name Role Name of Firm Address Postcode Email Telephone number If you require additional space please use Notes section at the back of the form. 5

SECTION 4: CORRESPONDENCE AND ADMINISTRATION (CONTINUED) 4.2 Instructions from Third Parties If you or the Policyholder wish to authorise a third party to provide instructions to us, please provide the details below. Consent from the Provider will be required. Do you want us to accept instructions from a third party? Yes No Please note that money laundering regulations require us to obtain proof of identity/address documentation in respect of any third party that exercises control over the account. We may need to contact you for further information. If yes, please authorise ONE third party here: Tax Adviser Solicitor Other Please provide contact details (if applicable) Contact Name Role Name of Firm Address Postcode Email Care Of/Hold Mail address Telephone Number of Birth Nationality Country of Birth Residency for Tax Purposes Domicile 4.3 Periodic Statements A Valuation Report will be provided quarterly. Would you like to receive monthly income statements when income is paid to the Provider? Yes No Portfolios will be valued in Sterling. If your clients wish to change the currency, please contact your Brewin Dolphin Investment Manager. Euro US Dollar 4.4 Would your client like access to their account online via our MyBrewin web portal? Yes No Your Client can view up-to-date information about their investments through the MyBrewin portal at www.brewin.co.uk/mybrewin. To enjoy the benefits of MyBrewin, we will simply need to confirm your Client s mobile telephone number and the email address that they would like to use for their MyBrewin account. Please note that for data security reasons and to reduce the risk of fraud, we will not create more than one MyBrewin account with the same email address. For joint account holders who would each like their own MyBrewin access, please provide two mobile telephone numbers and corresponding email addresses below. Client Mobile Telephone Number for MyBrewin Account Client E-mail Address for MyBrewin Account 6

I would like access to the online valuation system. Yes No SECTION 5: BANK DETAILS AND ASSET TRANSFERS 5.1 If funds are being transferred to us when this account is being opened, please provide the following information on the source of these funds. Provider Client Account Please do not insert Policyholder bank details here. Account Name Name of Bank or Building Society Branch Building Society Roll No. Bank Account Number Sort Code For Bank Accounts outside the UK please provide: IBAN number City Country Please confirm the source of funds and the source of wealth in relation to this account. Source of Funds e.g Bank/Building Society Account, etc. Source of Wealth e.g sale of property, etc. 5.2 Income Instructions Please complete this section on how you would like us to handle the Policyholder s dividends and interest and regular income payments. Dividend Income: Brewin Dolphin to hold as part of the portfolio Pay to the Provider Client account (as above) Regular Payment: If you would like a fixed sum paid to the Provider s Client bank account please indicate: Amount Frequency for first payment 7

SECTION 6: AGENT DECLARATION AND ACCEPTANCE OF TERMS BY THE AGENT 6.1 Data Protection The information given in this form will be handled in accordance with the provisions of all applicable data protection laws and regulations from time to time in force ( Data Protection Laws ), relating to data protection, privacy and the processing of personal data, including the General Data Protection Regulation (Regulation (EU) 2016/679) ( GDPR ) which governs how we may use your or your client s personal information and provides you or your client with certain rights in respect of your information. As a data controller, Brewin Dolphin is registered with the Information Commissioners Office ( ICO ) and Brewin Dolphin has the obligation to notify the ICO the purposes for which it processes personal information. You can access Brewin Dolphin s register entry via the ICO s website: www.ico.org.uk. You can also refer to our Retail Client Terms & Conditions for the Clients of Financial Advisers or read our privacy notice which is available at www.brewin.co.uk/privacynotice. 6.2 Agent Declaration and Acceptance In relation to our Client, the Policyholder, I/We declare that: I/we have undertaken an assessment of the suitability of Brewin Dolphin s services for the Policyholder. the information provided in this form is correct and complete to the best of my/our knowledge and I/we will notify Brewin Dolphin promptly of any changes. I/we have obtained information from the Policyholder in relation to their knowledge and experience in investments and confirm that the Policyholder has the neccessary experience and knowledge in order to understand the risks involved in the management of the portfolio. I/we have obtained information from the Policyholder in relation to their financial situation including the source and extent of their regular income, assets (including liquid assets) investments and real property and their regular financial commitments. I/we confirm that the Policyholder has the capacity to bear investment risks arising from the management of the portfolio, including the potential of significant loss. I/we confirm that I/we have read Brewin Dolphin s Risk Guide for Financial Advisers and that the Category identified in Section 3 of this Account Opening Form is suitable for the Policyholder. I/we have received Brewin Dolphin s Account Opening Information Pack, which includes the standard terms and conditions governing the services to be provided to us as agent for our Policyholder, and I/we shall seek clarification promptly if there is anything that I/we do not understand. I/we have obtained information from the Policyholder on their investment objectives, including the length of time they wish to hold investments, their preferences regarding risk taking, their risk profile and the purposes of investment. I/we confirm that I/we have verified and identified all parties to this agreement in accordance with the Intermediary Terms of Business for Agents. I/we have discussed and agreed with the Policyholder the overall charging structure (including trail commissions) in relation to this service. I/we will disclose to the Policyholder all details of any subsequent fees and commissions between us in accordance with all applicable statutory, regulatory and professional requirements. where we supply Brewin Dolphin with information about the Policyholder, we have obtained their prior consent to provide this information to Brewin Dolphin and for Brewin Dolphin to process it in order to provide its services. where we supply Brewin Dolphin with information about the Policyholder classed as special category personal data under Data Protection Laws, that I/we have the consent of the Policyholder to share this information with us. First Authorised Signature Second Authorised Signature (if appropriate) 8

SECTION 7: DECLARATION AND ACCEPTANCE OF TERMS BY THE POLICYHOLDER 7.1 Declaration by the Policyholder I declare that: the information provided in this form is correct, complete and up-to-date; my Agent will notify Brewin Dolphin promptly of any changes to the information provided in this form and of any other relevant information; and I have received a copy of Brewin Dolphin s Retail Client Terms and Conditions for the clients of financial advisers which govern the services to be provided to me and will seek clarification from my Agent if there is anything I do not understand. First Policyholder Second Policyholder Third Policyholder Fourth Policyholder SECTION 8: DECLARATION AND ACCEPTANCE OF TERMS BY THE PROVIDER/TRUSTEE(S) 8.1 Order Execution and Conflicts Policies You will have received summaries of our Order Execution Policy ( OEP ) and Conflicts Policy. Our OEP specifies that when we believe it is in your and the Policyholder s best interests we may execute transactions outside regulated markets and multilateral trading facilities such as a trade on an over the counter (OTC) basis with a market participant or by crossing your order with that of another opposing Client ( Agency Cross ). Part 4 of the Policy has further details. The OEP also allows us to exercise our discretion as to whether or not to publish limit orders depending on whether we believe it is in your best interests. We strongly believe that it is in both you and the Policyholder s interests that you accept our OEP as it better enables us to get the best outcomes for both you and the Policyholder. We would ask that you read the summary of the Order Execution Policy, and provide express consent to it by signing the Declaration in section 8.3. Please also complete the below FATCA self-certification to confirm the status of the Provider. 9

SECTION 8: DECLARATION AND ACCEPTANCE OF TERMS BY THE PROVIDER/TRUSTEE(S) (CONTINUED) 8.2 Self-Certification Of Status Under FATCA Tax Exchange Agreements Note: The term FATCA is used below to refer collectively to the following tax exchange regulations: The US Foreign Account Tax Compliance Act Regulations 2010, The UK International Tax Compliance (United States of America) Regulations 2013, The UK International Tax Compliance (Crown Dependencies and Gibraltar) Regulations 2014, The OECD Model Competent Authority Agreement and Common Reporting Standard, The UK International Tax Compliance Regulations 2015 Any other International Tax Exchange Agreements currently in force which apply to the UK or Jersey. Offshore Bond Provider Self-Certification: Please complete the following to confirm the status of the Offshore Bond Provider under FATCA tax authority exchange regulations: Section 1 to confirm the Offshore Bond Provider s country of residence for tax purposes, and Section 2 to confirm the Offshore Bond Provider s classification for the purposes of FATCA, and, Section 3 to confirm the Offshore Bond Provider s classification for the purposes of the Common Reporting Standard. Section 1. Offshore Bond Provider Tax Residency: Please indicate the country in which the Offshore Bond Provider is incorporated/organised for the purposes of that country s income tax. (If you do not have a tax identification number in your country of residence, please state the reason why) Country of Residency for Tax Purposes Tax Identification Number Section 2. Offshore Bond Provider FATCA Entity classification: (a) We confirm that the Offshore Bond Provider meets the definition of an Exempt Beneficial Owner for FATCA purposes. (Either under the IRS regulations, or under the legislation issued by the country stated in Section 1) (b) We confirm that the Offshore Bond Provider is a compliant Financial Institution. Please complete section (i), (ii), (iii) or (iv) to confirm the FI category Offshore Bond Provider Financial Institution (FI) Status i) If the entity is registered as an FI or as a Sponsored Entity please provide the Global Intermediary Identification Number (GIIN) ii) If the entity is a Sponsored closely held Investment Vehicle please provide the GIIN of the sponsoring FI Please confirm whether it is the GIIN of the Entity or the Sponsoring FI GIIN: Own Sponsoring Name of Sponsor If unable to provide a GIIN, please tick reason why your organisation does not have a GIIN: iii) The Entity has applied, or is going to apply, for a GIIN (but has not yet received it) iv) The Entity is a Certified or otherwise Deemed Compliant FI State reason for Deemed Compliant Status: (c) We confirm that the Offshore Bond Provider is not exempt from FATCA reporting, does not intend to register with the IRS (or otherwise be deemed compliant), and does not intend to report the underlying beneficiary(s) under FATCA Regulations By Checking this box we acknowledge and accept the following: Brewin Dolphin will classify this account as being held by a non-participating FFI Brewin Dolphin may be required to disclose certain details of the account to the IRS (via HMRC) under FATCA tax authority exchange agreements Brewin Dolphin may be obliged to deduct withholding tax from income paid to this account. 10

SECTION 8: DECLARATION AND ACCEPTANCE OF TERMS BY THE PROVIDER/TRUSTEE(S) (CONTINUED) Section 3. Offshore Bond Provider Classification for the Purposes of the Common Reporting Standard (CRS) Please tick one of the boxes below: (a) The Entity is a Managed Investment Entity (More than 50% of the Entity s gross income is attributable to investment activities AND the Entity has appointed a Financial Institution to manage its assets (in part or in whole) on a discretionary basis) (b) The Entity is a Financial Institution (other than a Managed Investment Entity) (c) The Entity is a Non-Reporting Financial Institution (i.e Governmental Entity) (d) The Entity is an Active NFE (e) The Entity is a Passive NFE if you tick this box please complete Section E below If you have ticked (a) or (b) above you may be responsible for reporting any reportable persons to your local tax authority that are tax resident in a Reportable Jurisdiction. 8.3 Declaration On behalf of the Provider or Trustees of the Policy, we declare that: we consent to the Order Execution Policy on behalf of the Policyholder the information provided in this form regarding the Provider /T rustees is complete and correct to the best of our knowledge and we shall notify Brewin Dolphin promptly of any changes in the details, status or circumstances of the Provider / Trustees; we expressly consent to the Agent (authorised to act on behalf of the Policyholder in Section 1 of this form) to communicate with, give instructions to, and otherwise deal with Brewin Dolphin in respect of the Policyholder s Account unless or until such authority is withdrawn by the Provider, by notice in writing, to Brewin Dolphin; where we supply Brewin Dolphin with information about the Policyholder we have obtained their prior consent to provide this information to Brewin Dolphin and for Brewin Dolphin to process it in order to provide its services. The tax residency / FATCA information provided in this form is, to the best of our knowledge and belief, accurate and complete. We undertake to advise Brewin Dolphin promptly of any change in circumstances which causes the tax residency / FATCA information contained herein to become incorrect or incomplete and to provide Brewin Dolphin with an updated declaration within 30 days of such a change in circumstances We understand that in certain circumstances Brewin Dolphin will be obliged to share this information with the UK or Jersey tax authorities, who may share this with other tax authorities. At least two Authorised Signatories must sign on behalf of the Provider/Trustee(s). First Authorised Signatory/Trustee 11

SECTION 8: DECLARATION AND ACCEPTANCE OF TERMS BY THE PROVIDER/TRUSTEE(S) (CONTINUED) Second Authorised Signatory/Trustee Third Authorised Signatory/Trustee Fourth Authorised Signatory/Trustee For Trust based schemes Brewin Dolphin require the Trust Deed to be provided if not already done so. IMPORTANT NOTE - IF THE PROVIDER HAS A GLOBAL AGREEMENT IN PLACE WITH BREWIN DOLPHIN THEIR SIGNATURE IS NOT REQUIRED. 12

FOR BREWIN DOLPHIN USE ONLY Agent s Name Short Name PRC Branch Code A/C Exec Responsible for account FCA Number Terms and Conditions B D 1 1 2 1 / / BD Number: Please record the reference number from the back of the Terms and Conditions document. Set Up Benchmark index agreed with Agent Rate Card Type Power of Attorney Specialist Service Parent Key

Account Title For office use only Client Code PRC Code CMS Contact Code (icode) CMS Organisation Code (O Code) Classification R E T A I L C L I E N T W brewin.co.uk E info@brewin.co.uk Brewin Dolphin Limited is a member of the London Stock Exchange, and is authorised and regulated by the Financial Conduct Authority (Financial Services Register reference number: 124444). Registered office: 12 Smithfield Street, London, EC1A 9BD. Registered in England and Wales company number: 2135876. VAT number: GB 690 8994 69 BD1459b_1805_4 Issue : May 2018