zenith - aviva · • the zenith principal brochure • the fund prices leaflet specimen policy...
TRANSCRIPT
Application Form
Zenith
Financial Adviser Details
Company name
Friends Provident International Agency number
Contact details for acknowledgement/queries on the application:
Contact name
Phone number
Email address
Policy Number
Policy number if known
Please contact Friends Provident International Limited (Friends Provident International) to obtain a pre-allocated
policy number if desired.
Please tick to confirm you have included with this application:
Verification of client identity*
Verification of client address*
Source of wealth (including supporting documents, where required*)
*suitably certified as being a true copy
Details of information required for Source of Wealth can be found on pages 6, 7 and 8.
XIM7/A 07.14
Failure to disclose relevant information may delay the processing of your application
2
This Form is not applicable to persons resident in Hong Kong.
This Form should be read in conjunction with the current edition of the following documents:
• theZenithPrincipalBrochure
• theFundPricesleaflet
SpecimenpolicyconditionsareavailablefromFriendsProvidentInternationalonrequest.
Please complete all details in Section 1
Pleaseprovideallrelevantinformationanddocumentationsothatwecanprocessyourapplicationassoonaspossible.Furtherinformation
mayberequiredduringthevalidationprocess(i.e.questionsarisingfromtheinformationprovided).
IfyoumakeanymistakeswhilecompletingthisForm,pleasecrossouttheerrorandwritethenewinformationasclearlyaspossible.
Each correction must be initialled by the person or persons completing the form.DoNOTusecorrectionfluidorotherwaysof
deletingincorrectinformation.
Additional information / Special instructions
Please let us know in the space below of any additional information we need to be aware of relating to the application.
XIM7/A 07.14
Section1:DetailsofApplicant(s) *Deleteasappropriate
3
To be completed by each investor who is the current legal owner of the premium(s).
Please refer to ‘What you need to provide’ for requirements to support verification of identity and address on page 18.
PleasewriteinINKanduseBLOCKCAPITALS
First (or only) Applicant
Second Applicant
1 Title
Mr
Mrs
Miss
Mr
Mrs
Miss
Other(pleasespecify)
Other(pleasespecify)
2 Surname
3 Firstname(s)
4 Marital status
5 Dateofbirth(DD/MM/YY) | | | | | |
6 Pleasetelluswhereyouwereborn.
Town
Country
Countrycode(ifknown)
7 Pleaselistallcountriesinwhichyouaretaxresident.Pleaseprovideyourtaxidentificationnumberforeachcountry.
(i) Country
Countrycode(ifknown)
Taxidentificationnumber
(ii) Country
Countrycode(ifknown)
Taxidentificationnumber
(iii) Country
Countrycode(ifknown)
Taxidentificationnumber
Ifnecessary,pleasesupplyanyadditionalinformationattheend.
Ifyouareunsureofyourstatusasataxresident,yourtaxidentificationnumber,oryouhaveanyothertaxqueries,westronglyrecommendyouseekprofessionaltaxguidanceinordertoavoiddelayingyourapplication.
8 Countryofresidence
9 Residence address
10 Telephone number
11 Emailaddress(mandatory)
Failure to disclose relevant information may delay the processing of your application
4 XIM7/A 07.14
First (or only) Applicant
Second Applicant
12 How long have you lived at this address?
13 Correspondenceaddress(ifdifferenttoresidenceaddress)
14 Correspondenceaddressphonenumber
15 Youwillreceiveallcorrespondenceandstatementsrelatingtoyourpolicy,unlessyouindicateotherwisebelow.Copieswillalsobesentyourfinancialadviser.
Alternatively,pleasetickhereifyouwouldpreferustosendallcorrespondenceandstatementsrelatingtoyourpolicytoyourfinancialadviseronly.
16 Inwhichcountriesdoyouhavenationality/citizenshipstatus?Ifyouhavemorethanonenationality/citizenshipstatuspleasesetoutall
countriesofwhichyouareanational/citizen,aswellastherelevanttaxidentificationnumber(s)whereapplicable.
(i) Country
Countrycode(ifknown)
Taxidentificationnumber
(ii) Country
Countrycode(ifknown)
Taxidentificationnumber
(iii) Country
Countrycode(ifknown)
Taxidentificationnumber
17 Occupation
(Ifretired,pleasestateformeroccupation) (Ifretired,pleasestateformeroccupation)
18 Natureofbusiness
19 Areyouingoodhealth?
Yes
No
Yes
No
IfNo,pleasegivedetailsbelow
20 AreyoutobeaPolicyholder?
Yes
No
Yes
No
21 AreyoutobeaLifeAssured?
Yes
No
Yes
No
IftheapplicantsarenottobetheLivesAssured,thesupplementaryapplicationform‘AdditionalLivesAssured/Policyholders’mustbecompleted.TheremustbeatleastoneLifeAssuredforeachpolicy.
5XIM7/A 07.14
Section2:Investmentdetails *Deleteasappropriate
Total Premium
USD/GBP/EUR/HKD* MinimumUSD15,000;GBP10,000;EUR15,000;HKD120,000
Plan Currency
Pleaseselectthecurrencyinwhichyouwishyourplantobedenominated.(Ifnoselectionismade,theplancurrencywillbethecurrencyin
whichthepremiumhasbeenpaid.)
USDollars(USD)
Sterling(GBP)
Euro(EUR)
HKDollars(HKD)
Optional Withdrawals
Investorsmaychoosetoreceivearegularincomefromtheirpolicy.ThecurrentminimumindividualwithdrawalisUSD750(orGBP500,
EUR750,HKD6,000).ThelevelofwithdrawalsmaybevariedorstoppedaltogetherbygivingwrittennoticetoFriendsProvident
InternationalLimited.
Iwishtoreceiveatotalyearlyamountof
USD/GBP/EUR/HKD*
or %
ofmyinitialinvestment,payablein
yearly
half-yearly
quarterly
monthly
termly instalments
commencing
(dateatwhichpaymentistobedispatchedfromtheCompany)
IrequestFriendsProvidentInternationaltopaythebenefitsbyTelegraphicTransfer.Pleasetransferthebenefitsintomyaccount(mustbe
policyholder’saccount).
Sortcode(ifapplicable)* | | |
SWIFT/BICcode(ifapplicable)*
IBAN(ifapplicable)*
Accountnumber
Accountname
Bank(nameandaddress)
Bank
Postcode(ifapplicable)
6 XIM7/A 07.14
Section2:Investmentdetails(continued) *Deleteasappropriate
Source of wealth
PleaserefertotheSourceofwealthtablewhichisavailableonourwebsiteorfromyourfinancialadviser,fortheevidentialrequirementsto
supportSourceofwealth.
Income and savings from salary (basic and/or bonus)
Ifself-employedoracompanyshareowner,pleasereferto‘Companyprofits’following.
Currentannualsalary Currency Amount
Employer’sname
Employer’saddress
Natureofbusiness
Maturity or encashment of life policy Amountreceived Currency Amount
Policyprovider
Policynumber/reference
Dateofmaturityorencashment
Sale of shares or other investments/liquidation of investment portfolio
Descriptionofshares/units/deposits(i.e.name/whereheld)
Nameofseller
Lengthoftimeheld Years Months
Sale amount Currency Amount
Datefundsreceived
Sale of property Sold property address
Dateofsale
Total sale amount Currency Amount
Company sale Companyname
Natureofbusiness
Dateofsale
Total sale amount Currency Amount
Client’s share %
7XIM7/A 07.14
Section2:Investmentdetails(continued) *Deleteasappropriate
InheritanceNameofdeceased
Dateofdeath
Relationship to applicant
Datereceived
Total amount Currency Amount
Solicitor’sname
Solicitor’sfirm’sname
Solicitor’saddress
Divorce settlement Datefundsreceived
Total amount received Currency Amount
Nameofdivorcedpartner
Company profits Companyname
Companyaddress
Natureofcompany
Amountofannualprofit Currency Amount
Asset (share) exchange Originandmeansofwealth
Gift Datefundsreceived
Pleaseprovideallofthefollowing:
• Letterfromdonorexplainingthereason for the gift and the source ofdonor’swealth
• Certifiedidentificationdocumentsfor donor
Total amount Currency Amount
Relationship to applicant
Donor’ssourceofwealth
Failure to disclose relevant information may delay the processing of your application
8 XIM7/A 07.14
Section2:Investmentdetails(continued)
Employer paying policy Countryofincorporation
Pleaseprovidethefollowing:
• Employer letterIncorporationnumber
Retirement income Retirement date
Previousoccupation
Nameoflast(final)employer
Addressoflast(final)employer
Pensionincomesource
Fixed deposit – savingsNameofinstitutionwheresavingsheld
Dateaccountestablished
Detailsofhowsavingsacquired
Dividend Payment Dateofreceiptofdividend
Total amount received Currency Amount
NameofCompanypayingdividend
LengthoftimetheshareshavebeenheldintheCompany Years Months
Other source of wealthPleaseprovideasmuchdetailaspossible.
Failure to disclose relevant information may delay the processing of your application
9XIM7/A 07.14
Section2:Investmentdetails(continued)
9
Choice of Funds
Pleaseindicatethefundsinwhichyouwishyourplantoinvest,uptoamaximumof10,showingthepercentageoftheinvestiblepremium
youwishtobeinvestedineachfund.Thetotalpercentagemustaddupto100%(pleasenotewecanonlyacceptwholepercentages).
Failure to include all relevant information accurately may delay the processing of your application.
Fund Code Fund % of Premium
Total 100%
XIM7/A 07.1410
Section2:Investmentdetails(continued)
Source of Payment
Option 1Use this option if you are paying by personal cheque or if you wish Friends Provident International Limited to collect the premium
from your bank on your behalf.
Please tick the appropriate box and follow the instructions carefully.
BY PERSONAL CHEQUE. PleasemakechequespayabletoFriendsProvidentInternationalLimited.
BY TELEGRAPHIC TRANSFER. PleasecompletetheappropriateBank Instruction Letter atthebackofthisFormandreturnittoFriendsProvidentInternationalLimitedwiththisApplicationForm.
Option 2Use this option if you are making your own arrangements for payment by Banker’s Draft or Telegraphic Transfer.
Please tick the appropriate boxes and complete the Source of Payment section below.
BY BANKER’S DRAFT. IhavearrangedforthepremiumtobepaidbyBanker’sDraft,asindicatedbelow,payabletoFriendsProvidentInternationalLimited(Ref:Policyholder).IhaveforwardedacertifiedcopyoftheBankAcknowledgementLettertoFriendsProvidentInternationalLimitedwiththisDraft.Please tick one box only
USDollarDraft,drawnonabankinNewYork
SterlingDraft,drawnonabankintheUnitedKingdom
EuroDraft,drawnonabankintheEuropeanEconomicandMonetaryUnion(EMU)
HKDollarDraft,drawnonabankinHongKong
BY TELEGRAPHIC TRANSFER. IhavearrangedforthepremiumtobepaidbyTelegraphicTransfer(Ref:Pre-AllocatedPlan
Number,ifknown:_______________________________)andIhaveforwardedacertifiedcopyoftheBankApplicationFormto
FriendsProvidentInternationalLimited.
I confirm the Banker’s Draft/Telegraphic Transfer is to be paid for by debit of funds from my personal bank account. The details of
this account are:Sortcode(ifapplicable)* | | |
SWIFT/BICcode(ifapplicable)*
IBAN(ifapplicable)
Accountnumber
Accountcurrency
Accountname
Bank(nameandaddress)
Bank
Postcode(ifapplicable)
Payment Methods
XIM7/A 07.14 11
Section3:Declarations
Important Notes
1 Aspecimenpolicydocumentand/orcopyofthiscompletedformareavailableonrequest.
2 Youareadvisedtosatisfyyourself/selvesthat,underanytaxation,exchangecontrolorinsurancelegislationtowhichyoumaybesubject,youarepermittedtoeffectthepolicy.
3 Youshouldseekguidancefromyourusualfinancialadviserastothesuitabilityofthepolicytoyourownparticularcircumstances.
4 InformationwhichyouprovideinconnectionwiththisApplicationandanysubsequentPolicywillbeheld(whetherstoredelectronicallyorotherwise),usedordisclosedbyFriendsProvidentInternationaloranyassociatedcompanythatexistsfromtimetotime.Youhavetherighttoobtainaccesstoandtorequestacorrectionofanypersonalinformationaboutyou.RequestscanbemadetotheDataProtectionOfficeratRoyalCourt,Castletown,IsleofMan,BritishIslesIM91RA.
5 EachpolicyisgovernedbyandshallbeconstruedinaccordancewiththelawsoftheIsleofMan.
6 UnderlyingfundprospectusesareavailablefromFriendsProvidentInternationalonrequest.
7 SPECIALISTFUNDACKNOWLEDGEMENT
Weofferproductsthatprovideaccesstoawiderangeoffunds,knownasmirrorfunds,thatinvestinallthemajorassetclassesandgeographicregionsoftheword.Someofthesemirrorfundsinvestintofundswhichareclassedasspecialistfunds,aimedatprofessionalorexperiencedinvestors.Ifyouweretoinvestintosuchafunddirectly,asaseparateventurenotlinkedtothisApplicationandinsteadofusingoneofourmirrorfunds,youmayhavetodeclarethat:
• Youhavereadandunderstoodtheinformationsuppliestoyouandunderstandthenatureofanyrisksinvolved.
• Youhavediscussedwithyourfinancialadviserwhethersuchanassetisappropriatetoyourinvestmentportfolio.
• Youareeligibleandabletoinvestintothefundandhavethelevelofinvestmentknowledgeandexperiencerequiredbythefundmanager.
• Youmeetcertainminimumfinancialrequirements.
Ordinarilysomeofthesefundscouldonlybeheldbyprofessional/experiencedinvestorsratherthanretailinvestors.Also,informationrelatingtosuchinvestmentsmaynotbeavailablefordistributionincertainjurisdictions.However,whentheinvestmentismadethroughyourpolicy,wearetreatedastheprofessionalorexperiencedinvestorandthisenablespolicyholdersthatmaynothavebeenabletodoso,toaccessthesefunds.
Pleasenotethatdifferentjurisdictionsmayimposedifferentcriteriaonthegenerallyaccepteddefinitionofaprofessional/experiencedinvestor.Fulldefinitions,restrictionsandinvestorrequirementscanbefoundineachfund’sprospectus/termsandconditions,whichisavailablefromthefundmanageroryourfinancialadviser.Werecommendthatyouobtain,readandfullyunderstandacopyoftheprospectus/termsandconditionsforyourchoseninvestment.
Professional Investor Funds
AProfessionalInvestorFund(‘PIF’)isavailableonlytoprofessionalinvestorswhoaregenerallymarketprofessionals.OfteninvestorsarerequiredtohaveanetworthrequirementthatistypicallyinexcessofUSD1million.ThetypicalminimuminvestmentinaProfessionalInvestorFundisUSD100,000.Therearelimitedregulationscoveringformalcontentoffundliteratureanddocuments.Itisnotsubjecttoanyregulatoryrestrictionsonitsinvestmentandborrowingpowers.TheOfferingDocumentmustcontainsufficientinformationtoenableaninformedinvestmentdecisionandmustcontainriskwarnings.
Liquidity Information
Someofourfundsmayhaverestrictionontheirabilitytopayredemptionsduetothetypeofunderlyinginvestmenttheyhold.Thiscouldlimityourabilitytoraisecashfromthefundinthefuture.
Investinginfundsshouldbeconsideredalong-terminvestment.Youinconjunctionwithyourfinancialadviser,shouldconsidertheamountyouinvestviayourpolicyifitislikelythatyouwillneedaccesstoyourcapitalquicklyinthefuture.
Failure to disclose relevant information may delay the processing of your application
12XIM7/A 07.14
Declarations
AttentionisdrawntothefollowingDeclarations.IftheApplicationformrequestsinformationwhichhastobeassessedbytheCompanybeforeacceptance,thenyoumustdiscloseallfactswhicharematerial.Suchfactsarethosewhichaninsurerwouldregardaslikelytoinfluencetheassessmentandacceptanceofaproposal.Ifyouareindoubtastotherelevanceofanyparticularinformationyoushoulddiscloseit,asfailuretodosocouldresultinyoubeingquotedthewrongterms,aclaimbeingrejectedorreduced,orthepolicybeinginvalid.
1 FUNDACKNOWLEDGEMENT Beforeyouinvestinanyspecialistfundsthroughyourpolicy,FriendsProvidentInternationalwishestoensurethatyouareawareofthenatureandpossiblerisksassociatedwiththem.Wouldyouthereforepleasemakethefollowingdeclarations:
(i) IunderstandthatImaychoosetheinvestmenttowhichmypolicyistobelinked.
(ii) Iacknowledgethatitismyresponsibilitytoensurethatthefundissuitablebearinginmindmyinvestmentobjectivesandattitudetorisk.
(iii)IconfirmthatIunderstandcertainfundsmayhaverestrictionsontheirabilitytoraisecashinthefuture,andthatfurtherdetailsareincludedintheprospectustermsandconditions.fortherespectiveunderlyinginvestment.Iunderstandtherisksassociatedwithinvestingthesefunds.
(iv)IfIchoosetoinvestintomirrorfundswhichinturninvestintospecialistfundsaimedatprofessionalinvestors,Iacknowledgethatitismyresponsibilitytoobtain,readandunderstandtheunderlyingfund’sprospectus.
(v) IacknowledgethatFriendsProvidentInternationalisnotresponsiblefortheinvestmentperformanceoranylosssufferedorreductioninthevalueofmypolicyarisingfrommyinvestment.FriendsProvidentInternationaldoesnothaveanyresponsibilityfortheinvestmentmanagementoftheunderlyingfundandFriendsProvidentInternationaldoesnotapproveanyassetasasuitableinvestment.
(vi)IacknowledgethatthepurchaseofmyinvestmentsmaybedelayedifFriendsProvidentInternationalrequiresasigneddeclarationinrespectofmychoseninvestments.
(vii)Iacknowledgethespecificinvestorprotectionandcompensationschemethatmayexistinrelationtocollectiveinvestmentsanddepositaccountsareunlikelytoapplyintheeventoffailureofsuchaninvestmentheldwithininsurancepolicies.
2 GENERALDECLARATIONS
IdeclarethatthisApplicationwassignedin (country)
and the advice was given in(country)
IfurtherdeclarethatalltheinformationprovidedinthisApplicationForm,includingthisDeclaration,arecompleteandtrue,tothebestofmyknowledgeandbelief,alltheabovestatementsaretrue.Iagreethatthey,togetherwithanyotherstatementsmadetoamedicalexaminerintheeventofamedicalexaminationortotheCompany,noworinthefuture,shallformthebasisofthepolicyunderthelawsoftheIsleofMan.IhavereadandunderstoodalltheprintedmaterialsrelevanttothispolicyandIhaveacquaintedmyselfwiththemanagementchargesmadebyFriendsProvidentInternational.
IfurtherdeclarethatIunderstandandagreethatthepolicyshallnotbecomeeffectiveuntilitisissuedwiththefirstpremiumpaidinfullandallrequirementshavebeenmet.
IunderstandthatthisApplicationcanonlybeacceptedbyemployeesofFriendsProvidentInternationalLimitedsituatedattheCompany’sHeadOfficeintheIsleofManandthatnootheremployeesorthirdpartieshavethenecessaryauthoritytocreateabindingcontract.
Iamawarethatdeliberatetaxevasionisacriminaloffence.IamresponsibleformyowntaxaffairsandIherebydeclarethatIunderstandmypersonaltaxobligationsandresponsibilitiesandIhavecompliedwithalllegalrequirementstomakedeclarationstotaxauthoritiesandpaythetaxthatIowe.AsappropriateandnecessaryIhavetaken,orwilltake,legaladviceinrelationtomytaxaffairsandinparticular,mytaxobligationsastheyapplytothisApplication.
3 CANCELLATIONRIGHTS IfyouareresidentintheUK,orhavesignedthisApplicationformintheUK,youwillbeabletocancelyourinvestmentduringa30day
periodafterconcludingtheagreement.Youwillreceivearefundofpremiumlessadeductionforshortfalltoreflectanyfallinthemarketsintheinterim.Youwillbetoldofthisrightinmoredetail,includingwhenitbeginsorendsandhowtoexerciseit,indocumentsthatwewillsendyouattherelevanttime.
Failure to disclose relevant information may delay the processing of your application
13XIM7/A 07.14
4 DATAPROTECTION IagreethatanypersonalinformationcollectedorheldbyFriendsProvidentInternational(whethercontainedinthisApplicationor
otherwise)isprovidedandmaybeheld,usedordisclosedbyFriendsProvidentInternationalandtransferredbetweenitsofficesandothermembersoftheFriendsLifegroupofcompanieswherevertheyaresituated.IunderstandthatFriendsProvidentInternationalandothermembersoftheFriendsLifegroupwill:
(i) useandtransfertheinformationtoprofessionaladvisers,ITserviceproviders,financialadvisers,mailinghouses,agents,underwritersandreinsurersforthepurposesofadministration,underwriting,claims,researchorstatisticalpurposes.Suchprocessingissubjecttocontractualrestrictionsandappropriatesecuritystepstoprotecttheinformation;
(ii) communicatewithme,myindependentfinancialadviserandfundadviserwhetherdirectlyorindirectlyforanypurpose;and
(iii) tosupplythedetailsorprovideacopyoftheinformationtoanyfinancialservicescompanywherevertheyaresituatedtoenablethepurchaseofassetsrequestedtobelinkedtothepolicy;
(iv) transferinformationtomirrorregulatorybodiesorauthorities,forexampletheInsuranceandPensionsAuthority,theUnitedArabEmiratesInsuranceAuthority,theUSInternalRevenueServiceandothertaxauthoritiestoenablethemtocarryouttheirregulatoryandstatutoryfunctions;and
(v) discloseinformationtothirdpartiesinordertocomplywithanti-moneylaunderinglawsandforotherpurposessuchasthepreventionofcrimeordetectionoffraud,enablingassetstoberightfullyclaimedorwhererequiredbylaworregulation.
BysigningthisformIconsenttothisuseofmypersonaldata.
IunderstandthatFriendsProvidentInternationalwouldliketokeepmeinformedaboutotherproductsandservicesprovidedbycompanieswithintheFriendsLifegroupandothercarefullyselectedorganisations.
Idonotwishyoutocontactmeby: First(oronly)Applicant SecondApplicant
Post Phone Email Post Phone Email
YoumaychangeyourmindatanytimebywritingtotheDataProtectionOfficer,RoyalCourt,Castletown,IsleofMan,BritishIsles,IM91RA.Otherwisewewillassumethatyouarehappytobecontactedinthiswayuntilinstructedotherwise.
5 WITHHOLDINGTAX/PREMIUMTAX
Iacknowledgethatintheeventofanypremiumtaxorwithholdingtaxbeingleviedinmy/ourcountryofresidenceitwillbethemyresponsibilitytoincreasethepremiumbyanamountequaltotheliabilityortosettletheliabilitydirectlywiththerelevanttaxauthorities.
6 IacknowledgethatFriendsProvidentInternationalandmyfinancialadviserhaveenteredintoanagreement(‘termsofbusiness’)whichsetsoutthebasisuponwhichFriendsProvidentInternationalispreparedtoacceptApplicationssubmittedbythefinancialadviseronmybehalf.Thisagreementcategoricallystatesthatthefinancialadviseractsasmyagent,andnottheagentofFriendsProvidentInternational.
Iacknowledgethatmyfinancialadviser,oranyother,hasnoauthoritytoactastheagentofFriendsProvidentInternationalortostate,
suggestorimplythatithassuchauthority.IacknowledgeandauthorisemyfinancialadvisertoberemuneratedforitsservicesbybrokeragecommissionfromFriendsProvidentInternational.
Signature(s) First (or only) Applicant Second Applicant
Signature Signature
Date Date
14 XIM7/A 07.14
Failure to disclose relevant information may delay the processing of your application
15XIM7/A 07.14
BankInstructionLetter(non-FarEastterritories) *Deleteasappropriate
Please note that some banks insist that their own Bank Instruction form is used, so you should check with your bank that they will accept this document.
ThislettershouldbereturnedwithyourApplicationForm.
PleaseuseBLOCKCAPITALS.
NameandfullpostaladdressofyourBank
To:TheManager Bank
Address
Postcode(ifapplicable)
AccountNumber SortCode(ifapplicable)
|
|
|AccountCurrency(mustbecompletediftheaccountismulti-currency) SWIFT/BICCode(ifapplicable)
AccountHolder’sName IBAN(ifapplicable)
Section A – Telegraphic Transfers
DearSir,
OnmybehalfwouldyoupleaseprepareaTelegraphicTransferandcarryoutthetransactionindicatedwithin48hoursofyoureceivingthis
instruction.
IfremittingSterlingfromaUK/ChannelIslandorIsleofManbankaccount,sendthepaymentbyCHAPSdirecttotheIsleofManBank
Limited,EastRegion,Douglas,SortCode60-95-45.Forallothercurrencies,pleaseremitaSWIFTPaymentOrderdirecttoIsleofManBank
Limited,SWIFTCodeRBOSIMD2,IBAN:GB48RBOS60954540038485.ThebeneficiaryaccountnameisFriends Provident International
Limited andthebeneficiaryaccountnumberisshownbelow.
Sterling,USDollarandEuroTransfer–AccountNo.9545-40038485
Thereferencenumberbelow(seeSectionB)mustbequotedbytheBankonalladvices.
GBP/USD/EUR/Other* (figures)
GBP/USD/EUR/Other* (words)
Pleasechargetheamountofthepaymenttogether with any bank and agent bank’s charges tomyaccount.
Yoursfaithfully,
Signature(s) Signature
Date
Signature
Date
MyAddress
Section B (tobecompletedbyFriendsProvidentInternationalLimited)
ThisReferenceNumbermustbequotedbytheBankonalladvices(tobecompletedbyFriendsProvidentInternationalLimited).
Failure to disclose relevant information may delay the processing of your application
16 XIM7/A 07.1416
XIM7/A 07.14
Failure to disclose relevant information may delay the processing of your application
17
Applicable to Applicants with bank accounts in the Far East.
Please note that some banks insist that their own Bank Instruction form is used, so you should check with your bank that they will accept this document.
ThislettershouldbereturnedwithyourApplicationForm.
PleaseuseBLOCKCAPITALS.
NameandfullpostaladdressofyourBank
To:TheManager Bank
Address
Postcode(ifapplicable)
AccountNumber SortCode(ifapplicable)
|
|
|AccountCurrency(mustbecompletediftheaccountismulti-currency) SWIFT/BICCode(ifapplicable)
AccountHolder’sName IBAN(ifapplicable)
Section A – Telegraphic Transfers
DearSir,
OnmybehalfwouldyoupleaseprepareaTelegraphicTransferandcarryoutthetransactionindicatedwithin48hoursofyoureceivingthis
instruction.
PleaseremittoHSBCLimited,1Queen’sRoad,Central,POBox64,HongKong,SWIFT CodeHSBCHKHH,forcredittoFriends Provident
International Limited andthebeneficiaryaccountnumbershownbelow.
USDollarTransfer–AccountNo.511-667685-201
SterlingTransfer–AccountNo.511-667685-202
EuroTransfer–AccountNo.511-667685-220.
HKDollarTransfer–AccountNo.511-667685-001
Thereferencenumberbelow(seeSectionB)mustbequotedbytheBankonalladvices.
USD/GBP/EUR/HKD* (figures)
USD/GBP/EUR/HKD* (words)
Pleasechargetheamountofthepaymenttogether with any bank and agent bank’s charges tomyaccount.
Yoursfaithfully,
Signature(s) Signature
Date
Signature
Date
MyAddress
Section B
ThisReferenceNumbermustbequotedbytheBankonalladvices(tobecompletedbyFriendsProvidentInternationalLimited)
BankInstructionLetter(FarEastbankaccountsonly) *Deleteasappropriate
What you need to provide
Step 3 Authentification of documents by a suitable certifier (for each Applicant)
18 XIM7/A 07.1418
What you need to provideVerification of identity and address
We have a legal obligation to verify the identity and residential address of each person who will apply for one of our
products.Wealsohavearegulatoryobligationtoobtaindetailsofhowtheapplicant(s)has/haveacquiredthemonies/
assetsthattheywillinvestwithus.
Therearegoodreasonsfordoingthis.Criminalsandterroristsoftentrytolaundermoneybyusingfalseorstolen
identitiesinordertoopenaccountsorplaceinvestmentswithfinancialinstitutionssuchasFriendsProvidentInternational
Limited.Byprovidingtheinformationanddocumentsrequested,youarenotonlyhelpingtheCompanytocomplywith
stringentmoneylaunderinglegislation,butyouarehelpingtoprotectyourownidentity.
Therequireddocumentstoverifyidentityare:
• APassport;or
• AGovernment-issuedIdentityCard(carryingaphotographoftheindividual).
WhereitisnotpossibletoobtaineitheraPassportoraNationalIdentityCard,twootherformalgovernment-issued
documentscarryingappropriatepersonaldetails,whichshowverifiablereferencenumbers,maybeaccepted.Examples
would include:
• DrivingLicensewithphotograph
• AnnualTaxAssessmentissuedbytheTaxAuthorities
• AGovernment-issueddocumentcontainingauniquereferencenumberwhichisspecifictoeachApplicant.
Thesedocumentsmustbecertified(pleaserefertoSTEP3).
Step 1Verify the identity of each Applicant
Step 2Verify the address of each Applicant
Wewillalsorequireanoriginalorcertifiedcopyofadocument,toverifyeachApplicant’sresidentialaddress(pleaserefer
to STEP3).Alistofthedocumentsthatareacceptableforthispurposeisprovidedbelow.
ThedocumentmustbeissuedinthenameoftheApplicantandshowtheresidentialaddressthatappearsonthe
applicationform.Inallcasesthedocumentsseenshouldbethemostrecentavailable,andnoolderthan3months,unless
thedocumentusedtoverifyaddressisonlyissuedonanannualbasis.
• UtilityBill,(water,Gas,electricity,landlinetelephoneconnection)RatesInvoice,counciltaxnotification
Please note, mobile telephone bills, cable TV bills and Internet service provider’s bills are not acceptable as
evidence of address
• Currentdrivinglicensewithphotograph
• Taxassessmentdocument
• ExtractfromtheofficialRegistrarofElectors
• BankAccountstatement
Please note, statements of credit cards and non-bank cards, such as store cards, are not acceptable
• Statepension,benefitorothergovernment-produceddocumentshowingbenefitentitlements
• LetterfromtheApplicant’semployer,confirmingtheirresidentialaddressandthepolicyholder’spositionwithinthe
company.WheretheApplicanthasaccompaniedapartnerorspouseonaworkassignmentorcontract,andthey
arealsoanApplicant,anemployermayconfirmtheaddressofanon-employeewherearelationshipisdetailed.If
theapplicant(orspouse)istheowner/partownerofthecompanyaletterfromthecompanywillnotbeaccepted.
• Proofofownershiporrentaloftheresidentialaddress
• Mortgagestatement.
Thesedocumentsmustbecertified(pleaserefertoSTEP3).
XIM7/A 07.14
What you need to provide19
Step 4Step 3Authenticationofdocumentsbyasuitablecertifier(foreachApplicant)
Background
Incorrectcertificationofdocumentsisoneofthemainreasonsfordelaysinprocessingapplications.TheIsleofMan
InsuranceandPensionsAuthority,ourprincipalregulator,isveryspecificabouthowdocumentsaretobecertified,and
whocanperformthisfunction.
Certificationofcopydocuments
The certifier must state on the document:
‘I certify that this is a complete and accurate copy of the original documentation that I have seen...’
Signed: (the signature of the certifier)
Name: (the printed name of the certifier)
Position/Capacity: (the position or capacity of the certifier)
Date: (the date of certification)
Impropercertificationcouldleadtodelays.
Ifthedocumentismorethanonepage,thecertifiercaneither:
• certifyeachpageindividuallyor,
• certifythetoppageandaddastatementdetailingthenumberofpagesoftheoriginaldocumentationseen.
Who can certify a copy of an original document?
The adviser you have appointed
Who has recommended this product to you
A notary public, licensed lawyer or solicitor
Anotarypublicisapublicofficerappointedunderauthorityofstatelawwithpowertoadministeroaths,certifyaffidavits,
takeacknowledgementsandtakedepositionsortestimony.
An authorised representative of an embassy or consulate ofthecountrythatissuedtheidentificationdocuments.
Translation of documents not written in English
WhereadocumentsubmittedforaddressverificationisnotwritteninEnglish,werequirethecertifiertoexplainonthe
document:
• What the document is
• Indicatewheretheapplicant’snameandaddressisprinted
• The certifier should also write a statement onto the document to the effect that:
‘I certify that the address stated on this document is a true translation of the English address written on the
application form…’
Signed: (the signature of the certifier)
Name: (the printed name of the certifier)
Position/Capacity : (the position or capacity of the certifier)
Date: (the date of certification)
What you need to provide20 XIM7/A 07.14
Step 4 Source of wealth
Background
IsleofManauthorisedlifecompaniesarerequiredbytheInsuranceandPensionsAuthoritytomakeenquiriesastohow
aclientapplyingforoneofourproductshasacquiredthemoniesthatwillbeinvested.ThisSourceofwealthinformation
isanintegralpartoftheoverall‘KnowYourClient’(KYC)requirementsthatwemustperform.Itisalsoalegal,aswell
asaregulatoryrequirement,toperformarisk-basedassessmentoftheapplicantandconductenhancedduediligence
wherehigherriskcircumstancesareidentified.Thismeansthatincertaincircumstancesindependentevidencewill
berequiredtosupporttheexplanationoftheclient’sSourceofwealth.Incorrectcertificationofdocumentsisoneof
themainreasonsfordelaysinprocessingapplications.TheIsleofManInsuranceandPensionsAuthority,ourprincipal
regulator,isveryspecificabouthowdocumentsaretobecertified,andwhocanperformthisfunction.
Information to be provided
Onpages6,7and8ofthisapplicationform,youshouldclearlyexplainhowyouhaveacquiredthewealththatyouwill
usetopaypremiums.
Supporting documentation to evidence Source of wealth
FriendsProvidentInternationalusesboththepremiumsizeandyourresidentiallocationtoidentifywhenapplications
requiredocumentaryevidence.Evidencewillberequiredwherethepremiumisonorabovethelimits.
Premiumlevelsandcountryriskratingsaresubjecttoalterationandforthatreasonyouwillneedtorefertothepremium
limitstablepublishedonthecompany’swebsite.ItisavailableinPDFformatonourwebsite.
Youwillneedtocombinethepremiumlevelsindicatedinthepremiumlimitstablewiththeriskratingofyourcountryof
residence(orcountrywherewealthisgenerated),todeterminewhetherevidentialsupportshouldbesubmittedwiththis
application.Weneeddocumentaryevidenceeachtimeapremiummovesthetotalcumulativepremiumon,orhigher,
thanthepremiumlimitsallocatedtotheparticularcountryrisk.Yourfinancialadviser,whohasrecommendedthisproduct
toyou,willbeabletohelpandadviseyouwiththis.
Important note to the introducing intermediary: ALL COPIES of original documentation must be properly certified by
you,theintroducingintermediary,inthesamemannerasyouwouldcertifyclientidentitydocumentationandresidential
addressproof.
Trust applications
Wherethepaymentismadebythetrustees,thesamesourceofwealthinformationasaboveshouldbeprovidedforthe
settlorandsettledmonies.
Important InformationThe information given in this document is based on Friends
ProvidentInternationalLimited’sunderstandingofcurrentIsleof
Manlawandtaxationpractice,whichmaychangeinthefuture.No
liabilitycanbeacceptedforanypersonaltaxconsequencesofthis
schemeorfortheeffectoffuturetaxorlegislativechanges.
Investmentinvolvesrisk.Pastperformanceshouldnotbeviewedas
areliableguideoffutureperformance.Fundpricesmaygoupand
downdependinguponunderlyinginvestmentperformance,andthe
valueofyourinvestmentcannotbeguaranteed.Investmentsheld
within a fund may not be denominated in the currency of that fund
and the value of those assets can go up and down simply because
ofmovementsincurrencyexchangerates.Allfundperformance
quotedisnetofannualcharges.Youmaygetbacklessthanyou
paidin.
Prospectiveinvestorsshouldconsultwiththeirfinancialadviser
beforeenteringintoapolicyofthisnature.
The product is intended for medium to long-term investment and is
notthereforedesignedforearlycash-in.Anearlycash-inchargemay
beapplied.
AllpolicyholdersareprotectedbytheLifeAssurance(Compensation
ofPolicyholders)Regulation1991oftheIsleofMan,wherevertheir
placeofresidence.
Investorsshouldbeawarethatspecificinvestorprotectionand
compensationschemesthatmayexistinrelationtocollective
investmentsanddepositsaccountsareunlikelytoapplyintheevent
offailureofsuchaninvestmentheldwithininsurancecontracts.
ComplaintswecannotsettlecanbereferredtotheFinancial
ServicesOmbudsmanSchemefortheIsleofMan.
SometelephonecommunicationswiththeCompanyarerecorded
andmayberandomlymonitoredorinterrupted.
EachPolicyisgovernedbyandshallbeconstruedinaccordance
withthelawsoftheIsleofMan.However,thiswillnotprecludethe
righttobringlegalactioninaHongKongcourt.Ifyoueffectapolicy
whilstresidentintheUnitedArabEmirates,alldisputesregarding
thepolicyshallbesubjecttothenon-exclusivejurisdictionofthe
courtsoftheUnitedArabEmirates.
Copyright©2014FriendsProvidentInternationalLimited.
Allrightsreserved.
XIM7/A07.14(43766)
Friends Provident International Limited
Registered & Head Office: Royal Court, Castletown, Isle of Man, British Isles, IM9 1RA Telephone: +44(0) 1624 821212 Fax: +44(0) 1624 824405Website: www.fpinternational.com
Incorporated company limited by shares Registered in the Isle of Man No. 11494Authorised by the Isle of Man Insurance & Pensions AuthorityProvider of life assurance and investment products
Authorised by the Office of the Commissioner of Insurance to conduct long-term insurance business in Hong Kong
Registered in the United Arab Emirates as an insurance company (Registration No.76) and as a foreign company (Registration No. 2013)Authorised by the United Arab Emirates Insurance Authority to conduct life insurance and savings business
Registered in Singapore No. F06835GRegistered by the Monetary Authority of Singapore to conduct life insurance business in Singapore