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Additional Investment Additional Investment This form is for use with the following: International Investment Bond International Investment Account International Savings Plan International Investment Plan Guernsey International Pension UltimaBond UltimaSave Flexible Savings Plan Flexible Investment Plan Versatile Investment Plan J22307_XGU02F_HL65001_1017.indd 1 30/08/17 3:12 pm Part 1 – Introduction – It is most important that you read this part before completing the application form. • Please use BLOCK CAPITALS throughout and tick the boxes where appropriate. • If you make a mistake please cross it out, put in the correct word or words and initial next to the correction. • Incorrect or incomplete application forms may delay the processing of this proposal. This may also result in the form being returned for completion. Part 2 – Details of Existing Policy Policyholder name(s) Policy number If you have changed your address since effecting the existing policy please provide the details below. Current residential address (including street name, town and area code if known) Email address Contact telephone number Part 3 – Financial Adviser Details Company name Contact details for acknowledgement/queries on the application. Contact name Telephone number Email address Country where advice given Country where application signed Part 4 – Details of Additional Investment Regular Single Amount of additional investment Minimum contribution Regular Single International Investment Bond n/a GBP 5,000 / USD 7,500 / EUR 7,500 International Investment Account GBP 50pm / GBP 600pa GBP 5,000 International Savings Plan GBP 50pm / GBP 600pa GBP 2,500 International Investment Plan GBP 50pm / GBP 600pa GBP 2,500 Guernsey International Pension GBP 50pm / GBP 600pa GBP 2,500 UltimaBond n/a GBP 5,000 / USD 10,000 / EUR 7,500 UltimaSave GBP 20pm / GBP 240pa GBP 500 USD 40pm / USD 480pa USD 1,000 EUR 30pm / EUR 360pa EUR 650 Flexible Savings Plan GBP 10pm / GBP 100pa GBP 500 Flexible Investment Plan GBP 10pm / GBP 100pa GBP 1,000 Versatile Investment Plan GBP 35pm / GBP 350pa n/a XGU02/F HL65001 10/2017 Page 2 J22307_XGU02F_HL65001_1017.indd 2 30/08/17 3:12 pm Part 4 – Details of Additional Investment (continued) Additional regular premium investments will be increased with effect from the next monthly or annual payment date. If your existing policy is written as a cluster of policies, your additional investment will be split equally between them. Each cluster is subject to the minimums shown in this section on page 2. Fund choice Please confirm which fund(s) you wish your increment to be invested in. Up to ten funds can be selected, including those in which you are already invested. For further information on funds please contact us. Our contact details can be found in the section ‘How to Contact Us’ on page 12. If this section is left blank we will assume you wish the fund choice to remain the same as your existing policy. Please use whole percentages only. Guernsey International Pensions only: Additional single contributions into the With Profit fund are only permitted provided the plan has a minimum of 10 years to run. Use existing fund selection. (Please tick if applicable.) Fund Manager Fund Name Currency % of contribution TOTAL 100% XGU02/F HL65001 10/2017 Page 3 J22307_XGU02F_HL65001_1017.indd 3 30/08/17 3:12 pm Part 5 – Trusts If the existing policy is written under trust, the trustees must sign this application authorising the additional investment. If there are more than two trustees, please submit this section from another form. Trustee Trustee Name Signature Date (DD/MM/YY) Part 6 – Declaration by the policyholder(s) – as named in the policy schedule l/We wish to make an additional investment into my/our policy, the details of which are shown above in accordance with the Policy Conditions. l/We understand that this will take effect upon acceptance of the application by Friends Provident International. l/We declare that any information and advice about this product given by my/our Financial Adviser was given only following my/our approach to the Financial Adviser requesting information and advice on life assurance contracts offered by Friends Provident International. Signature of first policyholder and date (DD/MM/YY) Signature of second policyholder and date (DD/MM/YY) XGU02/F HL65001 10/2017 Page 4 J22307_XGU02F_HL65001_1017.indd 4 30/08/17 3:12 pm Part 7 – Verification of Identity and Source of Funds (VISF) for Individuals Important note One VISF form must be completed for each individual, ie Applicant(s), Premium Payer(s). Guidance notes on how to complete this form and additional VISF forms are available in the ’IFA’ section of our website, www.fpinternational. com or by contacting us on +44(0) 1722 415088. The adviser must complete both sides of this form. It forms the prevention of money laundering check and is essential to the acceptance of this application. It will delay the processing of this application if not completed fully and correctly. Section A – Verification subject: Individual Please see appropriate ID and Residency guide for list of acceptable documentation. Full name Occupation Nature of Employer’s business Customer Type, please tick one of the boxes below: Premium Payer/ Applicant Other Joint account holder (ie Protector, Director, Shareholder, Settlor, Trustee or Major Beneficiary) Please go to section B Please go to section D Please go to section D If the verification subject is not an applicant, please go straight to section D. Section B – Source of Funds Please tick one of the following: I can confirm the premium is: Originating from the account details provided on the credit card mandate, direct debit mandate or cheque. If this is being paid by third party please proceed to section C. Being paid by telegraphic transfer and that it originates from the bank details provided below. Account holder Bank name name(s) and address Account number Sort Code/ Swift Number If this is a third party please proceed to section C. Being paid by a banker’s draft. I enclose proof of purchase/remittance advice with the application. If this is being paid by a third party please proceed to section C. Originating from a matured/surrendered policy or a withdrawal payment from the details below. Product provider Policyholder name name(s) Policy number If this is a third party please proceed to section C. XGU02/F HL65001 10/2017 Page 5 J22307_XGU02F_HL65001_1017.indd 5 30/08/17 3:12 pm Section C – Third Party Paying the Premium As the premium is being paid by a third party you must complete the questions below and a separate Verification of Identity or Source of Funds form, sections A and D. 1 Please confirm the relationship between the applicant(s) and premium payer(s) 2 Please provide a detailed explanation why the premium is not being paid by the applicant 3 If the premium originates from the applicant’s account via a third party account then you must provide the applicant(s) bank details below. Account holder Bank name name(s) and address Account number Sort code/ Swift code Section D – Verification of Identity and Proof of Residential Address Please see appropriate ID and Residency guide for list of acceptable documentation. Please tick one of the following: I am claiming the Small Premium Exemption as this premium and any premiums from existing policies the customer has, does not exceed £50pm or £600pa. I understand that if the premium exceeds the limits given above, I will be asked to fully complete a Verification of Identity and Proof of Residential address check for the individual. OR I have verified the identity of the individual overleaf and can confirm that I have seen the original document(s) specified. The document(s) were pre-signed and the photographs bears a true likeness. Verification of Identity Proof of residential address Type of document seen Reference number Issue date (DD/MM/YY) Expiry date (DD/MM/YY) Issuing authority IFAs outside of the EU, Channel Islands, Isle of Man, Iceland and Gibraltar must provide certified copies of documentary evidence. The document used to verify identity must not be the same as the document used for proof of residential address.* *Please note that we can no longer accept a credit card statement as proof of address. I/We hereby confirm that: A evidence of the identity of the above has been seen in accordance with the provisions of the European Council Directive 91/308/EEC and relevant national legislation. B (if premium exceeds £50pm or £600pa) I/we have identified the above and confirmed that I/we have seen the original document(s) specified, the document(s) were pre-signed and the photograph(s) bear a true likeness. C I/we am/are unaware of any activities on the part of the above customer(s) which lead me to suspect that the customer is or has been involved in criminal activity or Money Laundering. Should I/we subsequently become suspicious of any such activity, I/we shall advise you immediately. D I/we am/are satisfied that we could physically locate the residential address(es) by way of a recorded description or other means. E the particulars given and statements made within the Source of Funds and Verification of Identity sections are to the best of my/our knowledge and belief true. Financial Adviser Signed Full name, please print Date (DD/MM/YY) XGU02/F HL65001 10/2017 Page 6 J22307_XGU02F_HL65001_1017.indd 6 30/08/17 3:12 pm Verification of Identity and Source of Funds (VISF) for Non Individuals Important note Guidance notes on how to complete this form and additional VISF forms are available in the ’IFA’ section of our website, www.fpinternational.com or by contacting us on +44(0) 1722 415088.
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