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LIFE ASSURANCE (RL360)

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REGULAR
SAVINGS
PLAN
LIFE ASSURANCE
CORPORATE
TRUSTEE
APPLICATION
FORM
TABLE
OF
CONTENTS
01
PAGE 1
YOUR DETAILS
02
PAGE 3
LIVES ASSURED
03
PAGE 3
PLAN REQUIREMENTS
04
PAGE 4
CHOICE OF FUNDS
05
PAGE 5
SOURCE OF WEALTH DETAILS
Tell us how the Settlor's wealth was
accumulated. It is important that you
complete this section so that we can
meet Isle of Man anti-money laundering
requirements.
06
PAGE 6
ADDITIONAL INFORMATION
07
PAGE 6
PAYMENT OF PROCEEDS
08
PAGE 7
DECLARATION
In this section you must agree to the
plan terms and conditions and sign
where appropriate.
09
PAGE 10
FINANCIAL ADVISER DETAILS
10
PAGE 11
APPLICATION CHECKLIST
11
PAGE 13
PAYMENT METHODS
AUTHORISATION TO PAY A
FINANCIAL ADVISER FEE
(OPTIONAL)
PAGE 19
INVESTMENT ADVISER
APPOINTMENT (OPTIONAL)
PAGE 21
COMPLETION
Please complete this form using BLOCK CAPITALS throughout. Please tick boxes where applicable and follow the instructions
provided in each section. Please use Section 10 - Application Checklist before submitting your application, to make sure that you
provide us with everything we need to process your application.
US Specified Person means a US citizen or tax resident individual, who either holds a US Passport, a US Green Card, has a US
residential/correspondence address or who was born in the US and has not yet renounced their US citizenship. More information on
US FATCA can be found at www.irs.gov/businesses/corporations/foreign-account-tax-compliance-act-fatca.
A copy of the completed application and the plan Terms and Conditions are available on request. You should be aware that your
plan could be brought to an end if you fail to tell us any facts which might influence our assessment of your application. If you have
any doubt as to whether a fact is relevant, then you should disclose it to us.
Once you have completed and signed the application you should send it along with all requested additional information to our New
Business Team, RL360, International House, Cooil Road, Douglas, Isle of Man, IM2 2SP, British Isles.
Please note that the start date of your plan may be delayed if you fail to complete this application in full or provide suitable
evidence where required.
Where both the Corporate Trustee and the Settlor(s) are resident in the Isle of Man, the Settlor(s) must complete an Automatic
Exchange of Information - Individual Self Certification form. The form can be downloaded from www.rl360.com.
Remember, if you need any help, our Regional Support teams are on hand to guide you by telephone or by email.
All references to RL360 within this application form mean RL360 Insurance Company Limited.
1 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
01 YOUR DETAILS
If you require online servicing for your company please download our agreement and registration forms from our website
– www.rl360.com. If you wish to link this plan to your existing online service please quote your online reference or existing
username below.
Online reference or
existing username
Details of the trust
Name of the trust
Date trust was established
(dd/mm/yyyy)
Nature and purpose of the trust
Corporate trustee details
Corporate trustee name
Global Intermediary Identification
Number (FATCA GIIN)
Registered address and
postcode (in full)
Country
Contact name
Contact position
Telephone number
Email address
Correspondence details
Please note that any correspondence we are required to send to you will be sent to the address you provide here. If no
correspondence address is supplied we will use your registered address.
Address for correspondence
and postcode
Directors or partners
You will need to provide us with a list of all directors or partners for your business, but we also need you to name two directors,
one an executive director, for identity verification purposes. Please state their details here
Executive Director/Partner 1 (must be completed) Director/Partner 2 (must be completed)
Sex (please tick)
Male
Female
Male
Female
Title (please tick)
Mr
Mrs
Miss
Mr
Mrs
Miss
Other (in full) Other (in full)
First name(s)
Last name(s)
Date of birth (dd/mm/yyyy)
Current residential
address and
postcode (in full)
Country
Position
2 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
01 YOUR DETAILS CONTINUED
Authorised signatories
You will need to provide us with a list of all authorised signatories, but please tell us how many signatories will need to sign
in order to action changes to the plan (including any special instructions, for example – one from category ‘A’ and one from
category ‘B’)
Number of signatories required
Special instructions
Shareholders and beneficial interest
Please tell us who in your company has a shareholding or beneficial interest of 25% or more. You will have to provide verification
of identity for those listed.
First Name(s) Last Name(s) Position Shareholding (%)
Evidence required
As a corporate trustee applicant, please tick to confirm that you have supplied the following:
For the company
• A full list of all directors.
• Suitably certified certificate of incorporation.
• A copy of the latest annual report and accounts.
• Suitably certified documentation verifying registered address of the company.
• Suitably certified identity and address documentation for at least two directors, one of whom must be an Executive Director.
• A full list of authorised signatories (including board resolution for public limited companies) showing ocers from whom we
can take instructions and including specimen signatures.
• Suitably certified identity and address documentation for all shareholders with a beneficial interest of 25% or more.
For the trust
• Suitably certified copy of the trust deed and any subsequent deed(s) of appointment or retirement.
If not shown in the trust deed we will require details for each of the following:
Settlor(s) Protector(s) Beneficiaries (where named)
First name
✓ ✓ ✓
Last name
✓ ✓ ✓
Date of birth
✓ ✓ ✓
Current residential address
✓ ✓ ✓
Occupation
✓
x x
Date of death
✓
#
x x
#
for Settlor(s) no longer alive.
3 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
02 LIVES ASSURED
There may be up to 2 lives assured added to the plan.
Life assured 1 Life assured 2
Sex (please tick)
Male
Female
Male
Female
Title (please tick)
Mr
Mrs
Miss
Mr
Mrs
Miss
Other (in full) Other (in full)
First name(s)
Last name(s)
Date of birth (dd/mm/yyyy)
Nationality
Current residential
address and
postcode (in full)
Country
03 PLAN REQUIREMENTS
Who will fund
The applicant
Settlor(s)*
the plan?
* Please provide a certified copy of the Settlor's ID along with a certified copy of their proof of residential address.
IMPORTANT: The following information MUST match the details shown on your Key Information Document.
Plan currency GBP USD EUR CHF AUD HKD JPY
Amount
Payment frequency Monthly
Quarterly
Half-yearly
Yearly
Payment term
(years)
Establishment period
(months)
Segmentation
How would you like your plan to be segmented? 100 segments One segment
If you leave this section blank we will issue your plan with 100 segments.
Payment method
You can make payments monthly or quarterly by credit/debit card, standing order or direct debit. If you prefer, you can make
payments on a half-yearly or yearly basis by credit/debit card, standing order, direct debit, telegraphic transfer or cheque.
Credit/debit card (please complete the credit card mandate on page 14)
Direct debit (GBP payments from UK and Channel Island banks only) (please complete the direct debit instruction on page 16)
Standing order (please complete the standing order instruction on page 17)
Cheque (half-yearly or yearly payment only) (please complete the banking details on the next page)
Telegraphic transfer (half-yearly or yearly payment only) (please complete the banking details on the next page)
4 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
03 PLAN REQUIREMENTS CONTINUED
IMPORTANT:
some banking institutions may deduct charges for processing international payments. Please check with your bank
if any charges apply prior to transferring your payment to us. If they do, please make sure that the amount your bank transfers is
enough, so that the remaining amount received is at least equal to the amount due.
Payments by cheque or telegraphic transfer
Please confirm the details of the bank that you will be making payment from.
If you want to use a Currency Exchange House to transfer your payment to us, please ensure that it has been approved by
RL360 first. Please also provide your bank account details below from where the payment originates, along with a full audit trail
to evidence the transfer to us.
Bank name
Bank address and
postcode
Account holder’s name
Branch SWIFT code
OR Bank sort code
- -
(for all non–GBP and international payments) (for UK GBP payments only)
SWIFT code must be either 8 or 11 digits
IBAN/account number
OR
Account number
(all non–GBP accounts) (GBP UK Bank only)
Account held for
years
months
04 CHOICE OF FUNDS
Fund choice
Please list your choice of funds below, up to a maximum of 10 funds. The minimum investment per fund is GBP25/USD50/
EUR50/CHF50/AUD50/HKD500/JPY5,000.
Please ensure that the percentages invested total 100%.
ISIN Fund name Currency Percentage
of payment
%
%
%
%
%
%
%
%
%
%
100%
5 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
05 SOURCE OF WEALTH DETAILS
The Insurance (Anti-Money Laundering) Regulations 2008 requires all Isle of Man life companies to make enquiries as to how an
applicant has acquired the monies to be used as payment for their plan. This reflects the Isle of Man’s commitment to maintain
the highest possible standards of business practice and to counter money laundering and the financing of terrorism.
RL360 has adopted a risk-based approach to meet these regulations, categorising all countries that we will accept business from
into 1 of 3 tiers. Each tier has dierent source of wealth requirements. We have categorised countries according to their level of
compliance with international regulatory standards.
Full details on the source of wealth procedures can be obtained from your financial adviser or can be downloaded from
www.rl360.com/sourceofwealth.pdf.
You must complete the following questions below in all cases and for both Settlors as applicable.
Settlor 1 Settlor 2
Annual salary plus bonuses
Income this year
(include currency)
Income last year
(include currency)
Occupation
Employer’s company
name
Nature of business
Other unearned income
Amount received
(include currency)
Received from
Date received (dd/mm/yyyy)
If you intend to fund your plan from another source, please indicate which one from the list below for each Settlor and provide
the relevant information as requested in Section 06 – Additional Information.
Source of funds/wealth Settlor 1 Settlor 2 Information required
Savings
Amount* | Bank where savings were held | How were savings accumulated?
Property sale Amount* | Address of property | How long held | Date of sale
Sale of asset
Amount* | Asset type | How long held | Date of sale
Company profits
Profits this year* | Profits last year* | Company name and industry
Company sale
Amount* | Company name and industry | Date of sale
Maturing investment
Amount* | From which company | Date of sale
Lottery/betting/casino
Amount* | Source of win | Date received
Compensation
payment
Amount* | Reason for payment | Date received
Gift or Inheritance
Amount* | Relationship to benefactor | Reason for gift | Date received
Other
Amount* | Reason for payment | Date received
* Please include currency
RL360 reserves the right to request further documentary evidence of source of wealth should it be considered necessary.
6 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
06 ADDITIONAL INFORMATION
If you have no additional notes, please continue to Section 07 - Payment of Proceeds.
07 PAYMENT OF PROCEEDS
You do not have to complete this section now, however, if you do:
•
it may help us to speed up the payment of withdrawals or plan proceeds in the future; and
•
it will help strengthen our anti-fraud procedures.
Payment can only be made to a bank account in your name, as the applicant.
Bank name
Bank address and
postcode
Account holder’s name
Branch SWIFT code
OR Bank sort code
- -
(for all non–GBP and international payments) (for UK GBP payments only)
SWIFT code must be either 8 or 11 digits
IBAN/account number
OR
Account number
(all non–GBP accounts) (GBP UK Bank only)
7 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
08 DECLARATION
Plan literature
I confirm that I have read a copy of the plan literature including the Product Guide, Key Information Document, Terms and
Conditions and Fund Guide.
My application
I confirm that all of the information I have provided in this application, along with any supporting forms, questionnaires,
statements, reports or other information are true and complete.
I am aware that I am contractually required to make payments to RL360 on the frequency I have indicated, and if I stop paying
before the end of the payment term and cancel my plan, early exit charges will apply. I understand that if I stop payments during my
plans establishment period I will receive no money back, the only exception to this being where I have used my right to cancel.
Availability
I confirm that to the best of my knowledge and belief, I am not subject to any legislation that would make my investment into
this plan unlawful.
Financial adviser
I have appointed
(company name)
to act as my financial adviser.
I agree to RL360 disclosing all information relating to my plan to my appointed financial adviser. I will let RL360 know in writing
if I decide to change my appointed financial adviser.
Illustration
I understand that my Illustration is not guaranteed by RL360 or my adviser, and only oers an indication of what I might get
back under a limited number of scenarios. I accept that RL360 is not responsible for monitoring whether my plan's performance
matches the assumptions made in my Illustration.
Key Information Document (KID)
I confirm that I have included a signed KID with this application.
I understand that the KID sets out the details of my plan, and by signing it I acknowledge that I am aware of the charges that will
be deducted.
I am also aware that the details that I have provided in Section 03 – Plan Requirements must match my signed KID. If they are
dierent RL360 will ask me to sign a new KID matching Section 03 – Plan Requirements before it can allow my plan to start.
Investment
I am aware that RL360 does not provide investment advice, is not responsible for managing funds and does not determine
whether or not funds are suitable for me. I understand that my plan oers access to a range of funds and that these are
managed by external companies. I accept that ultimate responsibility for fund selection lies with me and/or my appointed
adviser; if funds underperform and as a consequence my plan drops in value, I accept this is not the fault of RL360.
I request that RL360 allocates my payments to the funds selected as part of this application. In order for RL360 to do this I
confirm the following:
a) I agree to RL360 acting on instructions received from me or my appointed adviser, and I will read the documentation issued
by the fund manager for each fund prior to selecting it for my plan.
b) I am aware that some funds may have terms and conditions that could:
i) restrict RL360 from realising a cash value when requested and prevent RL360 paying out benefits from the plan in a
timely fashion.
ii) result in RL360 having to pay back some or all of the sale proceeds if an adjustment has to be made after the payment. If
RL360 is required to make such a repayment and the plan value is too low to cover it, or I have cancelled my plan, I agree
to compensate RL360 for any loss that it has suered as a result.
c) I accept that RL360 has the right to sell funds linked to the plan without requiring my permission. RL360 may do this if it
decides that a fund may have harmful legal or tax consequences under law.
d) I am aware that there may be fees to pay when RL360 sells one or more of the funds linked to my plan. Any fees due when
selling a fund should be detailed by the fund manager in the fund documentation.
e) I confirm that I am aware of the fees that I must pay in relation to my chosen funds.
I confirm that I have the necessary powers to take out this plan and enter into a contract with RL360.
I also confirm that my company has not been, and is not in the process of being, struck-o, dissolved, wound-up or terminated.
8 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
08 DECLARATION CONTINUED
I agree that I will notify RL360 in writing immediately when any of the directors, list of authorised signatories or trustees change.
I agree that I will provide evidence of identity and current residential address when asked by RL360. I also acknowledge that
RL360 can ask for an up-to-date authorised signatory list at any time.
I am aware that RL360 is authorised to obtain a bank reference at any time.
Payments
Where the Settlor wishes to make payments direct to RL360, I acknowledge and confirm the following:
a) I acknowledge that it is usual practice for all initial and incremental settlements into a trust to be received by the Trustees and
then subsequently invested in accordance with the Settlor’s wishes.
b) I acknowledge and confirm that RL360 may accept payments directly from the Settlor(s), and that I am not aware of any legal
or regulatory reason why they should not do so.
c) I confirm that all payments made by the Settlor(s) into the plan constitute Trust funds.
d) I confirm that full customer due diligence documentation and source of wealth information will be supplied to RL360 in
respect of the Settlor(s).
e) I accept responsibility for informing you of any specific cases where the Trustees wish to make payments from the Trust bank
account to the plan.
f) I understand that RL360 may be unable to accept payments originating in some jurisdictions as a result of international or
banking sanctions.
Data protection
This form collects your personal data. We require your personal data so we can provide you with services relating to the
performance of your plan. You may ask us to stop processing your data, however this may disrupt the services RL360 can
provide to you or may stop us being able to assist you. To find out how long we will keep your data, please refer to our privacy
policy at www.rl360.com/privacy. Any data you provide to RL360 may be shared, if allowed by law, with other companies both
inside and outside of RL360 and to persons who act on your behalf. Data and information about you can be transferred outside
of the Isle of Man and RL360 may be required to provide it to its regulator, its government or anyone else required by law.
RL360 will use your data and information to allow for the administration of your plan, prevent crime, prosecute criminals and for
market research and statistics. RL360 will, at all times, make sure that your data and information is only used in ways that are
allowed by law.
You can receive a copy of the information RL360 holds about you free of charge by writing to our Data Protection Ocer at:
RL360, International House, Cooil Road, Douglas, Isle of Man, IM2 2SP, British Isles, or by emailing dpo@rl360.com. We can reserve
the right to not send you your personal data in some circumstances - if we do we will write to you setting out the reasons why.
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.
Politically Exposed Persons
A Politically Exposed Person (PEP) is a person entrusted with prominent public functions, their immediate family members or
persons known to be close associates of such persons.
Examples of PEPs include political figures, members of the judiciary, diplomatic service ocers, managers and supervisors of
state owned enterprises and senior ranking military ocers.
Please add the names of any PEPs associated with this application in the box below.
Where this box is left blank, you are confirming that no PEPs are associated with this plan.
Legal
I agree to my plan being governed by Isle of Man law and to the Isle of Man Courts having the right to decide any case that
maybe brought in relation to my plan.
9 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
08 DECLARATION CONTINUED
Cancellation
I am aware that I have the right to cancel my plan as detailed in the Key Information Document. I understand that the amount I
get back may be less than what I paid where my selected funds have fallen in value. I am aware that to cancel my plan I will need
to complete the Cancellation Notice and return it to RL360.
Final agreement
I agree to the following documents forming the basis of the contract between me and RL360:
• this Application Form
• My Key Information Document
• The Terms and Conditions
• The Plan Schedule
• Any Endorsement to the Plan Schedule.
I accept that RL360 can bring my plan to an end if I have failed to detail any facts that may influence the decision to accept
this application.
I confirm that this application was signed in (give country)
Trustee 1/Authorised signatory Trustee 2/Authorised signatory
Signed
Full name
Date (dd/mm/yyyy)
Trustee 3/Authorised signatory Trustee 4/Authorised signatory
Signed
Full name
Date (dd/mm/yyyy)
10 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
09 FINANCIAL ADVISER DETAILS
This section is to be completed by your financial adviser.
The RL360 adviser number can be obtained from your regional oce.
Company name
RL360 adviser number
Name of regulatory or
authorising body
Regulatory number
(if applicable)
Financial adviser's stamp
(if this does not state an
address, please complete
company address details too)
Full name
Online services username
(if registered)
Work telephone number
Mobile telephone number
Email address
I confirm that I have seen documentary proof of the applicant's identity, and certification of their residential address, and have,
where applicable, attached suitably certified copies of both as set out in the completion notes, along with this application.
Signed
Date (dd/mm/yyyy)
11 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
10 APPLICATION CHECKLIST
This checklist will help make sure you have provided everything we need to process your application.
Verification of identity – must be provided for all directors/partners named in Section 01 – Your Details.
Please send a suitably certified copy* of their passport or National Identity Card showing their photograph(s) and signature – If
you are unable to provide either of these please provide a reason why and contact us to discuss other acceptable documents
before sending in your application.
Applicants
I have provided identification (please tick to confirm)
If you are unable to provide ID please confirm why below:
Verification of current residential address – must be provided for all applicants
Please send a suitably certified copy* of at least one of the following documents for each director/partner named in Section
01 - Your Details. If you are unable to provide any of the documents listed below, please provide a reason why in Section 06 –
Additional Information and contact us to discuss other acceptable documents before sending in your application.
Please tick which
documents you
have sent us
Acceptable document
Latest bank account or credit card statement
Utility, rates or council tax bill (less than 3 months old). Mobile telephone bills are not acceptable
Current driving licence
Proof of ownership or rental at current residential address
Mortgage statement
Tax assessment document
State pension, benefit book or other government produced document showing benefit entitlement
Extract from ocial register of electors
Proof of payment for a PO Box service (which must also show the residential address) where the PO Box
shown is also the correspondence address of the applicant
Entry in local telephone directory.
Confirmation of plan details
Please make sure you have completed Section 03 – Plan Requirements and have included a signed Illustration and Key
Information Document.
I have provided my plan requirements and can confirm that they match my Key Information Document (please tick to confirm).
I have included a signed Illustration and Key Information Document (please tick to confirm).
Settlor(s)
Where the Settlor(s) fund the plan, please tick to confirm that you have provided the following documentation
Certified copy of the Settlor's ID
Certified copy of the Settlor's proof of residential address
12 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
10 APPLICATION CHECKLIST CONTINUED
*Suitably Certified Copy Documentation
Your financial adviser can certify your copy documents, if they hold established Terms of Business with us and, where appropriate,
have been granted Suitable Certifier status. Please consult your financial adviser to check if they can certify your documents.
If your financial adviser cannot certify your documents, we will accept certification by one of the following ‘Suitable Certifiers’:
• A Notary Public (or equivalent)
• A lawyer or advocate
• A formally appointed member of the judiciary
• An employee of RL360
• A Commissioner for Oaths
• A registrar or other civil or public servant authorised to issue or certify copy documents.
If you cannot have your documents certified by one of the above, please contact us.
The certifier must:
•
Add the statement ‘Certified as a true copy taken from the original’
•
Sign and date the copy document on all pages
•
Print their name clearly in BLOCK CAPITALS underneath their signature
•
Record the capacity or position in which they are certifying the document
•
Add their company name or ocial stamp or seal.
The documents which we receive
must
contain the original certification and stamp.
13 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
11 PAYMENT METHODS
If you wish to pay by card, standing order or direct debit, please complete the appropriate payment method form or
alternatively, please follow the relevant instructions below.
Cheque
Please send your cheque, made payable to RL360 Insurance Company Limited to RL360, International House, Cooil Road,
Douglas, Isle of Man, IM2 2SP, British Isles.
Your cheque must come from the bank account you have detailed in Section 03 – Plan Requirements.
Please note that GBP cheques can take up to five working days to clear. Other currency cheques may take considerably longer
to clear.
Telegraphic transfer
If you are paying into your plan by telegraphic transfer please instruct your bank to quote your name as a reference.
Your payment must come from the bank account you have detailed in Section 03 – Plan Requirements.
Please make your payment to RL360 Insurance Company Limited through the appropriate bank below.
Currency SWIFT code IBAN Sort code Account number Bank name Account name
AUD CITIGB2L GB45 CITI 1850 0813 1419 34 18-50-08 13141934 Citibank, London RL360
CHF CITIGB2L GB26 CITI 1850 0813 1418 88 18-50-08 13141888 Citibank, London RL360
EUR CITIGB2L GB20 CITI 1850 0813 1418 02 18-50-08 13141802 Citibank, London RL360
GBP CITIGB2L GB34 CITI 1850 0813 1420 35 18-50-08 13142035 Citibank, London RL360
HKD CITIGB2L GB10 CITI 1850 0813 1416 91 18-50-08 13141691 Citibank, London RL360
JPY CITIGB2L GB26 CITI 1850 0813 1415 00 18-50-08 13141500 Citibank, London RL360
USD CITIGB2L GB54 CITI 1850 0813 1415 78 18-50-08 13141578 Citibank, London RL360
Bank address
The bank address for all the above accounts is: Citibank, Citigroup Centre, Canada Square, Canary Wharf, London, E14 5LB, UK.
14 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
CREDIT AND DEBIT
CARD MANDATE
Important
We are only able to accept cards with one of the logos above and prefixed with a ‘3’, a ‘4’ or a ‘5’.
The maximum amount that can be collected by credit card is GBP99,999.99 (or currency equivalent) per payment.
I authorise you, until further notice in writing, to collect payments as detailed below:
Currency GBP USD EUR CHF AUD HKD JPY
Payment amount in figures
Payment amount in words
Payment frequency
Monthly
Quarterly
Half-yearly
Yearly
Starting on (dd/mm/yyyy)*
* this applies to initial payment only, future payments are deducted
2 working days prior to the payment due date.
Card type Mastercard/Eurocard
Visa
JCB
American Express*
* The amount we collect from your card will be 1% higher than your payment amount to cover
additional charges applied by American Express.
Card issued by
(name of bank)
Country of card issuer
Cardholder’s name(s)
Cardholder’s address
(as held by
the card issuer)
The cardholder’s address should be the same as that of the applicant(s). If it is not, please
provide reasons why in Section 06 – Additional Information.
Card number
- - -
Expiry date (mm–yy)
-
I understand that RL360 Insurance Company Limited (RL360) will advise me of the amount to be paid and the dates on which
payment is due and that RL360 may only change these after giving me prior notice.
I understand that this authority in favour of RL360 will remain in force until such time as I cancel it in writing.
Signature of
cardholder(s)
Date (dd/mm/yyyy)
REGULAR SAVINGS PLAN
15 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
Additional information
In order to comply with the Isle of Man Insurance (Anti-Money Laundering Regulations) 2008, we may require additional source of
wealth evidence subject to where the bank that issued your credit or debit card is registered. For further information about country
tiers please refer to our source of wealth information document available online at www.rl360.com/sourceofwealth.pdf.
CREDIT CARD PRE-AUTHORISATION
Pre-authorisation is the process of pre-approving payments with the card provider. We carry out this process to make sure that the
card’s details are correct and working properly prior to collecting the payment.
This process will create a pre-authorisation on the credit card for one unit of the currency payments are made in i.e. GBP1.00/
USD1.00/EUR1.00 etc. This amount may not appear on the credit card statement, but will aect the card balance or spending limit
until the card provider removes it.
If the cardholder has opted to receive text messages, they may get a confirmation text for this transaction.
16 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
REGULAR SAVINGS PLAN
DIRECT DEBIT
INSTRUCTION
Important
GBP payments from UK and Channel Island banks only.
Any changes to your payment will be applied without the need for a further instruction.
Service User Number
2 7 0 0 5 0
Name and full postal address of your bank or building society branch
To the manager
Bank/Building Society
Bank address
Name(s) of account holder(s)
Bank sort code
- -
Account number
Instruction to your bank or building society
Please pay RL360 Insurance Company Limited Direct Debits from the account detailed in this Instruction, subject to the
safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with RL360 Insurance Company
Limited and, if so, details will be passed electronically to my bank/building society.
Account holder 1/Authorised signatory Account holder 2/Authorised signatory
Signed
Full name
Date (dd/mm/yyyy)
Banks and building societies may not accept Direct Debit instructions from some types of account
THE DIRECT DEBIT GUARANTEE
• This Guarantee is oered by all banks and building societies that accept instructions to pay Direct Debits
• If there are any changes to the amount, date or frequency of your Direct Debit, RL360 Insurance Company Limited will notify you 14
working days in advance of your account being debited or as otherwise agreed. If you request RL360 Insurance Company Limited to
collect a payment, confirmation of the amount and date will be given to you at the time of the request
• If an error is made in the payment of your Direct Debit by RL360 Insurance Company Limited or your bank or building society
you are entitled to a full and immediate refund of the amount paid from your bank or building society – If you receive a refund
you are not entitled to, you must pay it back when RL360 Insurance Company Limited asks you to.
• You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be
required. Please also notify us.
This guarantee should be detached and retained by the payer.
17 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
STANDING ORDER
INSTRUCTION
Important
If you wish to change the amount you pay into your plan at a later date, you will need to complete a new standing order
instruction. If you wish to cancel your standing order you will need to do this directly through your bank.
To the manager
Bank/Building Society
Bank address
Plan reference
This reference number will be supplied by RL360 after receipt of the application and must be quoted by your bank on all
correspondence. Failure to do so may result in payment being rejected by our bankers.
Please debit the payment amount, together with any transfer charges, from my account detailed below:
Currency GBP USD EUR CHF AUD HKD JPY
Payment amount in figures
Payment amount in words
Payment frequency
Monthly
Quarterly
Half-yearly
Yearly
Payment start date
(dd/mm/yyyy)
Name(s) of account holder(s)
Branch SWIFT code
OR Bank sort code
- -
(for all non–GBP and international payments) (for UK GBP payments only)
SWIFT code must be either 8 or 11 digits
IBAN/account number
OR
Account number
(all non–GBP accounts) (GBP UK Bank only)
REGULAR SAVINGS PLAN
18 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
Please tick the box in the table below that matches your plan currency.
Tick one Currency SWIFT code IBAN Sort code Account
number
Bank name Account
name
AUD CITIGB2L GB45 CITI 1850 0813 1419 34 18-50-08 13141934 Citibank, London RL360
CHF CITIGB2L GB26 CITI 1850 0813 1418 88 18-50-08 13141888 Citibank, London RL360
EUR CITIGB2L GB20 CITI 1850 0813 1418 02 18-50-08 13141802 Citibank, London RL360
GBP CITIGB2L GB34 CITI 1850 0813 1420 35 18-50-08 13142035 Citibank, London RL360
HKD CITIGB2L GB10 CITI 1850 0813 1416 91 18-50-08 13141691 Citibank, London RL360
JPY CITIGB2L GB26 CITI 1850 0813 1415 00 18-50-08 13141500 Citibank, London RL360
USD CITIGB2L GB54 CITI 1850 0813 1415 78 18-50-08 13141578 Citibank, London RL360
Bank address
The bank address for all the above accounts is: Citibank, Citigroup Centre, Canada Square, Canary Wharf, London, E14 5LB, UK.
Account holder 1/Authorised signatory Account holder 2/Authorised signatory
Signed
Full name
Date (dd/mm/yyyy)
19 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
AUTHORISATION TO PAY
A FINANCIAL ADVISER FEE
Please complete in BLOCK capitals throughout.
Who is this form for?
This form is for applicants who wish to authorise RL360 to pay a financial adviser fee to:
(adviser company and address)
RL360 adviser number:
We can only accept instructions that have been signed by all applicants.
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. This fee is calculated and paid each quarter from the plan anniversary.
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.
Applicant to complete
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 (the fee should not be more than 1.0% per year).
Note: where this fee is used in conjunction with an investment adviser fee, the two fees combined cannot be more than 1.5%
per year.
Plan application dated (dd/mm/yyyy)
REGULAR SAVINGS PLAN
20 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
Fee deduction
Will start after the completion of the original establishment period.
Trustee 1/Authorised signatory Trustee 2/Authorised signatory
Signed
Full name
Date (dd/mm/yyyy)
Trustee 3/Authorised signatory Trustee 4/Authorised signatory
Signed
Full name
Date (dd/mm/yyyy)
21 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
INVESTMENT ADVISER
APPOINTMENT
Who is this form for?
This form is for applicants who wish to appoint an investment adviser to their plan. Investment advisers may act on a
non-discretionary or discretionary basis. This is your choice and an agreement that you must make with your investment adviser.
Completing this form
By completing this form you are informing RL360 about the appointment of a company to act as an investment adviser to your plan.
They will have the power to place dealing instructions on your behalf.
We can only accept written instructions that have been signed by all applicants.
Please complete in BLOCK capitals throughout.
Important notes
Please note that payments to your investment adviser may only commence once the plan's original establishment period is complete.
SECTION 1 INVESTMENT ADVISER APPOINTMENT
Applicant to complete
I wish to appoint
Investment adviser company name
to act in the capacity of an investment adviser to my plan
Application dated (dd/mm/yyyy)
I understand that my investment adviser will be able to act on my behalf, subject to the terms and conditions set out in Section 2
below, to advise on and change the funds to which the value of my plan is linked. I authorise RL360 Insurance Company Limited
(RL360) to release all relevant information relating to my plan to my investment adviser when requested.
I understand that RL360 is not responsible for any loss or liability incurred to my plan as a result of advice given, or negligence
by, my appointed investment adviser. I also understand that RL360 is not responsible for the performance of any funds linked to
my plan.
I confirm that all communications in relation to investment instructions should be directed to my investment adviser.
Please confirm on what basis you wish your investment adviser to be appointed, non-discretionary or discretionary, by ticking
the appropriate box below.
I confirm that my investment adviser will be acting on a non-discretionary basis. Instructions may only be forwarded to RL360
after my investment adviser has consulted me. My investment adviser has confirmed to me that they have the necessary
regulatory authorisations in order to perform this role. I understand that RL360 is not required to obtain proof that my
investment adviser has consulted with me, prior to acting on any instructions received.
I confirm that my investment adviser will be acting on a discretionary basis. Dealing instructions may be forwarded
to RL360 without my consent. My investment adviser has confirmed to me that they have the necessary regulatory
authorisations in order to perform this role.
I authorise RL360 to take a fee from my plan in line with the following:
A percentage
% per year, taken quarterly as percentage of my plan value (the fee should not be more than 1.0% per year).
Note: Where this fee is used in conjunction with a Financial Adviser fee, the two fees combined cannot be more than 1.5% per year.
REGULAR SAVINGS PLAN
22 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
SECTION 1 INVESTMENT ADVISER APPOINTMENT CONTINUED
I am aware that for as long as I have an appointed investment adviser I will be unable to access online dealing facilities.
I confirm that should I change my investment adviser, or bring this agreement to an end in the future, I agree to inform RL360 in
writing (originals only), immediately.
I acknowledge that RL360 has the right to reject the appointment of my investment adviser at its discretion.
I agree that I am solely responsible for the appointment of an investment adviser to my plan and that I am also responsible for
ensuring that they have the appropriate experience, and/or qualifications and permissions to provide me with investment advice.
I acknowledge that RL360 is not liable for the performance or conduct of my investment adviser, or for ensuring that they hold
and continue to maintain any regulatory or legal permissions required to provide investment advice.
Trustee 1/Authorised signatory Trustee 2/Authorised signatory
Signed
Full name
Date (dd/mm/yyyy)
Trustee 3/Authorised signatory Trustee 4/Authorised signatory
Signed
Full name
Date (dd/mm/yyyy)
SECTION 2 INVESTMENT ADVISER DETAILS AND CONDITIONS
Investment adviser to complete
Full name
Online services username
(if registered)
Company name
RL360 adviser number
Investment adviser
company address
Email address
Telephone number
Fax number
If you do not have Terms of Business with RL360, please contact your Regional Sales Manager before submitting this form.
23 REGULAR SAVINGS PLAN CORPORATE TRUSTEE APPLICATION FORM – LIFE ASSURANCE
SECTION 2 INVESTMENT ADVISER DETAILS AND CONDITIONS CONTINUED
In accepting the appointment of investment adviser to the above stated plan, I agree to the following terms and conditions:
1. All instructions relating to the purchase, sale or switching of funds will be in respect of the range agreed by RL360 as being
eligible for the plan.
2. All instructions should be provided in a format as agreed by RL360.
3. RL360 will purchase, sell or switch funds at the relevant market price as available at the time of placing an instruction.
4. RL360 has the right to accept or reject any instruction from the investment adviser at its own discretion.
5. The investment adviser must maintain such authorisation as is necessary to act as an investment adviser under the
legislation and regulation in the country in which advice is given.
6. RL360 and the plan owner cannot be held responsible for any future tax liability, that may accrue to the investment adviser,
as a result of a failure to levy tax where it later transpires that it should have been charged. The investment adviser is
responsible for deciding whether or not the service they are providing is subject to the levy of any additional taxes.
7. RL360 has the right to remove the investment adviser from the plan, without specifying a reason, and on giving one month’s
written notice to the plan owner and the investment adviser.
8. The investment adviser may resign their appointment by giving written notice to the plan owner and RL360. RL360 will
remove the investment adviser from the plan as soon as the notification is received.
9. The appointment will cease immediately upon written notification of bankruptcy, dissolution or insolvency of the investment
adviser, or any composition with creditors, or if the investment adviser is in breach of any regulatory requirement, or it
becomes illegal for the investment adviser to act in this capacity.
10. This appointment and agreement shall be subject to, and interpreted in, accordance with the laws of the Isle of Man.
11. RL360 will not be liable in the event that the appointed investment adviser or the plan owner fails to notify RL360 of any
material factor aecting the above.
Please submit a current certified copy of your company’s Authorised Signatory list with this form. If you have an additional list
for persons authorised to sign dealing instructions, please also submit a certified copy with this form.
If your company is not regulated in the UK, Isle of Man, Channel Islands, Hong Kong or Gibraltar, please provide identification
and address verification for each person on the Authorised Signatory list.
Investment adviser
Signed
Date (dd/mm/yyyy)
www.rl360.com
CHOOSE HOW YOU
SPEND TOMORROW
BY SAVING TODAY
RL360 Insurance Company Limited
T +44 (0)1624 681681
E csc@rl360.com
Registered Oce: 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.
RSL04a 01/19
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LIFE ASSURANCE (RL360)

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Completed 21 June 2021

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