1
Who is this form for?
This form is for applicants or plan owners of any of the following RL360 products:
Oracle
Personal Investment Management Service (PIMS)
Completing this form
Please complete in BLOCK capitals throughout.
By completing this form you will be authorising RL360 to take a fee from your plan that will be paid to:
(financial adviser company and address)
RL360 adviser number:
We can only accept written instructions that have been signed by all applicants, plan owners, trustees or
authorised signatories.
When you have completed this form, please send it to: RL360, International House, Cooil Road, Douglas, Isle of
Man, IM2 2SP.
Important notes
1. As this instruction will result in a deduction from your plan to meet the fee you are agreeing to pay, you should
note that this deduction may form part of any deferred tax allowance for your country of residence. You should
consult your tax adviser to determine whether this could aect you.
2. RL360 cannot be held responsible for any future tax liability that may accrue to the adviser as a result of a failure
to levy tax where it later transpires that it should have been charged. The adviser is responsible for deciding
whether or not the service they are providing is subject to any additional taxes.
3. The fee will be added to your plan from the date when we receive the completed form. Commencement will be
subject to product rules, details of which can be found on page 2.
4. The value of any additional payments made to the original plan will be treated as part of its value when the fees
are calculated.
5. This agreement shall be subject to, and interpreted in, accordance with the laws of the Isle of Man.
6. I confirm that I will inform RL360 in writing should I wish to terminate payment of this fee.
AUTHORISATION TO PAY
A FINANCIAL ADVISER FEE
SERVICING
2
Applicant(s) or plan owner(s) to complete
Plan reference
I authorise RL360 to pay the following fee to my financial adviser:
Financial adviser fee
%
per year, paid quarterly in arrears as percentage of my plan value.
For Oracle plans:
The fee will commence from the date when we receive your completed form. It will be calculated and paid each quarter from
the plan anniversary.
The fee should not be more than 1% per year.
Where this fee is used in conjunction with an Investment Adviser Fee, the two fees combined cannot be more than 1.5%.
For PIMS plans:
The fee will commence from the date when we receive your completed form. It will be calculated and paid each quarter from
the plan anniversary.
The fee should not be more than 1.5% per year.
Where this fee is used in conjunction with an Investment Adviser Fee, the two fees combined cannot be more than 2%.
Applicant/Plan owner/Trustee/ Applicant/Plan owner/Trustee/
Authorised signatory Authorised signatory
Signed
Full name
Trust or company
name (if applicable)
Date (dd/mm/yyyy)
Trustee/Authorised signatory Trustee/Authorised signatory
Signed
Full name
Trust or company
name (if applicable)
Date (dd/mm/yyyy)
Privacy policy
Our full privacy policy can be viewed at www.rl360.com/privacy or can be obtained by requesting a copy from our Data
Protection Ocer.
RL267a 02/19
RL360 Insurance Company Limited. Registered Oce: International House, Cooil Road, Douglas,
Isle of Man, IM2 2SP, British Isles. Registered in the Isle of Man number 053002C. RL360
Insurance Company Limited is authorised by the Isle of Man Financial Services Authority.