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Fund switch Form

Please complete this form using BLOCK CAPITALS only and blue or black ink.

With this form you can:

– change your current choice of funds – redirect future regular payments into different funds This form cannot be used for the following products: – Old Mutual International Isle Of Man Limited investments – the Collective Investment Account, Collective Investment Bond, Collective Retirement Account, ISA.

• capital & income Bond, skandia investment Bond and skandia distribution Bond only – If you wish to switch into distribution funds, you must switch all of your current funds into distribution funds. – However, it is not possible to switch into distribution funds while you have additional life cover. In order to switch to

distribution funds, you would first need to cancel the extra life cover. Once cancelled, any future extra life cover would be subject to our requirements. If your health has changed we may not be able to offer extra life cover on the same terms, or at all. You should consult your financial adviser before taking action.

– If you are already taking regular withdrawals from your bond, and you switch to distribution funds, you should consider the possible tax implications.

• AllreferencestoOldMutualWealthinthisformmeanOldMutualWealthLifeAssuranceLimited.• Missingorunclearinformationwillresultindelaysorthereturnofthisform.• Errorsoromissionsbyyouoryourfinancialadviserwillnotbecorrectedretrospectively.

notE

• Ifyoudonotcompletethissection,futureregularcontributionswillcontinuetobeinvestedinthefundsyouhavealreadychosen.• Enteryournewfundchoicebelowstatingfullfundnames,includingfundmanagers.• Thefundchoicebelowwillnotapplytosinglecontributionsortransferpaymentspaidtopensionplansorschemesinthefuture.

B new Fund choice For Future reGuLAr contriButions (also known as a‘redirection’)

1.

2.

3.

4.

Telephone number E-mailaddress

A Your detAiLs

fuLL namEs of PoLicyhoLDErs (including additional trustees, where applicable)

PLan/BonD/account numBErs (egSIB-001234567)

–

–

–

–

–

–

whole %(1%minimum)

total 100%

new fund choice

notE

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1. switch out of individual funds•Completethissectionifyouwanttochangeone or some of your existing funds (toswitchALLfunds,usepart2).•Enteryournewfundchoicestatingfullfundnames,includingfundmanagers.•Ifyoudonotwishtoswitchoutofthecurrentfundcompletely,usethelistofreplacementfundstostatethepercentageyouwanttokeep.we will

only sell the difference.

c new Fund choice For existinG investments

SK0015/217-0039/January2017HSwitchForm

current fund to switch out

whole %(1%minimum)

total 100%

replacement fund(s)

Percentage to keep in current fund (if any)

current fund to switch out

whole %(1%minimum)

total 100%

replacement fund(s)

Percentage to keep in current fund (if any)

current fund to switch out

whole %(1%minimum)

total 100%

replacement fund(s)

Percentage to keep in current fund (if any)

current fund to switch out

whole %(1%minimum)

total 100%

replacement fund(s)

Percentage to keep in current fund (if any)

Please continue on a signed copy of this page if necessary

•WereservetherighttoinvesttheswitchproceedsintotheOMWDepositfundifanypartoftheswitchinstructionisincompleteorotherwise invalid.

•Wecannotacceptmonetaryamountsorpartpercentages.

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Thissectionmustbecompletedandsignedbytheperson(s)requestingthechangestothefundchoice.Pleaseindicatebelowthecapacityinwhichyou are acting (notes relating to the numbered examples are on the next page).1. I request the new fund choice transactions specified in this form.2. IconfirmthatIhaveauthoritytorequestthesetransactionsjointlywiththeotherperson(s)(ifany)signingbelowinthecapacityalsoshown.3. IconfirmthatthereisnobankruptcyordercurrentlyinforceagainstthePolicyholderifapplicabletoaplan/bond/account.4. Iconfirmthattheplan/bond/accountisnotsubjecttoanyassignmentexceptaspreviouslynotified.5. (Appliesonlyifswitchrequestedbythefinancialadviser) The financial adviser: a) confirmsthatanInvestmentManagementAuthorityorsimilardocument(‘TheAuthority’)iscurrentlyinforceauthorisingthesignatory/ies

belowtomakeinvestmentdecisionsonbehalfofthePolicyholder.TheAuthority(oracertifiedcopy)hasbeensenttoOldMutualWealthorisenclosed.TheAuthorityhasbeendrawnupinaccordancewiththerulesestablishedundertheFinancialServicesandMarketsAct2000orany other relevant statutory provisions.

b) willindemnifyOldMutualWealthforanylossesarisingfromprocessingthisformiftherequestismadewithoutsufficientlawfuland/orPolicyholder authority.

continued

d decLArAtion And siGnAture(s)

c new Fund choice For existinG investments (continued)

•CompetethissectionifyouwishtochangeALLofyourexistingfunds.•Enteryournewfundchoicestatingthefullfundnames,includingfundmanagers.

2. switch 100% out of ALL funds

Print full name

Print full name

Print full name

Signed Date (ddmmyyyy)

Signed Date (ddmmyyyy)

Signed Date (ddmmyyyy)

Capacity eg Policyholder, Trustee, Assignee1,Employer2, Scheme Member3,FinancialAdviser4

Capacity eg Policyholder, Trustee, Assignee1,Employer2, Scheme Member3,FinancialAdviser4

Capacity eg Policyholder, Trustee, Assignee1,Employer2, Scheme Member3,FinancialAdviser4

SK0015/217-0039/January2017HSwitchForm

whole %(1%minimum)

total 100%

new fund choice

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www.oldmutualwealth.co.ukCalls may be monitored and recorded for training purposes and to avoid misunderstandings.OldMutualWealthLifeAssuranceLimitedisregisteredinEngland&Walesundernumber1363932. RegisteredOfficeatOldMutualHouse,PortlandTerrace,SouthamptonSO147EJ,UnitedKingdom. AuthorisedbythePrudentialRegulationAuthorityandregulatedbytheFinancialConductAuthorityandthePrudentialRegulationAuthority. FinancialServicesregisternumber110462.VATnumber386130159.OldMutualWealthPensionsTrusteeLimitedisregisteredinEngland&Walesundernumber1538109.RegisteredOfficeasabove.WhenprintedbyOldMutualthisitemisproducedonamixedgradematerial,whichusesacombinationofrecycledwoodorpaperfibrefromcontrolled sources and virgin fibre sourced from well managed, sustainable forests.SK0015/217-0039/January2017HSwitchForm

Notes1. ASSIGNEDPOLICIES Ifapolicyisassignedorchargedassecurity(forexampletoabankorbuildingsocietyassecurityforaloan),theassignee’swrittenconsentor

authorisation may be needed for any transactions. Transactions should only be requested by the assignor if the assignee has given written consent or authority.

2. EMPLOYER-SPONSOREDPENSIONSCHEMES Changestofundchoiceforanexecutiveordirector’spensionschemeshouldnormallyberequestedbytheschemememberorbythesponsoringemployer

as agent of the scheme member.

3. PERSONALPENSIONSCHEMESANDFREESTANDINGAVCSCHEMES Changes to fund choice for these schemes should normally be requested by the scheme member.

4. FINANCIALADVISER Financialadvisermeanstheindividual,partnership,companyorotherbodyauthorisedtomakeinvestmentdecisionsunderthetermsofanInvestment

ManagementAuthorityandinaccordancewiththeirFCApermissions.

Print full name

Print full name

Signed D D M M Y Y Y YDate (ddmmyyyy)

Signed D D M M Y Y Y YDate (ddmmyyyy)

d decLArAtion And siGnAture(s) (continued)

Capacity eg Policyholder, Trustee, Assignee1,Employer2, Scheme Member3,FinancialAdviser4

Please return the completed form to:OldMutualWealthHead OfficeOld Mutual HousePortland TerraceSouthamptonSO147AY

Capacity eg Policyholder, Trustee, Assignee1,Employer2, Scheme Member3,FinancialAdviser4