EVOLUTION - Utmost Wealth Docs

E VO LU T I O NA p p L I c AT I O N f O r m f O r c O r p O r AT E A p p L I c A N T s

complete this form using blue or black ink and BLOCK CAPITALS. If you make a mistake, cross it out, put in the correct words and sign your initials next to the correction. Do not use correction fluid.

Once completed, arrange for your financial adviser to return this form and any supporting documents to: Utmost Limited, Royalty House, Walpole Avenue, Douglas, Isle of Man, IM1 2SL, British Isles.

for help completing this form, refer to our Guide for Evolution Corporate Applicants.

pAgE sEcTION rEqUIrEmENTTIck sEcTION cOmpLETEd

Applicant and Policy details

2 A — policy details mandatory

2 B — politically Exposed persons details mandatory

3 c — corporate applicant details mandatory

9 d — Life assured details Optional

9 E — premium details mandatory

10 f — regular withdrawals Optional

11 g — Adviser charging Optional

12 H — source of wealth mandatory

14 I — Identification requirements Mandatory*

16 J — Introducer’s details Mandatory*

17 k — Investment optionsIt is mandatory for you to complete at least one of these sections.

17 L — funds, cash deposits & dealing Account

19 m — Nomination of Emc

Declarations 20m3 — Applicant investment terms

declarationmandatory if section m is completed

22 m4 — platform Adviser declaration mandatory if a platform is nominated

24 N — standard applicant declaration mandatory

*Financial adviser to complete.

Ensure that all relevant sections of this application are completed before submitting.

Utmost Wealth solutions is a trading name used by a number of Utmost companies. Utmost Trustee solutions is the trading name used by Utmost Trustee solutions Limited. This item has been issued by Utmost Limited.

The following companies are registered in the Isle of man: Utmost Limited (No 056473c), Utmost Administration Limited (No 109218c) and Utmost Trustee solutions Limited (No 106739c) which are regulated or licensed by the Isle of man financial services Authority. Utmost services Limited (No 059248c) is an appointed representative of Utmost Limited. Each has its registered office at: royalty House, Walpole Avenue, douglas, Isle of man, Im1 2sL, British Isles. Utmost Limited is authorised in the Uk by the financial conduct Authority (160418).

Utmost panEurope dac (No 311420), trading as Utmost Wealth solutions, is regulated by the central Bank of Ireland. Its registered office is Navan Business park, Athlumney, Navan, co. meath c15 ccW8, Ireland.

Where required, all promotional material has been approved by Utmost Limited which is authorised in the Uk by the financial conduct Authority.

IOm pr 0085/13.08.2020

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1 Type of contract Life Assurance capital redemption

2 Provide a copy of the Personal Illustration that you have been given or enter your Personal Illustration reference number here

A p O L I c y d E TA I L s

B p O L I T I c A L Ly E x p O s E d p E r s O N s d E TA I L s

refer to the Guide for Evolution Corporate applicants for a definition of ‘politically Exposed persons’.

Once your bond is established you cannot change the bond’s currency.

3 Welcome Team Case ID reference

If the Welcome team produced a personal Illustration for you, a case Id can be found at the top of page one.

Under our current anti-money laundering obligations we are required to identify persons associated with this application who could be classed as a politically Exposed person (pEp). A pEp is a term used to describe someone who is currently, or has previously been, entrusted with prominent public functions or responsibilities, for example: a Head of state, a holder of a senior political or government post, a senior member of the Judiciary or the military, a senior employee of a state Owned corporation, or a board member of a central Bank. Immediate family members or close associates of a pEp should be considered a pEp in their own right.

provide details in the box below of any persons that could be considered a pEp (as defined above) in relation to this application. Non-completion confirms that there are no associated pEps:

mANdATOry

section d does not need completing if capital redemption is chosen.

4 Utmost’s Product Management Charge What is your chosen flex-charge option?

full initial charge full ongoing charge

*If you choose a combination of initial and ongoing product management charge, enter your

chosen combination to a maximum of 3 decimal places:

% Initial % Ongoing (per annum)

5 Currency of bond sterling Us dollar Euro

6 Number of segments If you do not specify the number of segments the bond will automatically default to the maximum

available for the investment amount.

The number of segments available is subject to a minimum investment of £500 in each. The maximum number of segments available is 9,999.

mANdATOry

OR OR

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A p p L I c AT I O N f O r m f O r c O r p O r AT E A p p L I c A N T s

E V O L U T I O N

combination of initial and ongoing*

1 company name

2 company registration number

3 registered address (pO Boxes and ‘care of’ addresses are not acceptable)

postcode —

4 state the jurisdiction in which the company is liable for tax

5 full correspondence addressIf your correspondence address is the same as your residential address, tick here

postcode—

6 If the correspondence address is different from the registered address, give a reason

c c O r p O r AT E A p p L I c A N T d E TA I L s

7 Is this investment in respect of employee benefits?

yes No

8 Is the company an investment company controlled by persons residing in the Uk?

yes No

9 Is the company a trading company?If yes, state its main business

yes No

12 Has the company been established or owned by a government department, political party, Local council Authority, Trade Union or state Owned Industry?If yes, give description.

yes No

11 Is the company quoted on a recognised stock exchange?

yes No

If yes, which one?

for this purpose, a holding company or a collective investment scheme is not an investment company.

refer to our separate document entitled ‘politically Exposed persons’ which is available from your financial adviser who can obtain this on our website www.utmostwealth.com

10 Is the company in the process of being dissolved, struck off, wound up or terminated?

yes No

mANdATOry

273 |


E V O L U T I O N

E N T I T y c L A s s I f I c AT I O N

In the below section, you must populate the status of the entity for fATcA and crs by ticking the relevant box against one of the categories listed below. Ensure that you provide a status for both fATcA and crs which could be same, but they may be different.

If you require clarification with regards to any of the entities, refer to our Tax Information Exchange Pack for Entities or contact our Welcome team on +44 (0) 1624 653 251.

1 If you are a direct reporting passive NffE for fATcA you will also need to complete a gIIN below. This status will not apply unless you have registered as such.

2 If the entity is registered deemed compliant then a gIIN would be expected. If the entity is certified deemed compliant, or owner documented, then no gIIN is required for fATcA but, dependent on your categorisation for crs, you may still need to supply a tax reference number.

Ref No

Entity Classification FATCA CRS

1 passive Non-financial foreign Entity (fATcA)1 passive Non-financial Entity (crs)

2 Active Non-financial foreign Entity (fATcA) Active Non-financial Entity (crs) If you have ticked that the entity is an Active NFE please also tick one of the boxes (2.1-2.6) below

2.1 A corporation, the stock of which is regularly traded on one or more established securities markets

2.2 Any corporation that is a related Entity of a corporation described in 2.1

2.3 A government Entity

2.4 A central Bank

2.5 An international Organisation

2.6 Other

3 crs financial Institution or a partner Jurisdiction financial Institution under fATcA (including an investment entity or a ‘managed’ investment entity, such as a professionally managed trust)

4 deemed compliant foreign financial Institution2

5 Exempt Beneficial Owner

6 financial Institution resident in the Us or in a Us Territory

7 Non-participating foreign financial Institution

8 participating foreign financial Institution

9 A specified Us person

10 Non-reporting crs financial Institution, which would include Broad and Narrow participation retirement funds, Trustee documented Trust or other entity under domestic law as low risk of being used to evade tax.

provide us with your company entity tax identification number:

— — —

11 for financial Institutions, including Investment Entities, managed Investment Entities and Trustee documented Trusts, provide the global Intermediary Identification Number (gIIN) here.

provide gIIN below

— — —

sponsor Entity gIIN (where applicable)

12 for other entities provide the tax reference number for the entity here

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E V O L U T I O N

Authorised signatorySIGNATURE

print full name

date d d m m y y y y

The self-certification for any entity must be signed by the person(s) with authority to sign on behalf of that entity. for example, director(s) or authorised signatories.

The Applicant declares that the information provided is to the best of my knowledge and belief, accurate and complete.

The Applicant understands and agrees that the information provided to Utmost Limited may be shared with the Isle of man government in accordance with various exchange agreements, including fATcA and the crs.

The Applicant agrees to inform Utmost Limited immediately should any information provided change, and understands that the Applicant is obliged to do so.

E N T I T y d E c L A r AT I O N

Only one controlling party is required to sign.

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E V O L U T I O N

c O m p A N y d I r E c T O r s

List all the current directors of the company (continue as necessary on a separate sheet).

Full name Date of birth

1 d d m m y y y y

2 d d m m y y y y

3 d d m m y y y y

4 d d m m y y y y

4 maiden name, previous names or aliases (if applicable)

5 forenames (in full)

6 permanent residential address (pO Boxes and ‘care of’ addresses are not acceptable)

postcode — —

7 Nationality

8 date of birth d d m m y y y y d d m m y y y y

from the list above, supply the details of two directors, including at least one executive director, and provide suitable verification of identity and residential address.

11 Would you like to be provided with login credentials to view your policy online at utmostwealth.com?

yes yesIf so, provide a unique personal code

Executive Director Director

1 Title (mr, mrs, miss or Other)

2 gender male female male female

12 country/countries of Tax residency

10 Email address

Your personal code must be something memorable as it will be required when you first receive your login credentials.

A personal code can be made up of a mixture of letters, numbers and symbols with a minimum of 4 characters, maximum of 13. personal codes are case sensitive.

Login credentials will only be sent (to your email address above) once your policy is in force and policy documentation sent.

3 surname

9 country of birth

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E V O L U T I O N

s H A r E H O L d E r s

for private companies, provide details of all shareholders holding 25% or more of the issued share capital at the date of the application.

Shareholder 1 Shareholder 2

1 percentage share % %



4 surname

5 maiden name, previous name or any aliases (if applicable)



postcode — —

8 Nationality


10 country of birth


ONLy complete this section if you are a Uk tax resident.

ONLy complete this section if you are a Us tax resident.

If there is a corporate shareholder or any of the shares are held within a Trust contact our Welcome Team on +44 (0)1624 653 251.



ONLy complete this section if you are NOT a Uk or Us tax resident.


13 National Insurance (NI) number

14 Us Tax Identification Number (T.I.N)

15 Other tax reference number(s)

L L — N N — N N — N N — L L L — N N — N N — N N — L

N N N — N N — N N N N N N N — N N — N N N N






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E V O L U T I O N

proof of identity and verification of address will be required for the above named shareholders. The required documents are outlined in section I of this application. further details of these requirements are available from us or on our website www.utmostwealth.com.

Shareholder 3 Shareholder 4

1 percentage share % %



4 surname




postcode — —

8 Nationality


10 country of birth










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E V O L U T I O N

Life Assured 1 Life Assured 2



3 surname




postcode — —

7 Nationality


9 country of birth

10 relationship to applicant(s)

The completion of this section is not required if you applying on a capital redemption basis.

d L I f E A s s U r E d d E TA I L s

If there are more than two lives assured (up to a maximum of six), photocopy this section, complete all the details for the lives assured and attach securely to the form.

OpTIONAL

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E V O L U T I O N

E p r E m I U m d E TA I L s mANdATOry

Address royal Bank of scotland International Limited, floor 2, 2 Athol street, douglas, Isle of man, Im99 1AN, British Isles.

Swift code rBOsImdx

Sort code 16-58-80

Account number 58098652

Account name Utmost Limited, premium collection Account.

IBAN gB58rBOs16588058098652

Payment reference [client name / proposal number]

O U r B A N k d E TA I L s

Total premium (monetary amount)

We will deduct any charges you have specified from the premium amount stated here. refer to the Guide for Evolution Corporate Applicants or speak to your financial adviser for more details.

How would you like to pay cheque BAcs cHApsyour bank may charge depending on the payment method chosen.

cheques can only be accepted for sterling payments. cheques must be made payable to Utmost Limited. please ensure that the company name is clearly referenced.

Example:Utmost Limited re: Example client

£/US $/€*

Telegraphic Transfer

Payment should only be transferred once the application has been received and we have confirmed that all requirements have been met.

*delete as applicable.

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E V O L U T I O N

Complete this section if you wish to set up regular withdrawals from the start of your bond.

regular withdrawals will be taken equally across all policy segments.

minimum £200 per payment (or currency equivalent). payments will only be made in the currency of the bond.

payment method will be BAcs transfer for sterling payments to Uk clearing banks only or telegraphic transfer for other currencies or for payments to banks outside of the Uk. A charge will be levied by our bankers for telegraphic transfer payments which will be deducted from the value of the bond.

The annual percentage/monetary amount specified will be divided by the frequency you specify.

1 Amount of withdrawal (per annum)

2 frequency of withdrawals

3 payment start date

or

d d m m y y y y

yearlyquarterly

Annual percentage of premium

f r E g U L A r W I T H d r AWA L s

Annual monetary amount

As soon as possible (30 days after inception)

OpTIONAL

%

monthly Half-yearly

payments to third parties are only considered in exceptional circumstances. If you have any questions regarding payments to third parties contact our Welcome Team on +44 (0)1624 653 251.

d E TA I L s O f T H E A c c O U N T T H AT W I T H d r A W A L s W I L L B E s E N T T O :

1 Account name

2 Account number (for BAcs payments this

must be 8 digits)

3 Bank sort code — — (must be 6 digits)

4 Building society roll number (if applicable)

5 Bank BIc/swift code (required for all banks outside the Uk)

6 IBAN

7 Bank/Building society name

8 Address

9 postcode —

10 Telephone number (including international

dialling code)

11 How long has the account been held? years

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E V O L U T I O N

g A d V I s E r c H A r g I N g OpTIONAL

Tick one of the following payment options:

1 Outside of the bond - the payment will be made prior to the capital being invested.

OR

Inside of the bond - the payment will be made after the capital has been invested.

2a specify the amount as either a monetary figure or a percentage value:

monetary amount (£/Us$/€) % of premium

. or %

2b does the initial adviser charge attract VAT? yes

This amount should be specified excluding VAT.

I N I T I A L A d V I s E r c H A r g E

complete this section if you would like us to facilitate an initial adviser charge and/or ongoing adviser charge payments to your financial adviser.

for detailed information about adviser charges and how these may be applicable to you see the Guide to Charges available on our website www.utmostwealth.com or from your financial adviser on request.

To set up an investment adviser charge you will need to complete the separate Nomination of Investment Adviser form.

1 frequency of payments

2 specify the total annual amount as either a monetary figure or a percentage of the bond value

3 Ongoing adviser charge start date d d m m y y y y

As soon as possible(30 days after inception)

4 does the ongoing adviser charge attract VAT? yes

Annual monetary amount (£/Us$/€) Annual % of bond value

. or %

O N g O I N g A d V I s E r c H A r g E

state the total percentage of bond value or monetary amount you wish to pay per year. for example, if you wish to pay 0.1% payable on a half-yearly basis, the annual amount you should state here is 0.2%. Alternatively, if you wish to pay £500 on a half-yearly basis, the annual amount you should state is £1,000.

complete this section if you would like to make regular payments to your financial adviser for ongoing advice.

yearlyquarterlymonthly Half-yearly

The taxation of bonds held by corporate entities is a complex matter. The tax treatment will depend on the basis upon which the entity declares its annual accounts. Utmost Limited is unable to provide advice in this regard and accepts no responsibility if adverse tax consequences result from the application of adviser charges to the bond.

(If yes, this will be applied in addition to that stated in question 2a of this section)

(If yes, this will be applied in addition to that stated in question 2a of this section)

sOUrcE(s) TIck BOx %

maturing investments or policy claims

share sale

property sale

company sale or sale of interest in the company

Loan

compensation payment

company profits (trading companies only)

Other sources

H s O U r c E O f W E A LT H

you should tick all appropriate boxes and enter the percentage from each, then answer the relevant questions on the following pages. Note, more than one source may be applicable. you may wish to use a separate sheet of paper.

All investments are assessed on a case by case basis; depending on the answers provided in this application we may request independent evidence of source of wealth. We are able to accept scanned copies of source of wealth evidence.

provide as much details as possible, if it is unclear how the money was accumulated, we will request further information.

The bond will not be issued until the information is received and a satisfactory risk assessment is completed.

sOUrcE INfOrmATION

Provide details in regard to the source of your investment in accordance with the table below.

1

2

3

4

5

6

7

8

Where have the funds for this investment been held since receipt?

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E V O L U T I O N

mANdATOry

s O U r c E (s ) I N f O r m AT I O N T O B E p r O V I d E d

Maturing investments or policy claims 1 Name of company the proceeds came from2 How long the investment/policy was held3 Amount received4 date proceeds were received

Share sale 1 What shares were held2 Amount of sale proceeds3 How they were sold (bank, stockbroker etc.)4 Their address inc. postcode (bank, stockbroker etc.)5 date shares were sold6 How long the shares were held

Property sale 1 Address of property sold (inc. postcode)2 Amount received by beneficial owner3 date of purchase4 date of sale

Company sale or the sale of interest in the company

1 Name and address of the company (inc. postcode)2 company registration number3 Nature of the company’s business4 Amount of sale proceeds5 Amount received by beneficial owner6 date amount received

Loan 1 Why the loan was required2 Loan amount3 date of the loan4 Who provided the loan5 Name and address of provider

Compensation payment 1 Name of payer2 Amount received by company or beneficial owner3 date amount received4 reason for payment

Company profits (trading companies only)

1 Attach a certified copy of the latest available annual report and accounts; or2 A letter from a regulated accountant giving details of company profits over

the last two years.

Other sources 1 Type of income2 Amount received3 date received 4 details of where the income came from5 frequency of income

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E V O L U T I O N

2714 |


E V O L U T I O N

p A r T 1 p E r s O N A L I d E N T I T y

I I d E N T I f I c AT I O N r E q U I r E m E N T s

Where the applicant does not hold an item from part 1, indicate why in the box below and supply a second document from part 2.

Under Isle of man Anti-money Laundering regulations we are required to verify the identity and address of all applicant(s) related to a contract. refer to our Anti-Money Laundering and Source of Wealth Pack for more information.

Below you will find the standard minimum requirements. In some circumstances we may request additional information.

for director(s) and shareholder(s) we require one suitably certified document from Part 1, together with one suitably certified document from Part 2.

for verification of the company see Part 3. All documentation in this section must be supplied.

Executive Director Director Shareholder 1* Shareholder 2*

1 Valid passport

2 National Identity card(with photograph)

p A r T 2 V E r I f I c AT I O N O f A d d r E s s

mANdATOry

Executive Director Director Shareholder 1* Shareholder 2*

1 A recent utility bill dated and certified within the last 3 months

2 A recent mortgage statement, giving the residential address

3 A current driving licence

4 A state pension, benefit or other government produced document showing benefit entitlement

5 A recent tax assessment document

6 rates or council tax billdated and certified within the last year

7 An account statement from bank or bank credit card dated and certified within the last 3 months

mobile phone bills, store cards and online statements are not acceptable.

*We will require identification verification for individual shareholders that hold 25% or more of the issued share capital.

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E V O L U T I O N

(Ensure that any separate list quotes the name of the applicants and is signed by the certifier)

p A r T 3 c O r p O r AT E V E r I f I c AT I O N

s U p p Ly A L L O f T H E f O L L O W I N g d O c U m E N T s

A certificate of Incorporation, company memorandum and Articles of Association

Evidence of the registered office

A set of the latest annual reports and accounts

An authorised signatory list

A certified copy of the Board resolution appointing the authorised signatories

If there are other parties to the application not quoted on the form, have you enclosed a list of copy evidence submitted and can you confirm that you have seen the originals of such evidence?

yes

The following declaration must be fully completed in all cases, this method of certification is required for Isle of man regulatory purposes.

I confirm that I have had sight of the original documents and all documents enclosed are true copies of the originals. yes

2716 |


E V O L U T I O N

1 How and when were you introduced to the company?

2 Is the company acting as a nominee for someone else?

yes No

(If yes, give details)

3 Which country was the advice leading to this application given in?

4 Which country was this application signed in?

5 The basis on which the advice was offered is (Uk advisers only)

Independent restricted

6 Name of regulatory body

7 regulatory body membership number e.g. fcA number

8 print full name

9 certifier and authorised signatory

J I N T r O d U c E r ’ s d E TA I L s

SIGNATURE

mANdATOry

financial adviser to sign here.

10 date d d m m y y y y

11 Telephone number

12 Email address

13 financial adviser company name and address (company stamp if possible)

14 Name of your usual Utmost sales consultant

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E V O L U T I O N

k I N V E s T m E N T O p T I O N s mANdATOry

certain funds require completion of the Investor Declaration form which is available from your financial adviser on request.

L1 f U N d s E L E c T I O N

Full fund name Fund reference/SEDOL/ISIN %

Total 100%

refer to our website www.utmostwealth.com for details of the funds available and the relevant sEdOL or IsIN codes. Ensure that the full fund name and fund references are provided.

you may only choose one of the three investment options for your bond. Therefore please ensure you only complete those sections applicable to your investment selection.

L1 & L2 L3 L4 M M1 M2 M3 M4

Funds and Deposits

External Manager

Platform/Platform Adviser

Utmost Limited is not responsible for any reduction in the value of investments arising directly or indirectly from the policyholders’ investment decisions or those of a properly nominated third party (such as, but not limited to, an External manager or platform adviser).

The letters referenced correspond to relevant sections of this form you will need to complete in the noted circumstance.

L f U N d s E L E c T I O N , c A s H d E p O s I T s A N d d E A L I N g A c c O U N T

Any missing information will result in a delay in investment. requests to link the value of the bond to any fund in which we have not previously traded will firstly need to go through our Asset Onboarding process. Investment cannot be made until this process is complete.Where relevant we will purchase accumulation units unless otherwise instructed. If income units are selected, the fund manager will be requested to pay all income as cash which will be credited to the dealing Account.

OpTIONAL

If you choose to invest in cash deposits and funds the combined total should equal 100%. for example, 30% cash deposits & 70% funds. please note rates are not guaranteed.

L 2 c A s H d E p O s I T s

Bank/Building Society Full name of deposit account %

If you do not specify an amount to be left in the dealing Account the investment amount calculated will be net of any initial charges.

This amount will cover charges and withdrawals, and will be retained net of any initial policy charges.

L 3 d E A L I N g A c c O U N T

Cash to be retained in the Dealing Account to cover charges and withdrawals.

If no funds are selected, then from within the portfolio, we will automatically sell units from the highest value fund that is liquid at the time of sale. If an Emc has been selected we may set up a regular payment from the externally managed account.

you cannot specify a deposit account.

L 4 N O m I N AT I O N O f f U N d s T O c O V E r O V E r d r A W N d E A L I N g A c c O U N T

Full fund name %

All transactions (including charges and withdrawals) will go through the dealing Account and it may become overdrawn. In these circumstances, we will sell sufficient funds to clear the negative debit balance.

Indicate in the box below which fund(s) you would like us to sell in these circumstances.

If more than one fund is selected, each fund sale will be subject to the prevailing dealing fees.

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E V O L U T I O N

2719 |


E V O L U T I O N

m N O m I N AT I O N O f E x T E r N A L m A N A g E r A N d / O r c U s T O d I A N ( E m c )

W H AT B A s I s W I L L T H E N O m I N AT I O N B E m A d E O N ?

for an explanation of each basis refer to the Guide for Evolution Corporate Applicants which your financial adviser has provided to you. This basis cannot be changed without prior written authority from Utmost Limited.

If you are nominating an External Manager, complete section m, m1 and m3. If you are nominating a Platform and Platform Adviser, complete section m, m2, m3 and m4.

This nomination is made in line with the terms agreed between Utmost Limited and the EMC and is subject to change.

1. A Discretionary basis

2. An Advisory basis

m 1 E x T E r N A L m A N A g E r d E TA I L s

3 contact name

4 Telephone number (including international

dialling code)

5 facsimile number (including international

dialling code)

6 Email address

1 Name of the nominated firm

2 Address

postcode —

OpTIONAL

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E V O L U T I O N

m 2 p L AT f O r m A N d p L AT f O r m A d V I s E r d E TA I L s

1 Name of the nominated platform

platform dm refers to a discretionary fund manager that holds an agreement with your nominated platform.

If you will be appointing a Platform Discretionary Fund Manager (Platform DM) you must appoint them via the Platform and not on this form.

The nominated platform Adviser must now sign section m4.

2 Name of the nominated platform Adviser firm

3 Address

postcode —

4 contact name

5 Telephone number(including international dialling code)

6 facsimile number (including international dialling code)

7 Email address

details only required for the platform Adviser, NOT the platform.

Throughout this declaration the term ‘Applicants’ refers to the persons applying for the Evolution bond and who will be the ‘Policyholders’ of the bond once established.

The Applicants request and agree the Emc specified in section M is appointed in accordance with the Applicants’ wishes set out in that section, to advise and/or manage the External Account (the Account) to which the performance of the Applicants’ bond is linked. The Emc, Utmost Limited or the Applicants may terminate this appointment at any time by giving written notice to all other parties.

The Applicants are aware this appointment will be based on terms agreed between the Emc and Utmost Limited. some of the most important terms have been set out below.

The Applicants understand and agree that where applicable:

› The Applicants’ adviser has explained Utmost Limited’s charges associated with this nomination

› Utmost Limited will recover any necessary money from the Account to cover Utmost Limited’s fees and expenses, as detailed in the policy schedule, provisions and fund rules

› Utmost Limited shall not be responsible for any loss or liability to the Account (a) resulting from this appointment, or (b) from services rendered or procured by the Emc to Utmost Limited

› There are risks associated with the appointment of an Emc, where the Emc is responsible for the selection and/or safekeeping of the assets linked to the bond

› Utmost Limited is, and must remain, the beneficial owner of all assets linked to the bond. further to this, Utmost Limited has the right to place trading instructions directly with the Emc at any time without requiring the Applicants’ approval. This may affect the value of the bond. Where there are conflicting instructions, Utmost Limited’s instructions override the Applicants’ or the Emc’s instructions

› The Applicants have no legal right to the investments held by the Emc. Apart from agreeing or rejecting recommendations given to the Applicants where an advisory basis has been selected, the Applicants may not give any direct instructions to the Emc regarding the investments, including

m 3 A p p L I c A N T ( p O L I c y H O L d E r ) I N V E s T m E N T T E r m s d E c L A r AT I O N

2721 |


E V O L U T I O N

Applicant(s) signature(s)

Authorised Signatory Authorised SignatorySIGNATURE

print full name

date d d m m y y y y d d m m y y y y

SIGNATURE

The Applicants agree and understand that the Emc:

› may take charges for services other than advice, including those for transactions and/or custody services provided, as detailed under the standard charges section of their terms and conditions or as agreed separately with the Applicants. The Emc will deduct such charges for transactions and/or custody services directly from the Account

› Is authorised by Utmost Limited to take the agreed fees from the Account and make any separate investment management service payments on its behalf.

The Applicants promise to be responsible for reimbursing Utmost Limited for any costs, losses and/or expenses incurred by Utmost Limited as a result of any legal claims, complaints or proceedings brought by any party in respect of loss arising from the services and performance of the Emc, including those described above.

The Applicants confirm that the above statements have been explained to the Applicants by the financial adviser and that the Applicants understand and agree to them.

instructions relating to the selection of assets, or with respect to withdrawals or surrenders. further the Applicants may not give any legal charge, pledge or lien over the Account, nor may the Applicants instruct the Emc to give any guarantee, indemnity or counter-indemnity in favour of any person or company

› Utmost Limited extends a Limited power of Authority (LpOA) on the Applicants’ behalf which enables the Applicants to agree certain charges (not linked to advice), investment strategy and risk profile. The Applicants’ financial adviser and the Applicants can also obtain valuation statements directly from the Emc. If the Applicants are nominating a platform and platform Adviser, the Applicants are also given limited powers to agree the appointment of a platform dm who hold agreements with the platform and platform Adviser. Utmost Limited retains the right to decline any such appointment

› The Emc will be responsible for ensuring compliance with the objectives and risk information provided by the Applicants to the Emc via the separate Investment mandate document

› The range of assets available is restricted in line with Utmost Limited’s Investment parameters. If assets other than the restricted range are linked to the bond, it could be deemed highly personalised and may be subject to penal taxation. Utmost Limited is not responsible for monitoring the bond’s assets or for any costs resulting from a breach of these restrictions

› Utmost Limited’s ability to sell, reinvest or pay cash in a timely manner can be restricted by certain types of assets the Applicants’ Emc can hold. Utmost Limited reserves the right to delay settlement or reinvest at its discretion.

Ensure ALL applicants sign here where appointing an external manager. This is required in addition to signing section N - Applicant declaration.

If there are more than two authorised signatories photocopy this page and after signing, attach securely to this form.

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E V O L U T I O N

Indicate which of the following regulatory authorisations are currently held by the Platform Adviser:

1. fcA permission Managing Investments (article 37)

2. fcA permission Advising on Investments (article 53)

4. Isle of man fsA regulated class 2 class 3

class cclass B class d5. Jersey fsc regulated

6. guernsey fsc regulated category 1 and 2 restricted Activities held to

Advise on investments

Act as discretionary manager

3. fcA permission Arranging safeguarding and administration of assets (article 40)

m 4 p L AT f O r m A d V I s E r d E c L A r AT I O N

This declaration should be signed by the platform Adviser nominated within this document to confirm acceptance of the appointment and to confirm understanding and agreement to the terms and responsibilities set out below.

1. I, the undersigned, being an authorised signatory of the platform Adviser, agree on behalf of the Platform Adviser to manage and/or advise on (as applicable) Utmost Limited’s Account with the platform named in section M2 on the basis stated in section M.

2. I agree and understand that this appointment will be on terms agreed between the platform and Utmost Limited, and that my/our operation of the Account is subject to these terms, and to the terms specified in this document which, among other things, shall include the following terms to which I undertake to fully adhere to through the signing of this document:

› By way of this appointment, the platform Adviser is being authorised to buy and sell assets within the platform Account on behalf of Utmost Limited. Unless written authorisation stating otherwise is provided by Utmost Limited, all investments must be in accordance with the Investment parameters provided to the platform Adviser by Utmost Limited. Utmost Limited is not responsible for monitoring the assets held within the Account, or for any costs resulting from a breach of these restrictions. Utmost Limited reserves the right to update the Investment parameters from time to time

› Utmost Limited at all times reserves the right to refuse individual assets for investment and to override instructions given by the platform Adviser in relation to investment or any other function of the Account. Utmost Limited may at any time at its sole discretion give instructions directly to the platform without notice and without requiring the platform Adviser’s approval. In the event that instructions given by Utmost Limited conflict with instructions given by the platform Adviser, Utmost Limited’s instructions shall have priority

› The Account is legally owned by Utmost Limited, and Utmost Limited is the sole beneficial owner of all assets within the Account. Neither the platform Adviser nor the policyholder have any claim or ownership over the Account or the assets within. The platform Adviser is being appointed by Utmost Limited upon the Account to instruct trades directly with the platform on a restricted basis

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› changes to the basis of this appointment, between discretionary, advisory or otherwise, may only be made with Utmost Limited’s prior written authority

› The platform Adviser may accept instructions from the policyholder to appoint one of a restricted list of discretionary fund managers who have a direct agreement with the platform (platform dm). Written evidence of the instruction and/or agreement must be retained and made available to Utmost Limited on request. The platform Adviser will retain its responsibility for adherence to the Investment parameters even where an additional platform dm is selected

› The Account will not be more than 100% invested (i.e. no overdrawn positions shall be created), nor any other commitments made beyond the amount of the cash available in the Account without Utmost Limited’s prior written authority

› Where charges for general advice or investment advice are agreed the platform Adviser is not permitted to take such charges from the Account unless Utmost Limited has given prior written consent

› The platform Adviser is not permitted to arrange any transfers of cash or investments into or out of the Account, except where cash is to be returned to the Utmost Limited bond to a bank account designated in writing by Utmost Limited, or as a part of supporting regular trading or settlement activity

› manufacturing costs relating to trading transactions, custody fees and discretionary fund management costs can be charged to the Account as a fund expense

› Where the conditions of this appointment conflict with the platform Adviser’s standard terms and conditions applicable to its operation of the Account, these conditions will prevail.

3. I agree and understand that by accepting this appointment, the platform Adviser will be appointed as an Investment Adviser to manage the Utmost Limited bond’s linked assets which include the management of the policyholder’s Utmost Limited’s dealing Account. It is the platform Adviser’s responsibility to ensure that there is sufficient cash in the dealing Account to cover the cost of any charges or withdrawals. debit interest will be charged on any negative balance.

4. I agree and understand that the platform Adviser is solely responsible for ensuring that it acts within the limits of the authority set out in this appointment and the terms agreed with the platform.

By signing below the Platform Adviser confirms that:

› It has the necessary authorities under the legislation and regulations in its regulatory jurisdiction to act in the capacity of this nomination and will remain authorised and comply with the rules of the appropriate regulatory bodies whilst acting in this capacity. The platform Adviser shall notify Utmost Limited of any changes to its regulatory authorisation, including any disciplinary action taken against it, relevant to this nomination. The platform Adviser confirms it is willing and able to select and/or hold assets in the Account in accordance with the investment strategy and/or objectives agreed with the policyholder where applicable

› It accepts full responsibility and legal liability for loss, damages or expenses which it or any other party may suffer or incur, directly or indirectly, as a result of acting outside the limits of this authority and promised to reimburse Utmost Limited for any costs, claims, damages or liabilities incurred by Utmost Limited as a result of acting in its appointed capacity

› It promises not to make or bring any formal or informal legal claims, complaints or proceedings against Utmost Limited in respect of its activities under this limited investment authority.

signature on behalf of the nominated platform Adviser

Platform AdviserSIGNATURE Authorised signature on behalf of the nominated firm

date d d m m y y y y

SIGNATURE

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E V O L U T I O N

source of funds – statement of truth

The Applicants truthfully confirm that:

i) All funds invested in the bond applied for have been or will be properly declared to the relevant tax authorities in the jurisdiction of the Applicants’ tax residence and/or any other jurisdictions as necessary or appropriate in accordance with applicable laws and regulations.

ii) None of the funds invested derive, directly or indirectly, from illegal activities or sources and/or tax evasion or conduct which will or may be regarded as such.

Potential consequences of misleading Utmost Limited

The Applicants fully acknowledge and agree that if Utmost Limited discovers that the Applicants misled Utmost Limited in respect of any part of the statements confirmed above, Utmost Limited shall, to the fullest extent permitted by applicable law and regulation, without limiting Utmost Limited’s legal remedies or options, have the contractual ability to:

i) terminate the bond immediately and, regardless of the actual date of the bond termination, impose the maximum encashment and any other relevant charges which may be imposed on the Applicants under the bond as if the bond had been encashed immediately after issue. such charges shall be applied to the extent that they cover any costs, expenses or losses caused by Utmost Limited being misled, without limiting Utmost Limited’s ability to seek additional recompense from the Applicants in respect of any shortfall.

ii) notify relevant government authorities and provide all information considered necessary or appropriate at Utmost Limited’s discretion concerning the Applicants and/or the bond; and

iii) if considered appropriate after consultation with government authorities and/or legal counsel, either:

a) subject to satisfying Utmost Limited’s further reasonable requirements, refund the Applicants’ premium(s) and other amounts paid to Utmost Limited to the date of such termination less applicable encashment and other charges in accordance with clause (i) above (the ‘refund Amount’), or

In this declaration ‘the Applicants’ mean the corporate applicants, its officers and/or authorised signatories applying for this bond, who also will be the ‘Policyholders’ of the bond once established.

It is important that the Applicants read this section carefully. This application forms the basis of Utmost Limited’s agreement with the Applicants, along with the Policy Conditions.

If the Applicants do not understand any part of this application, the Applicants should ask the financial adviser for further information.

Companies holding contracts of life assurance are caught under the Loan Relationship rules. Before signing below ensure the Applicants’ adviser(s) and/or accountant(s) have explained the tax implications of effecting an Evolution bond, including how withdrawals and any adviser charges will be treated.

In addition, before signing, the Applicants should also read the Key Features Document, Product Guide, Guide to Charges, the Personal Illustration and the Key Information Document where applicable, which explain the key features of and the specific charges applicable to the Evolution bond. They will assist the Applicants to be sure statements made by the financial adviser are not relied upon if they are not supported in the literature. The Applicants’ financial adviser will provide these documents and copies are also available from Utmost Limited.

Utmost Limited proposes that the laws of the Isle of man shall apply to any contract relating to this application and that the Isle of man courts shall be the sole forum to consider disputes in relation to any contract arising from this application. Any decision to alter the Isle of man court’s jurisdiction shall be at the discretion of Utmost Limited.

The Evolution bond will be issued in accordance with the policy conditions and policy schedule which will be issued by Utmost Limited upon acceptance of this application.

The charges laid out in this document should match those shown in the Applicants’ personal Illustration provided to the Applicants by the financial adviser. should there be any inconsistencies ask the financial adviser for an updated illustration.

Utmost Limited will only issue your bond once we have received all the information and documentation required to satisfy regulatory requirements relating to anti-money laundering and the prevention of tax evasion.

A N T I - m O N E y L A U N d E r I N g A N d TA x E V A s I O N p r O V I s I O N s

N s TA N d A r d A p p L I c A N T d E c L A r AT I O N

The Applicants may request a copy of the policy conditions at any time from Utmost Limited’s Welcome team on +44 (0)1624 653 251.

mANdATOry

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E V O L U T I O N

b) if legally required to do so by competent government authorities, freeze or pay over to relevant government authorities all or a portion of the refund Amount or take such other actions as competent government authorities may legally require.

disclosure of information to tax and other government authorities

The Applicants have been advised that the Utmost group and Utmost Limited have a longstanding policy of cooperating with tax and other government authorities to combat money laundering, tax evasion or other illegal activities or conduct that will or may be regarded as such.

In cases where Utmost Limited suspects that the funds invested in the bond are wholly or partly derived from illegal activities/sources and/or tax evasion, then Utmost Limited shall, to the fullest extent permitted by applicable law and regulation, without limiting the Utmost Limited’s legal remedies or options, have the ability to disclose to the Applicants’ home country tax and/or other government authorities, the Applicants’ identity and any relevant information considered necessary or appropriate, in Utmost Limited’s discretion, concerning the bond.

Utmost Limited’s obligations under the policy, including the payment of benefits, will be suspended either in whole or in part, to the extent that performance of any policy obligation may expose Utmost Limited to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanction, laws or regulations of the European Union, United kingdom or United states of America.

confirmations and acknowledgements The Applicants understand and agree that this contract is of the utmost good faith and that the information the Applicants supply in this application form, together with any supporting information completed or given by the Applicants in the Applicants’ name, shall form the basis of the contract with Utmost Limited.

The Applicants agree that if it subsequently comes to light that any information supplied to Utmost Limited by the Applicants or on the Applicants’ behalf was misleading or incomplete, then this might invalidate the Applicants’ contract and adversely affect the Applicants’ right to the payment of policy benefits. The Applicants understand the requirement to provide accurate and relevant information in the Applicants’ dealings with Utmost Limited is continuous and binding upon the Applicants or any subsequent holder of the policy.

The Applicants agree to inform Utmost Limited immediately should any information within this application change, and understand that the Applicants are obliged to do so.

The Applicants understand that no contract shall be issued in respect of this application and Utmost Limited shall be under no obligation in respect of this application until the first premium has been received by Utmost Limited and Utmost Limited has expressly confirmed in writing that it accepts this application.

The Applicants accept that:

› The selection of investments is the Applicants’ responsibility or, where appropriate, that of the Applicants’ Investment Adviser or any appointed Emc

› Utmost Limited has no legal responsibility in respect of future performance of such linked assets.

The Applicants confirm that the firm named in section J – Introducer’s details will be acting as the Applicants’ financial adviser on an ongoing basis and the Applicants agree that Utmost Limited is able to disclose all information relating to the Applicants’ bond to this financial adviser. The Applicants understand that if the Applicants decide to change the Applicants’ financial adviser it is the Applicants’ responsibility to tell Utmost Limited in writing of this change.

The Applicants agree that a copy of the Applicants’ agreement given in this declaration will have the validity of the original. The Applicants understand that the Applicants’ financial adviser is acting as the Applicants’ agent and not an agent of Utmost Limited.

The Applicants confirm and declare that the corporate applicant is liable for tax in the jurisdiction entered in section C of this application form.

The Applicants understand and agree that Utmost Limited will, as appropriate, report the Applicants’ policy under the various exchange of information agreements including the foreign Account Tax compliance Act (fATcA) and the common reporting standard (crs).

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E V O L U T I O N

A d V I s E r c H A r g E s

Where the Applicants have requested Utmost Limited to facilitate the payment of adviser charges:

The Applicants authorise Utmost Limited to pay the adviser charges as set out in this Agreement.

The Applicants understand and accept that where the adviser charge is being facilitated from the bond:

› The taxation of bonds held by corporate entities is complex and tax treatment will depend on the basis upon which annual accounts are declared. Utmost Limited is unable to provide advice in this regard and accepts no responsibility for any adverse tax consequences resulting from the application of adviser charges to the bond

› The Applicants should contact the Applicants’ financial adviser in the first instance to discuss anything regarding adviser charges paid to them

› The Applicants cannot cancel an adviser charge after it has been paid, even if the Applicants decide to cancel the bond during the cancellation period

› If the application is not proceeded with, the Applicants will be refunded the premium in full, less any adviser charges; any adviser charges that the Applicants paid/owed will be the Applicants’ responsibility to settle

› Where an External Account is linked to the bond, any fund based adviser charge payments will be based on the last available fund value for the External Account held in Utmost Limited’s records.

H O W U T m O s T L I m I T E d U s E s A p p L I c A N T s ’ I N f O r m AT I O N

Utmost Limited uses the information the Applicants provides about themselves and other people, to provide its products and services. In order to support Utmost Limited’s products and services, Utmost Limited transfers information between different entities within Utmost’s immediate operating group and to appointed data processors, but Utmost Limited does not transfer information to other parties, unless required to do so by law or regulation. Utmost Limited does not carry out marketing using the information or transfer, or sell, the Applicants’ personal information to others for marketing purposes.

more details about how Utmost Limited uses the Applicants’ information, the Applicants’ rights over this information and how the Applicants can exercise those rights can be found in the applicable privacy Notice. Utmost Limited publishes their privacy Notices on Utmost Limited’s website at www.utmostwealth.com or the Applicants can ring Utmost Limited on +44 (0)1624 643 345 and request a copy.

The Applicants acknowledge that:

Utmost Limited will store, process or pass on the Applicants’ data whether or not the Applicants’ application is accepted.

Utmost Limited will, in the event of the death of the Applicants or Life Assured (as applicable), obtain necessary evidence as to the cause and circumstances relating to the Applicant’s or Life Assured’s death should it wish to do so.

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E V O L U T I O N

If there are more than four authorised signatories photocopy this page and after signing the additional copies attach securely to the form.

Authorised Signatory 1 Authorised Signatory 2SIGNATURE

print full name


SIGNATURE

SIGNATURE

Authorised Signatory 3 Authorised Signatory 4SIGNATURE

print full name


A U T H O r I s E d s I g N AT O r y d E TA I L s

› confirm the minimum number of authorised signatories that will be required to sign the contract and provide instructions.

(number)

Documents

EVOLUTION - Utmost Wealth Docs