Trustee Application Form · 2 XIM16/A/TRUSTEE 05.13 Please complete this Application Form in English ... Source of Wealth (including supporting documents, where required)* *Suitably

Premier AdvanceTrustee Application Form

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XIM16/A/TRUSTEE

Failure to disclose relevant information may delay the processing of your application

2 XIM16/A/TRUSTEE 05.13

Please complete this Application Form in English

This Application Form should only be completed where the Applicants are trustees of an existing trust. The form should be read in conjunction

with the current edition of the following documents, which set out the terms and conditions of the policy and the various investment options

available to you:• thePremierAdvancePrincipalBrochure• thePremierAdvanceTechnicalGuide• thecurrentFundPricesleaflet• thePremierAdvancePolicyConditions

IfyoumakeanymistakeswhilecompletingthisApplicationForm,pleasecrossouttheerrorandwritethenewinformationCLEARLY.Each correction must be initialled by the person or persons completing the form. Do NOT use correction fluid or other ways of deleting incorrect information.

Your financial adviser

Companyname

Financial adviser’s name

Contactemailaddress

Financial adviser’s account number

Policy number allocated (if known)

Your reason for investing into Premier Advance

Please tick the appropriate box

Retirementfunding

Educationfunding

Medium to long-term savings

For a special event (please complete)

If no reason has been ticked, we will assume Premier Advance is required for medium to long-term savings.

Additional information / Special instructions

Please complete all sections

Failure to provide all relevant information and documentation may delay the processing of your application. Further information may be required during the validation process (i.e. questions arising from the information provided). Please note that even if the premium has been received

and banked, the policy will not be issued until all documentation has been received and validated.



Checklist (please tick boxes)

ReceiptandexplanationgivenoftheinformationcontainedinthePrincipalBrochureandotherrelevant materials

Section 1: Setting up the policy

Section 2: Declarations

Method of payment details

Please ensure that ALL relevant certified documentation is enclosed with this application

For each Trust

CopyofAppointmentofTrusteesdocument(usuallytheTrustDeedorDeclaration)*

For each individual Trustee

VerificationofIdentity*

VerificationofAddress*

For Corporate Trustees

CopyofCertificateofIncorporation*

Copyoflatestauditedaccounts*

CopyofShareRegister*

CopyofSignatorylistandsigningpowers*

Evidenceoftheregisteredofficeaddress(ifthisisnottheaddressontheapplicationwerequireevidencethattheaddressisbeing used and confirmation of why there is a difference)

Please supply ID for Directors, one of which must be an Executive Director

DIRECTOR1:Verificationofidentity*

DIRECTOR1:Verificationofaddress*

DIRECTOR2:Verificationofidentity*

DIRECTOR2:Verificationofaddress*

Verificationofidentityandaddressforanyshareholderowning25%ormore*

SourceofWealth(includingsupportingdocuments,whererequired)*

*Suitablycertifiedasbeingatruecopy.



Failure to disclose relevant information may delay the processing of your applicationSection 1: Setting up the policy

This page should be completed if the Applicant is a Corporate Trustee.Please use BLOCK CAPITALS.

Corporate Trustees

Company name

Registered address

Country of registration

Registration number

Regulated by/Authorisation number

Telephone number

Fax number

Correspondence address (if different)

Contact name

Telephone number

Fax number

Email address

Directors’ details (if more than four, please provide details on a separate sheet)

First Director

Second Director

Title

Mr

Mrs

Miss

Mr

Mrs

Miss

Other (please specify)


Name(s) (as shown on ID Card/Passport)

Surname

First name(s)

Address

Third Director

Fourth Director

Title

Mr

Mrs

Miss

Mr

Mrs

Miss




Surname

First name(s)

Address


XIM16/A/TRUSTEE 05.13 5

Failure to disclose relevant information may delay the processing of your applicationSetting up the policy (continued)

This page should be completed if the Applicant(s) is/are a Non-Corporate Trustee(s).Please use BLOCK CAPITALS.

Trustee for correspondence

Title

Mr

Mrs

Miss



Surname

First name(s)

Address

Contact numbers

Home telephone

Office telephone

Mobile

Fax

Email address

Other Trustees (if more than four, please provide details on a separate sheet)

First Trustee

Second Trustee

Title

Mr

Mrs

Miss

Mr

Mrs

Miss




Surname

First name(s)

Address

Third Trustee

Fourth Trustee

Title

Mr

Mrs

Miss

Mr

Mrs

Miss




Surname

First name(s)

Address




Please use BLOCK CAPITALS.

Lives Assured (if more than four lives assured are required, please complete the Supplementary Form for AdditionalLivesAssured).

First Life Assured

Second Life Assured

1 Title

Mr

Mrs

Miss

Mr

Mrs

Miss



2 Name(s) (as shown on ID Card/Passport)

Surname

First name(s)

3 Date of birth (dd/mm/yyyy) | | | | | | | | | |

4 Country of residence

5 Residential address

6 Relationship to trust

Third Life Assured

Fourth Life Assured

1 Title

Mr

Mrs

Miss

Mr

Mrs

Miss



2 Name(s) (as shown on ID Card/Passport)

Surname

First name(s)

3 Date of birth (dd/mm/yyyy) | | | | | | | | | |

4 Country of residence

5 Residential address

6 Relationship to trust



Failure to disclose relevant information may delay the processing of your applicationSetting up the policy (continued) *Deleteasappropriate

Total premium

Monthly Premiums USD/GBP/EUR/HKD* MinimumUSD300(orGBP200,EUR300,HKD2,400)

Quarterly Premiums USD/GBP/EUR/HKD* MinimumUSD900(orGBP600,EUR900,HKD7,200)

Half-YearlyPremiums USD/GBP/EUR/HKD* MinimumUSD1,800(orGBP1,200,EUR1,800,HKD14,400)

YearlyPremiums USD/GBP/EUR/HKD* MinimumUSD3,600(orGBP2,400,EUR3,600,HKD28,800)

The plan will be issued as 10 individual policies. If you wish your plan to be issued as one single policy, tick here.

Payment methods

Please tick the appropriate box and follow the instructions carefully. Please note that cash is not an acceptable payment method.

BY STANDING ORDER/BANK TRANSFER. We have arranged for the premium to be paid by debit of funds from our personal/companybankaccountandhaveforwardedacertifiedcopyofthebankinstructiontoFriendsProvidentInternationalLimited(Friends Provident International).

Details of our bank account:

Bankname

Bankpostaladdress

Postcode (if applicable)

Account name

Account number

Account currency (must be completed if the account is multi-currency)

Sort Code(ifapplicable) | | |SWIFT/BICCode(ifapplicable)

IBAN(ifapplicable)

Note: We must have either a sort code, SWIFT/BIC code or IBAN.

We have arranged to transfer the amount of:

USD/GBP/EUR/HKD* (figures)

USD/GBP/EUR/HKD* (words)

We have arranged for this transfer to start on the day of (month) (year)

and on the same day monthly quarterly half-yearly yearly

until this order is cancelled in writing.

We have charged the amount of the payment together with any bank and agent bank’s charges to our account.

For applicants with bank accounts in the Far EastBank: HongKong&ShanghaiBankingCorporationLimitedAddress: MainOffice,1Queen’sRoad,Central,HongKong,SWIFTCodeHSBCHKHHAccountname: FriendsProvidentInternationalLimitedUSDpolicies: 511-667685-201GBPpolicies: 511-667685-202EURpolicies: 511-667685-220HKDpolicies: 511-667685-001Reference: (pre-allocated policy number – must be quoted by the bank on all payments)




Source of payment

For all methods of payment excluding Credit Card.

We confirm the premium is to be paid for by debit of funds from our personal/company bank account. The details of this account are as

follows.

Note: We must have either a sort code, SWIFT/BIC code or IBAN.

Sort code (if applicable)

SWIFT/BICcode(ifapplicable)

IBAN(Europaymentsonly)

Account number

Account currency

Account name

Bank(nameandaddress) Bank

Postcode (if applicable)

For applicants with bank accounts not in the Far East (USD, GBP, EUR policies only)Bank: IsleofManBankLimitedAddress: EastRegion,Douglas,IsleofMan,IM991ANAccountname: FriendsProvidentInternationalLimitedAccountnumber: 9545-40038485(allcurrencies)SWIFT/BIC: RBOSIMD2SortCode: 60-95-45IBAN: GB48RBOS60954540038485Reference: (pre-allocated policy number - must be quoted by the bank on all payments)We accept payment by:USD: Telegraphic Transfer (TT)GBP: CHAPS/BACS/FasterPayment(fromUK/ChannelIslandorIsleofManbanks) or Telegraphic Transfer (TT - from other regions)EUR: SEPA(fromEurozonebanks)orTelegraphicTransfer(TT)HKD: ACHorTelegraphicTransfer(TT)FriendsProvidentInternational’sfullpostaladdressis:RoyalCourt,Castletown,IsleofMan,IM91RA.

BY CREDIT CARD. IfyouarereturningthisApplicationFormbypostorfaxpleasecompletetheDirectChargeAuthorityonpage18.If you intend applying electronically please submit credit card details via our secure website: www.fpinternational.com/creditcard

BY CHEQUE/BANKERS DRAFT.

Please tick one box only

USDDraft,drawnonabankinNewYork

GBPDraft,drawnonabankintheUnitedKingdom

EURDraft,drawnonabankintheEuropeanEconomicandMonetaryUnion(EMU)

HKDDraft,drawnonabankinHongKong

Important note: This method is for half-yearly or yearly premiums only. AcertifiedcopyoftheBankAcknowledgementLettermustbesenttoFriendsProvidentInternationalwitheveryDraft.Pleasemakecheques/draftspayabletoFriendsProvidentInternationalLimited(Ref:policynumber).Theseshouldbesentdirectlytothe address below. FriendsProvidentInternational,RoyalCourt,Castletown,IsleofMan,BritishIsles,IM91RA




Option Date

The Option Date must be not less than 5 years and not more than 25 years from inception of the policy. The maximum age of the youngest

LifeAssuredatthechosenOptionDateis75.

Currency

The currency of your policy will be the currency in which you pay your premiums. If you wish to receive valuations of your policy in a different currency from the policy currency, please tick the appropriate box. If no selection is made, valuations will be produced in the policy currency.

US dollars (USD)

Sterling(GBP)

Euro(EUR)

HKdollars(HKD)

Choice of mirror funds

Please indicate the funds in which you wish your policy to invest, up to a maximum of 10, showing the percentage of each investible premium you wish to be invested in each fund. The total percentage must add up to 100% (please note we can only accept whole percentages). Failure to include all relevant information accurately may delay the processing of your application.

Fund Code Mirror fund % of premium

Total 100%

Lifestyling Investment Strategy

DoyouwishtoselecttheLifestylingInvestmentStrategy? Yes No

Ifyes,whichLifestylingInvestmentStrategydoyouwishtoselect?

Cautious(10years)

Balanced(5years)

Speculative (3 years)

Please note the maximum 10 fund limit includes any Lifestyle Investment Strategy selected by you.

Correspondence

Please indicate where you wish all correspondence/statements to be sent. If the box is not ticked, all correspondence will be sent to the

introducing financial adviser.

Direct to the introducing financial adviser

Direct to the Trustees (with copies to the introducing financial adviser)

Setting up the policy (continued)


Setting up the policy (continued) *Deleteasappropriate

Source of Wealth

Please refer to ‘What you need to provide’,Step4andSourceofWealthTable(pages15and16)fortheevidentialrequirementstosupport Source of Wealth

Savings from salary

(basic and/or bonus) Currentannualsalary USD/GBP/EUR/HKD* permonth/year*

Employer’sname

Employer’saddress

Pension provision by employer

Employer’sname

Employer’saddress

Pleaseprovidetheemployer’sLetterofConfirmationandCertificateofIncorporation.

Other regular income

Amount of income USD/GBP/EUR/HKD*

Details, i.e. name of payer, frequency of payment, reason for payment, etc.

Company Annual Profits

(please provide a certified

copy of the latest audited

company accounts)

Nature of business

Amount of annual profit(last 12 months)

USD/GBP/EUR/HKD*

Other Source of Wealth. Please provide as much detail as possible

See ‘What you need to provide’,Step4andSourceofWealthTable(pages15and16)and use

the box provided for explanation / provision of

required details


Section 2: Declarations

Important notes

1 A specimen policy document and/or copy of this completed form are available on request.

2 Youareadvisedtosatisfyyourself/selvesthat,underanytaxation,exchangecontrolorinsurancelegislationtowhichyoumaybesubject,you are permitted to effect the policy.

3 Youshouldseekguidancefromyourfinancialadviserastothesuitabilityofthepolicytoyourownparticularcircumstances.PremierAdvanceand Ultra Advance should be regarded as a medium to long-term investment.

4 YouareobligedtoprovidetheinformationasrequiredinthisApplicationanditisaprerequisiteforyoutoapplyforthepolicy.Informationwhich you provide in connection with this Application and any subsequent policy will be held (whether stored electronically or otherwise), usedordisclosedbyFriendsProvidentInternationaloranyassociatedcompanythatexistsfromtimetotime.Youhavetherighttoobtainaccesstoandtorequestacorrectionofanypersonalinformationaboutyou.RequestscanbemadetotheComplianceOfficeratRoyalCourt,Castletown,IsleofMan,BritishIslesIM91RA.

5 EachpolicyisgovernedbyandshallbeconstruedinaccordancewiththelawoftheIsleofMan.

6 Fund Acknowledgement

Friends Provident International offers products that give you an investment choice from a very wide-ranging menu of investments via a range of internal funds, which includes mirror funds, that Friends Provident International has created. Some of these internal funds invest into funds which are classed as specialist funds aimed at professional or experienced investors. If you were investing into such a fund yourself, rather than through one of our internal funds, you may have to declare that:

• Youhavereadandunderstoodtheinformationsuppliedtoyouandunderstandthenatureofanyrisksinvolved.

• Youhavediscussedwithyourfinancialadviserwhethersuchanassetisappropriatetoyourinvestmentportfolio.

• Youareeligibleandabletoinvestintothefundandhavethelevelofinvestmentknowledgeandexperiencerequiredbythefundmanager.

• Youmeetcertainminimumfinancialrequirements.

Ordinarily some of these funds could only be held by professional/experienced investors rather than retail investors. Also, information relating to such investments may not be available for distribution in certain jurisdictions. However, when the investment is made through your policy, Friends Provident International is treated as the professional or experienced investor and this enables policyholders that may not have been able to do so, to access these funds.

Please note that different jurisdictions may impose different criteria on the generally accepted definition of a professional/experienced investor. Full definitions, restrictions and investor requirements can be found in each fund’s prospectus/terms and conditions, which is available from the fund manager or your financial adviser. Friends Provident International recommends that you obtain, read and fully understand a copy of the prospectus/terms and conditions for your chosen investment.

Liquidity Information

Some of our internal funds, particularly our specialist ones may have restrictions on their ability to pay redemptions due to the type of underlying investments they hold. This could limit your ability to raise cash from the fund in the future. Information and definitions for our specialist internal funds are available on www.fpinternational.com. Friends Provident International recommends that you visit our website and take time to read and understand the definitions if you intend to invest into our internal fund range. Investment into specialist via our internalfunds,shouldbeconsideredalong-terminvestment.You,inconjunctionwithyourfinancialadviser,shouldconsidertheamountyou invest via your policy if it is likely that you will need access to your capital quickly in the future.

Declarations

Attention is drawn to the following Declarations. If the Application Form requests information which has to be assessed by Friends Provident Internationalbeforeacceptance,then:Youmustdiscloseallfactswhicharematerial.Suchfactsarethosewhichafinancialinstitutionwould regard as likely to influence the assessment and acceptance of an application. If you are in doubt as to the relevance of any particular information you should disclose it, as failure to do so could result in you being provided with the wrong terms, a request being rejected or reduced, or the policy being invalid.

1 Fund Acknowledgement

(i) We understand that we may choose the investments to which our policy is to be linked.

(ii) We acknowledge that is our responsibility to ensure that the asset is suitable, considering our investment objectives and attitude to risk.

(iii) We confirm that we understand certain assets may have restrictions on their ability to raise cash in the future, and that further details are included in the prospectus or terms and conditions for the respective investment. We understand the risks associated with investing in these assets.

(iv) We understand that we may be investing into assets aimed at a professional or experienced investor and agree to such investments.



Section 2: Declarations *Deleteasappropriate

(v) We acknowledge that Friends Provident International is not responsible for the investment performance or any loss suffered or reduction in the value of our policy, arising from my/our chosen investment. Friends Provident International does not have any responsibility for the management of the assets within our policy and Friends Provident International does not approve any asset as a suitable investment.

(vi) We acknowledge that Friends Provident International reserves the right to reject any asset, for example if certain administration criteria are not met.

(vii) We acknowledge that our investments may be delayed if Friends Provident International requires a signed declaration in respect of our chosen investments.

(viii) We acknowledge that specific investor protection and compensation schemes that may exist in relation to collective investments and deposit accounts are unlikely to apply in the event of failure of such an investment held within insurance contracts.

2 Declarations

We, the current Trustees of the Trust created on the day of (month) (year)

Name of the Trust

(Please include a certified copy of the Trust Settlement / Declaration of Trust) (by the Settlor)

Full Name Address (or date of death) Date of birth

confirm the following to Friends Provident International:

(i) ThatwehavethenecessarypowersofinvestmenttoinvestinpoliciesofLifeAssurance.

(ii) ThattheTrusteesdetailedinSECTION1ofthisApplicationFormarethecurrentTrusteesoftheTrust.

(iii) TheprincipalBeneficiary/ies*is/are*

Full Name Address Date of birth

(iv) The nature and purpose of the Trust is

(v) Thatwithoutprejudicetothegeneralityofthisclause,allTrustees(orinthecaseofaCorporateTrustee,therequirednumberofauthorised signatories) must sign all types of instructions (for example, instructions to change underlying investments, make cash withdrawals, totally encash the contract).

(vi) That we will advise Friends Provident International in writing immediately of any changes in the Trustees.

(vii) The protector of the Trust is

Full Name Address Date of birth

(viii) This Application was signed in (country)

and the advice was given in (country)

and that, to the best of our knowledge and belief, all the above statements are true. We agree that they, together with any other statements made to Friends Provident International, now or in the future, shall form the basis of the contract under the law of the Isle of Man. We have read and understood all the printed materials relevant to this contract and we have acquainted ourselves with



the management charges made by Friends Provident International. We understand that we may choose the investments to which ourPoliciesaretobelinked.Consequently,FriendsProvidentInternationalshallnotberesponsiblefortheinvestmentperformanceor for any loss or liability arising from our choice of investment, however arising.

WeunderstandthatthisapplicationcanonlybeacceptedbyemployeesofFriendsProvidentInternationalsituatedattheCompany’sHead Office in the Isle of Man and that no other employees or third parties have the necessary authority to create a binding contract.

3 Data Protection

We understand and agree that any personal information collected or held by Friends Provident International (whether contained in this Application or otherwise) is provided and may be held, used or disclosed by Friends Provident International and transferred between its offices andothermembersoftheFriendsLifegroupofcompanies†wherevertheyaresituated.IunderstandthatFriendsProvidentInternationalandothermembersoftheFriendsLifegroupwill:

(i) use the personal information to set up and administer the contract;

(ii) transfer the information to third parties, agents and reinsurers for the purposes of administration, underwriting, claims, research or statistical purposes. (These agents and other third parties may be located in countries that do not have laws to protect your information. Such processing is subject to contractual restrictions and appropriate security measures to protect the information.);

(iii) communicate with us, our financial adviser and fund adviser whether directly or indirectly for any purpose;

(iv) supply the details or provide a copy of the information to any financial services company wherever they are situated to enable the purchase of assets requested to be linked to the contract; and

(v) transfer information to relevant regulatory bodies or authorities, for example the Insurance and Pensions Authority, and tax authorities to enable them to carry out their regulatory and statutory functions. Friends Provident International may also be required to disclose information to third parties in order to comply with anti money laundering laws and for other purposes such as the prevention of crime or detection of fraud, enabling assets to be rightfully claimed or where required by law or regulation.

Bysigningthisformweconfirmtheabovedeclarationsandunderstandandconsenttothisuseofourpersonaldataassetoutabove.

†FriendsLifegroupmeansFriendsLifegroupplcandallsubsidiariesofthatcompany.

We understand that Friends Provident International would like to keep us informed about other products and services provided by companies withintheFriendsLifegroupandothercarefullyselectedorganisations.

We do not wish you to contact us by: Post

Phone

Email

YoumaychangeyourmindatanytimebywritingtoInternationalComplianceManager,RoyalCourt,Castletown,IsleofMan,BritishIsles,IM91RA.Otherwisewewillassumethatyouarehappytobecontactedinthiswayforthetimebeing.

4 WeacknowledgethatFriendsProvidentInternationalandourfinancialadviserhaveenteredintoanagreement(‘termsofbusiness’)whichsets out the basis upon which Friends Provident International is prepared to accept applications submitted by the financial adviser on our behalf. This agreement categorically states that the financial adviser acts as our agent, and not the agent of Friends Provident International. We acknowledge that our financial adviser, or any other, has no authority to act as the agent of Friends Provident International or to state, suggest or imply that it has such authority. We acknowledge and authorise our financial adviser to be remunerated for its services by brokerage commission from Friends Provident International.

5 Bank Reference

We agree to the bank providing a reference on the account detailed in Section 1 of this Application Form to Friends Provident International now or at any time in the future.

Signature(s)

First Applicant (Trustee)

Second Applicant (Trustee)

Signature

Date (dd/mm/yyyy)

Signature

Date (dd/mm/yyyy)

Third Applicant (Trustee)

Fourth Applicant (Trustee)

Signature

Date (dd/mm/yyyy)

Signature

Date (dd/mm/yyyy)

What you need to provide

Step 3 Authentification of documents by a suitable certifier (for each Applicant)


What you need to provideVerification of identity, address and source of wealth accumulation

Friends Provident International has a legal obligation to verify the identity and residential address of each person who will apply

for one of Friends Provident International’s products. Friends Provident International also has a regulatory obligation to obtain

details of how the applicant(s) have acquired the monies/assets that they will invest with Friends Provident International.

Therearegoodreasonsfordoingthis.Criminalsandterroristsoftentrytolaundermoneybyusingfalseorstolenidentitiesin

ordertoopenaccountsorplaceinvestmentswithfinancialinstitutionssuchasFriendsProvidentInternational.Byproviding

the information and documents requested, you are not only helping Friends Provident International to comply with stringent

money laundering legislation, but you are helping to protect your own identity.

Step 1

Step 2The required documents to verify identity are:

• A Passport; or

• AGovernment-issuedIdentityCard(carryingaphotographoftheindividual).

WhereitisnotpossibletoobtaineitheraPassportoraNationalIdentityCard,twootherformalgovernment-issued

documentscarryingappropriatepersonaldetails,whichshowverifiablereferencenumbers,maybeaccepted.Examples

would include:

• DrivingLicencewithphotograph

• Annual Tax Assessment issued by the Tax Authorities

• AGovernment-issueddocumentcontainingauniquereferencenumberwhichisspecifictoeachTrustee.

These documents must be certified (please refer to STEP4).

Step 2 Verify the identity of each Trustee

Step 1 Verify the identity of the Trust

The required documents to verify identity are:

• CopyofAppointmentofTrusteesdocument(usuallytheTrustDeedorDeclaration)

• Verification of identity for each Trustee (please refer to STEP2)

• Verification of address for each Trustee (please refer to STEP3)


ForCorporateTrustees,pleaserefertothechecklistonpage3fortheadditionaldocumentationrequired.

Step 3 Verify the address of each Trustee

We will also require an original or certified copy of a document, to verify each Trustee’s residential address (please refer to

STEP4). A list of the documents that are acceptable for this purpose is provided below.

The document must be issued in the name of the Trustee and show the residential address that appears on the application

form. In all cases the documents seen should be the most recent available, and no older than 3 months, unless the

document used to verify address is only issued on an annual basis.

• Utility bill, (water, gas, electricity, landline telephone connection) rates invoice, council tax notification

Please note, mobile telephone bills, cable TV bills and internet service provider’s bills are not acceptable as

evidence of address

• Currentdrivinglicencewithphotograph

• Tax assessment document

What you need to provideXIM16/A/TRUSTEE 05.13 15

Step 3 (continued)

Background

Incorrect certification of documents is one of the main reasons for delays in processing applications. The Isle of Man

InsuranceandPensionsAuthority,theCompany’sprincipalregulator,isveryspecificabouthowdocumentsaretobe

certified, and who can perform this function.

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 or capacity: (the position or capacity of the certifier)

Date: (the date of certification)

Improper certification could lead to delays.

Whocancertifyacopyofanoriginaldocument?

A Regulated Introducer, or authorised employee of a Regulated Introducer

ARegulatedIntroducerisanIntroducerwhoisbasedin,incorporatedinorformedunderthelawofajurisdictionwhere

an authority exercises regulatory functions and controls and, has been accepted as regulated through the terms of

business process.

A Suitable Certifier appointed by Friends Provident International

TobeapprovedbytheCompanyasaSuitableCertifier,theindividualmusthavesubmittedtheAppointmentofSuitable

CertifierFormtothiscompany,togetherwithcopiesofhis/herpassport,andproofofaddressdocument,certifiedbya

CommissionerforOaths,aNotaryPublicoraSuitableCertifieralreadyapprovedbyFriendsProvidentInternational.

A notary Public, licensed lawyer or solicitor

A Notary Public is a public officer appointed under authority of state law with power to administer oaths, certify affidavits,

take acknowledgements and take depositions or testimony.

An authorised representative of an embassy or consulate of the country that issued the identification documents.

Step4Authentication of documents by a suitable certifier (for each Trustee)

• ExtractfromtheofficialRegistrarofElectors

• Bankaccountstatement

Please note, statements of credit cards and non-bank cards, such as store cards, are not acceptable

• State pension, benefit or other government-produced document showing benefit entitlements

• LetterfromtheTrustee’semployer,confirmingtheirresidentialaddress.WheretheTrusteehasaccompanieda

partner or spouse on a work assignment or contract, and they are also a Trustee, an employer may confirm the

address of a non-employee where a relationship is detailed

• Proof of ownership or rental of the residential address

• Mortgage statement.


What you need to provide16 XIM16/A/TRUSTEE 05.13

Step4(continued)

Background

Isle of Man authorised life companies are required by the Insurance and Pensions Authority to make enquiries as to how a

client applying for one of our products has acquired the monies that will be invested as insurance premiums. This “Source

ofWealth”informationisanintegralpartoftheoverall‘KnowYourClient’(KYC)requirementsthatFriendsProvident

International must perform. It is also a legal, as well as a regulatory requirement, to perform a risk-based assessment

of the applicant and conduct enhanced due diligence where higher risk circumstances are identified. This means that in

certain circumstances independent evidence will be required to support the explanation of the client’s Source of Wealth.

Information to be provided

On page 10 of the application form you should clearly explain how you have acquired the funds that you will use to pay

insurancepremiums.YouwillfindaSourceofWealthTableoverleaftohelpyou.Column1providesanumberofcommon

examplesofwealthgeneratingactivity.Column2detailsthelevelofinformationthatyoushouldincludeonpage10ofthe

application.Column3providesguidanceonthesortofdocumentaryevidencethatwouldnormallybesufficient.

Supporting documentation to evidence Source of Wealth

FriendsProvidentInternationalusesboththepremiumsizeandyourresidentiallocationtoidentifywhenapplications

requiredocumentaryevidence.Evidencewillberequiredwherethepremiumisonorabovethelimits.Premiumlevels

andcountryriskratingsaresubjecttoalterationandforthatreasonyouwillneedtorefertothePremiumLimitsTable

published in PDF format on our website, www.fpinternational.com (click Downloads → PDF library International (Isle of

Man) → Source of Wealth).

YouwillneedtocombinethepremiumlevelsindicatedinthePremiumLimitsTablewiththeriskratingofyourcountry

ofresidence (or country where wealth is generated), to determine whether evidential support should be submitted with

thisapplication.Yourfinancialadviser,whohasrecommendedthisproducttoyou,willbeabletohelpandadviseyou

with this.

Important note to the introducing financial adviser: ALL COPIES of original documentation must be properly certified

by you, the introducing intermediary, in the same manner as you would certify client identity documentation and

residential address proof.

Source of wealth

TranslationofdocumentsnotwritteninEnglish

WhereadocumentsubmittedisnotwritteninEnglish,werequirethecertifiertoexplainonthedocument:

• What the document is

• Thecertifiershouldtranslatetherelevantpart(s)intoEnglish

• The certifier should also write a statement onto the document to the effect that:

‘I certify that the English translation provided is a true translation of the relevant part(s) of this document…’

Signed: (the signature of the IFA)

Name: (the printed name of the IFA)

Date: (the date the IFA has certified the copy document)

What you need to provideXIM16/A/TRUSTEE 05.13 17

Source of wealth table

Description of

Source of Wealth

Below premium limits On or above premium limits(Documentary evidence of one item is required in addition to information requested for below premium limits business)

1 Savings from salary (basic and/or bonus)

If you own or part-own the company where you are employed, please follow the guidance detailed in 8 below

• Salaryperannum• Employer’sname• Employer’saddress• Natureofbusiness

• Originalorcertifiedcopyofapayslip(orbonus payment) from within the last three months

• Letterfromemployerconfirmingsalary

2 Maturity or surrender of life policy • Policyprovider• Policynumber/reference• Dateofsurrender• Amountreceived

• Certifiedcopyofclosingstatement• Letterconfirmingsurrender

3 Sale of shares or other investments/liquidation of investment portfolio

• Descriptionofshares/units/deposits• Nameofseller• Howlongheld• Saleamount• Datefundsreceived

• Certifiedinvestment/savingscertificates,contract notes, or surrender statements

• Bankstatementclearlyshowingreceiptoffunds and investment company name

• Signedletterdetailingfundsfromaregulated accountant

4 Sale of property • Soldpropertyaddress• Dateofsale• Totalsaleamount

• SignedletterfromSolicitor• Certifiedcopysalecontract• SignedletterfromEstateAgent

5 Company Sale •Nameandnatureofthecompany•Dateofsale•Totalamount•Applicant’ssignature

•Signedletterfromsolicitororregulatedaccountant

•Copyofcontractofsale,plusbankstatement showing proceeds

•Copiesofmediacoverage(ifapplicable)assupporting evidence

6 Inheritance • Nameofdeceased• Dateofdeath• Relationshiptoapplicant• Datereceived• Totalamount• Solicitor’sdetails

• GrantofProbate(withacopyofthewill),which must include the value of the estate

• SignedletterfromSolicitor

7 Divorce settlement • Datereceived• Totalamountreceived• Nameofdivorcedpartner

• Copyofcourtorder or• Solicitor’sletter

8 Company Profits • Nameandaddressofcompany• Natureofcompany• Amountofannualprofit

• Certifiedcopyoflatestauditedcompanyaccounts

9 Gift • Datereceived• Totalamount• Reasonforgift• Relationshiptoapplicant• Certifiedidentificationdocumentsfor

donor• Donor’ssourceofwealth–pleasefollow

standard requirements

• Donor’ssourceofwealth–requirementsof evidence as stated above for each individual source of wealth and a letter from the donor confirming details of the gift

10 Employer paying premium • Employerletter• Countryofincorporation• Incorporationnumber

• Employerletter,CertificateofIncorporation and certified copy of latest audited company accounts

Trust Applications

Where the payment is made by the trustees the same source of wealth information as above should be provided for the settlor and

settled monies.


DirectChargeAuthority

Please do not complete this page if you intend emailing (or scanning and emailing) this form back to us. We can only accept this

form via post or fax. Details can be accepted electronically via our secure website at www.fpinternational.com/creditcard

Credit Card payments can only be accepted in USD, GBP, HKD or EUR.

Please use BLOCK CAPITALS

We authorise you to debit our

Mastercard

VISACreditCard(8)

Name of issuing company or bank

Countryofissue

CreditCardNumber

| | |

| | |

| | |

| | |

CreditCardexpirydate(1)

| (month)

| | | (year)

with the sum of (3)

(figures)

(words)

(currency)

in respect of premiums for our Policy Number

collected on the (4)

of (month)

(year)

and on the same day until further notice

or cancelled in writing monthly

quarterly

half-yearly

yearly

NameonCreditCard

AddressofCreditCardHolder

(asheldbytheCardProvider)

Postcode Country

Telephone number (Daytime including area code)

Emailaddress

Signature

Date

Important notes1 WhenyourcurrentCreditCardexpiresorisreplaced,wewill

requireyoutocompleteanewDirectChargeAuthorityform.Alternatively,youcanupdateyourCreditCarddetailsonlineatwww.friendsprovident.co.uk/creditcard

2 WhenyourCreditCardpaymentisfirstset-upcertaincheckswillbe administered, including a pre-authorisation check. A nominal amount may show on your account, but the pre-authorisation is not a charge and no money will be deducted from your account.

3 Where premiums are paid by credit card there will be a handling charge of between 1% and 1.95% (depending on residency) of each premium paid. The handling charge will be collected in addition to the total premium amount meaning we will collect the total premium amount plus the handling charge from your credit card. The handling charge will be used to cover the charges imposed by the credit card issuing company.

4 Thepremiumcollectiondateisonaveragesixdayspriortothe due date on the policy. This may vary slightly to take into account seasonal and bank holidays.

5 Ifyouamendyourpremium,anewDirectChargeAuthorityformwill need to be completed and returned to us.

6 Ifapaymentisdeclined,wewillautomaticallyinformyourfinancial adviser by fax and request a duplicate payment the following month. This will apply to consecutive months if the policy remains in arrears. No more than two premiums should be collected each month until the premiums are up to date.

7 PleasenotethatsomeCreditCardscannotbeusedoutsidetheircountry of issue and therefore we strongly recommend that you contact your card issuer to ensure your card can be used in this instance.

8 PleasenotethatDebitCardscannotbeacceptedforpremiumpayments.

9 Please note we cannot accept this form via email.


Important Information

Product information

The information given in this document is based on Friends Provident International’s understanding of current Isle of Man law and taxation practice which may change in the future. No liability can be accepted for any personal tax consequences of this scheme or for the effect of future tax changes or legislative changes.

A copy of the Premier Advance policy document and provisions may be obtained from Friends Provident International on request.

Insurance policies may not be suitable for everyone. Investment involves risk and each class of investment will involve its own individual level of risk. We recommend that you read the Premier Advance product brochure carefully and discuss fully both the suitability of Premier Advance and the specific risks associated with individual investments with your financial adviser before making any investment decisions.

Premier Advance is intended for long-term investment and is not therefore designed for early encashment. If you do encash your policy early, an encashment charge may be applied. The earlier you terminate your policy, the more you may lose.

Mirror funds

All mirror fund performance is quoted net of annual charges. However, mirror fund performance should not be viewed as an indication of future performance – the value of your investment cannot be guaranteed and you may get back less than you paid in.

Mirror fund prices may go up and down depending upon the underlying investment performance or, where investments held within a mirror fund are not denominated in the currency of that mirror fund, simply because of movements in currency exchange rates.

Policyholder protection

To ensure the protection of policyholders’ interests the Isle of Man Insurance and Pensions Authority has put in place a number of statutory measures:

• Ring fencing of assets — the Insurance Act 2008 requires insurers to keep premiums received in a special‘long-termbusinessfund’,whichcanonlybeused to meet the claims and long-term liabilities of policyholders. The Act also requires the insurer to hold funds in excess of its long-term liabilities, and submit independently audited annual solvency reports to the regulator.

• A policyholder compensation fund — in the event that the above measures fail, and Friends Provident International is unable to meet its liabilities, all policyholders will benefit from the protection of the LifeAssurance(CompensationofPolicyholders)Regulations1991oftheIsleofMan,wherevertheirplaceofresidence.TheRegulationsensurethatintheunlikelyevent of Friends Provident International becoming insolvent, a levy would be made against all other Isle of Man resident life assurance companies so that up to 90% of our liabilities to eligible policyholders would be met (without any upper monetary limit).

Eachpolicyisgovernedbyandshallbeconstruedinaccordance with the law of the Isle of Man.

Investors should be aware that specific investor protection and compensation schemes that may exist in relation to collective investments and deposits accounts are unlikely to apply in the event of failure of such an investment held within insurance contracts.

ComplaintswecannotsettlecanbereferredtotheFinancialServices Ombudsman Scheme for the Isle of Man.

Please note that some telephone communications with Friends Provident International are monitored and may be randomly interrupted.

Copyright©2013FriendsProvidentInternational.

All rights reserved.

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 824405 Website: www.fpinternational.com

Incorporated company limited by shares Registered in the Isle of Man No. 11494 Authorised by the Isle of Man Insurance & Pensions Authority Provider 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. F06835G Registered by the Monetary Authority of Singapore to conduct life insurance business in Singapore

XIM16/A/TRUSTEE 05.13

Documents

Trustee Application Form · 2 XIM16/A/TRUSTEE 05.13 Please complete this Application Form in English ... Source of Wealth (including supporting documents, where required)* *Suitably