Fillable LIFE ASSURANCE (RL360)

Fill Online, Printable, Fillable, Blank LIFE ASSURANCE (RL360) Form

Use Fill to complete blank online RL360 pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

LIFE ASSURANCE (RL360)

On average this form takes 167 minutes to complete

The LIFE ASSURANCE (RL360) form is 50 pages long and contains:

  • 0 signatures
  • 18 check-boxes
  • 661 other fields

Country of origin: UK
File type: PDF

Use our library of forms to quickly fill and sign your RL360 forms online.

BROWSE RL360 FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
REGULAR
SAVINGS
PLAN
COMPANY AND
INDIVIDUAL TRUSTEE
APPLICATION FORM
LIFE ASSURANCE
TABLE
OF
CONTENTS
01
PAGE 1
APPLICANT TYPE
02
PAGE 1
COMPANY DETAILS
03
PAGE 6
TRUSTEE DETAILS
04
PAGE 8
LIVES ASSURED
05
PAGE 8
PLAN REQUIREMENTS
06
PAGE 9
CHOICE OF FUNDS
07
PAGE 10
SOURCE OF WEALTH DETAILS
Tell us how the wealth was accumulated
to fund this plan. It is important that
you complete this section so that
we can meet Isle of Man anti-money
laundering requirements.
08
PAGE 12
ADDITIONAL INFORMATION
09
PAGE 12
PAYMENT OF PROCEEDS
10
PAGE 13
DECLARATION
In this section you must agree to the
plan terms and conditions and sign
where appropriate.
11
PAGE 16
FINANCIAL ADVISER DETAILS
12
PAGE 17
APPLICATION CHECKLIST
13
PAGE 19
PAYMENT METHODS
AUTHORISATION TO PAY A
FINANCIAL ADVISER FEE
(OPTIONAL)
PAGE 25
INVESTMENT ADVISER
APPOINTMENT (OPTIONAL)
PAGE 27
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 12 - 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.
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 COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
01 APPLICANT TYPE
Company (complete Section 02)
Trustee (complete Section 03)
02 COMPANY 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
Type of company
Public Limited Company
- Please tell us which stock exchange you are listed on
Private Limited Company
Limited Liability Partnership
Partnership
- Please tell us the nature of your business
Company details
Company name
Permanent registered
oce address (in full)
Postcode
Country of
incorporation/
organisation
Date of incorporation
(dd/mm/yyyy)
Contact name
Correspondence
address (in full) - if
dierent to above
Postcode
Contact name
Contact position
Telephone number
Email address
At a meeting of the board of directors held on the
date (dd/mm/yyyy)
at (location)
it was agreed that we have the capacity to make this investment.
2 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
02 COMPANY DETAILS CONTINUED
Directors/authorised signatories
Please enclose certified copy passports for at least two of the listed directors one of whom must be an executive director.
Director 1 Director 2
Title (please tick)
Mr
Mrs
Miss
Mr
Mrs
Miss
Other (in full) Other (in full)
First name(s)
Last name(s)
Current residential
address and
postcode (in full)
Date of birth (dd/mm/yyyy)
Country of birth
Country of residence for
tax purposes
Tax Identification Number (TIN)
If unavailable, provide a functional equivalent (eg National Insurance Number, Social Security Number, resident registration number)
Are you a US Specified Person?
Yes
No
Yes
No
Signed
Date (dd/mm/yyyy)
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 – 1 from category ‘A’ and 1 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.
Shareholder 1 Shareholder 2 (if applicable)
First name(s)
Last name(s)
Date of birth (dd/mm/yyyy)
Country of birth
Position held
Shareholding (%)
Country of residence for
tax purposes
Tax Identification Number (TIN)
If unavailable, provide a functional equivalent (eg National Insurance Number, Social Security Number, resident registration number)
Are you a US Specified Person?
Yes
No
Yes
No
3 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
02 COMPANY DETAILS CONTINUED
Shareholder 3 (if applicable) Shareholder 4 (if applicable)
First name(s)
Last name(s)
Date of birth (dd/mm/yyyy)
Country of birth
Position held
Shareholding (%)
Country of residence for
tax purposes
Tax Identification Number (TIN)
If unavailable, provide a functional equivalent (eg National Insurance Number, Social Security Number, resident registration number)
Are you a US Specified Person?
Yes
No
Yes
No
Verification of identity i.e. certified copy passport and address verification for each of the shareholders as documented above
must be submitted with this Application Form.
Evidence required
As a corporate applicant, please tick to confirm that you have supplied the following:
• A full list of all directors
• Suitably certified certificate of incorporation or equivalent document showing date and place 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 2 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.
AUTOMATIC EXCHANGE OF INFORMATION – ENTITY SELF-CERTIFICATION
Instructions for completion
Under Tax Regulations and intergovernmental agreements entered into by the Isle of Man in relation to the automatic exchange of
information for tax matters (collectively “AEOI”), RL360 is required to collect information about each applicant’s tax status.
This section is for applicants who are classified as an Entity under the Tax Regulations. For a definition of AEOI Entity Types,
download our AEOI Definitions at: http://www.rl360.com/row/downloads/forms.htm
Please note that in certain circumstances the information you provide may be disclosed to the Isle of Man Income Tax Division who in
turn may exchange this information with tax authorities in other jurisdictions.
If any of the information that you provide changes in the future, you must advise us of these changes by completing a new Entity
Self-Certification form and/or an Individual Self Certification as appropriate.
Please note that your Common Reporting Standards (CRS) classification does not necessarily coincide with your classification
for US FATCA purposes.
PART A – Passive Non-Financial Entity (NFE) and Passive Non-Financial Foreign Entity (NFFE)
If the entity is a NFE or NFFE please tick here and complete Parts A (i) and Part C
If the entity is not an NFE or NFFE, please complete Part B and Part C.
If the entity is a Specified US Person, please complete our AEOI Entity Self-Certification Form which you can download from
http://www.rl360.com/row/downloads/forms.htm
4 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
02 COMPANY DETAILS CONTINUED
PART A (i) - Entity Declaration of Tax Residency
Country/countries of tax residency Taxpayer Identification Number
(TIN) or functional equivalent
Reference number type (TIN, Business
Registration Number, other (please specify)).
PART B – Please complete if you are NOT an NFE or NFFE
Please provide your Common Reporting Standards (CRS) classification by ticking the appropriate box(es).
If the entity is a Financial Institution, please specify the type of Financial Institution below:
Reporting Financial Institution under CRS.
OR
Non-Reporting Financial Institution under CRS. Specify the type of Non-Reporting Financial Institution below:
Governmental Entity
International Organisation
Central Bank
Broad Participation Retirement Fund
Narrow Participation Retirement Fund
Pension Fund of a Governmental Entity, International Organisation, or Central Bank
Exempt Collective Investment Vehicle
Trust whose trustee reports all required information with respect to all CRS Reportable Accounts
Qualified Credit Card Issuer
Other Entity defined under the domestic law as low risk of being used to evade tax.
Specify the type provided in the domestic law:
If the Financial Institution is resident in a Non-Participating Jurisdiction under CRS, please specify the type of Financial
Institution resident in a Non-Participating Jurisdiction below:
a)
Investment Entity and managed by another Financial Institution.
If you have ticked this box please indicate the name of the Controlling Person(s) in Part F.
b) Other Financial Institution, including a Depositary Financial Institution, Custodial Institution, or Specified Insurance Company.
c) Other Investment Entity
If the entity is an Active Non-Financial Entity (“NFE”) please specify the type of NFE below:
a)
Corp
oration that is regularly traded or a related entity of a regularly traded corporation.
Provide the name of the stock exchange where traded:
b) If you are a related entity of a regularly traded corporation, provide the name of the regularly traded corporation:
c) Governmental Entity, International Organisation, a Central Bank, or an Entity wholly owned by one or more of the foregoing
d) Other
Active Non-Financial Foreign Entity
5 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
02 COMPANY DETAILS CONTINUED
PART C – US FATCA Classification for all non-US Entities
If you are a US Entity, please complete our AEOI Entity Self-Certification Form which you can download from
http://www.rl360.com/row/downloads/forms.htm
Please complete this section if the entity is not a US Tax Resident
If the entity is a Registered Financial Institution, please tick one of the below categories, and provide the entity’s GIIN.
a)
IGA Partner Jurisdiction Financial Institution
b)
Registered Deemed Compliant Foreign Financial Institution
c)
Pa
rticipating Foreign Financial Institution
Global Intermediary Identification number (GIIN):
If the entity is a Financial Institution but unable to provide a GIIN, please tick one of the below reasons:
a)
The Entity is a Sponsored Financial Institution and has not yet obtained a GIIN but is sponsored by another entity that has
registered as a Sponsoring Entity. Please provide the Sponsoring Entity’s name and GIIN.
Sponsoring Entity’s Name:
Sponsoring Entity’s GIIN:
b)
The Entity is a Trustee Documented Trust. Please provide your Trustee’s name and GIIN.
Trustee’s Name:
Trustee’s GIIN:
c)
The Entity is a Certified Deemed Compliant, or otherwise Non-Reporting, Foreign Financial Institution (including a Foreign
Financial Institution deemed compliant under Annex II of an IGA, except for a Trustee Documented Trust or Sponsored
Financial Institution).
Indicate exemption:
d)
The Entity is a Non-Participating Foreign Financial Institution.
If the entity is not a Foreign Financial Institution, please confirm the Entity’s FATCA status below:
a)
The Entity is an Exempt Beneficial Owner Indicate status:
b)
The Entity is an Active Non-Financial Foreign Entity (including an Excepted NFFE)
i. If the Entity is a Direct Reporting NFFE, please provide the Entity’s GIIN:
ii. If the Entity is a Sponsored Direct Reporting NFFE, please provide the Sponsoring Entity’s name and GIIN.
Sponsoring Entity’s Name:
Sponsoring Entity’s GIIN:
6 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
03 TRUSTEE DETAILS
Details of the trust
Name of the trust
Date trust was
established
(dd/mm/yyyy)
Nature and purpose
of the trust
Correspondence
address and
postcode
Country
Trustee details
Trustee 1 Trustee 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)
Country of birth
Nationality
Country of residence
for
tax purposes
Tax Identification Number (TIN)
If unavailable, provide a functional equivalent (eg National Insurance Number, Social Security Number, resident registration number)
Are you a US Specified Person?
Yes
No
Yes
No
Current residential
address and
postcode (in full)
Country
Length of time at
Years
Months
Years
Months
current address
Home telephone number
Mobile telephone number
Online services
If you wish to access details of your plan online, you must supply us with the following information.
Email address
Password (you will
only use this once)
Password hint
7 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
03 TRUSTEE DETAILS CONTINUED
Trustee 3 Trustee 4
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)
Country of birth
Nationality
Country of residence
for
tax purposes
Tax Identification Number (TIN)
If unavailable, provide a functional equivalent (eg National Insurance Number, Social Security Number, resident registration number)
Are you a US Specified Person?
Yes
No
Yes
No
Current residential
address and
postcode (in full)
Country
Length of time at
Years
Months
Years
Months
current address
Home telephone number
Mobile telephone number
Online services
If you wish to access details of your plan online, you must supply us with the following information.
Email address
Password (you will
only use this once)
Password hint
Evidence required
As an individual trustee applicant, please tick to confirm that you have supplied the following:
• Suitably certified identity and current residential address documentation for each trustee
• Suitably certified copy of the trust deed and any subsequent deed(s) of appointment or retirement.
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.
8 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
04 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
05 PLAN REQUIREMENTS
Who will fund the plan?
The applicant
Settlor(s)*
* Trustee applicants - 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 20)
Direct debit (GBP payments from UK and Channel Island banks only) (please complete the direct debit instruction on page 22)
Standing order (please complete the standing order instruction on page 23)
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)
9 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
05 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
06 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%
10 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
07 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.
Trustee applicants must complete the following questions below in all cases and for both settlors as applicable.
Applicant/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 are retired please tell us your previous occupation, salary, employer and date of retirement.
Previous occupation
Salary
(include currency)
Employer’s company
name
Date retired (dd/mm/yyyy)
Where your source of wealth for this application is from any of the following, please provide details.
Savings
Amount received
(include currency)
Bank where savings
were held
How were savings
accumulated?
11 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
07 SOURCE OF WEALTH DETAILS CONTINUED
Applicant/Settlor 1 Settlor 2
Pension transfer
Amount received
(include currency)
Received from
Date received (dd/mm/yyyy)
Property or asset sale
Amount received
(include currency)
Address of property
sold or asset type
How long held
Date of sale (dd/mm/yyyy)
Company profits
Profits this year
(include currency)
Profits last year
(include currency)
Industry
Company sale
Amount received
(include currency)
Company name
Company industry
Date received (dd/mm/yyyy)
Other (such as a lottery or betting win, gift or inheritance. For inheritance please state from who.)
Amount received
(include currency)
Source
Date received (dd/mm/yyyy)
RL360 reserves the right to request further documentary evidence of source of wealth should it be considered necessary.
12 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
08 ADDITIONAL INFORMATION
If you have no additional notes, please continue to Section 10 - Declaration.
09 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)
13 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
10 DECLARATION
Plan literature
I confirm that I have read a copy of the plan literature including the Product Guide, Key Information Document and Terms and
Conditions.
My
application
I confirm that all of the information provided in this application, along with any supporting forms, questionnaires, statements,
reports or other information is 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 investment into this
plan unlawful.
Financial adviser
I have appointed
(company name)
to act as my financial adviser.
I agree to RL360 Insurance Company Limited (RL360), disclosing all information relating to the 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 05 – Plan Requirements must match my signed KID. If they are
dierent RL360 will ask me to sign a new KID matching Section 05 – 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.
14 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
10 DECLARATION CONTINUED
Trustee applicants
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.
Company applicants
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.
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.
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 contract. 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.
15 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
10 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
• the Key Information Document
• the Terms and Conditions
• the Plan Schedule
• any Endorsement to the Plan Schedule
I accept that RL360 can bring the 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)
16 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
11 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)
17 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
12 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 and trustees named in Sections 02 or 03.
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 or trustee named in
Sections 02 or 03. If you are unable to provide any of the documents listed below, please provide a reason why in Section 08 –
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 05 – 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).
Trustee applicants
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.
18 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
12 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.
19 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
13 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 05 – 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 05 – 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.
20 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL TRUSTEE APPLICATION FORM – LIFE ASSURANCE
REGULAR SAVINGS PLAN
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 08 – 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)
21 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL 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.
22 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL 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.
23 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL 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
24 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL 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)
25 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL 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
26 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL 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)
27 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL 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
28 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL 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.
29 REGULAR SAVINGS PLAN COMPANY AND INDIVIDUAL 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
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.
RSL05a 01/19
CHOOSE HOW YOU
SPEND TOMORROW
BY SAVING TODAY
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

LIFE ASSURANCE (RL360)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 21 June 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document