Fillable PAYMENT FORM ADDITIONAL FOR INDIVIDUAL PLAN OWNERS ORACLE (RL360)

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PAYMENT FORM ADDITIONAL FOR INDIVIDUAL PLAN OWNERS ORACLE (RL360)

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1
Please complete this form in BLOCK CAPITALS throughout.
This form is for plan owners who wish to make an additional payment into their ORACLE plan.
Corporate and Trustee plan owners must complete Additional Payment Form – ref. OR02.
Company and Individual Trustee plan owners must complete Additional Payment Form – ref. OR03.
You can download these forms from our website www.rl360.com.
01 PLAN DETAILS
Plan reference
Plan owner 1 Plan owner 2
Name
Country of residence
for tax purposes
Tax Identification
Number (TIN)
If unavailable, provide a functional equivalent (eg national insurance, social security, resident registration number)
Are you a US Specified
Yes
No
Yes
No
Person?
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.
Do you want to update your contact/address details as part of this application?
Yes No
If yes then please provide new details in Section 05 - Additional Information.
Online services
If you haven’t yet registered for online access to your plan but would like to, download our agreement and registration
forms from our website - www.rl360.com.
ADDITIONAL
PAYMENT FORM
FOR INDIVIDUAL
PLAN OWNERS
ORACLE
2
02 PAYMENT DETAILS
Please confirm the amount of your additional payment below:
Additional payment (Currency and cash amount)
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
Who will fund the additional
The plan owner(s)
Employer
Spouse
payment?
Parent
Other
3
03 FUND REQUIREMENTS
Please list your choice of funds below. There are no limits to the number of funds you can hold in your plan subject to the
minimum investment level of GBP500 per fund. Please refer to the Product Guide for currency equivalent minimums.
Please ensure that the percentages invested total 100% of the payment.
Note: If you require more room then please use the space provided in Section 05 – Additional information.
ISIN Fund managers
Fund name
Percentage
%
%
%
%
%
%
%
%
%
%
%
%
Total 100%
4
04 SOURCE OF WEALTH
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 in full, in all cases, and for both settlors as applicable.
Plan owner 1 Plan owner 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?
5
04 SOURCE OF WEALTH DETAILS CONTINUED
Plan owner 1 Plan owner 2
Pension transfer
Amount received
(include currency)
Received from
Date received (dd/mm/yyyy)
Property or fund sale
Amount received
(include currency)
Address of property
sold or fund 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.
6
05 ADDITIONAL INFORMATION
If you have no additional notes, please continue to Section 06 - Declaration.
7
06 DECLARATION
My application
I understand that my additional payment will be treated in line with the terms and conditions of my plan.
Key Information Document (KID)
I confirm that I have included a signed KID with this Additional Payment Form.
I understand that the KID sets out the details of my additional payment, and by signing it I acknowledge that I am aware of the
charges that will be deducted.
I am also aware that the payment details provided in Section 02 - Payment Details must match my signed KID. If they are
dierent, RL360 will ask me to sign a new KID matching Section 02 - Payment Details before my additional payment can be
added to my plan.
Illustration
I confirm that I have included a signed Illustration with this Additional Payment Form.
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.
Availability
I confirm that to the best of my knowledge and belief, I am not subject to any legislation that would make my additional
payment unlawful.
Investment
I understand that RL360 is not responsible for the choice of funds within my plan.
I agree to RL360 acting on dealing instructions received from me or my appointed adviser, and I will read all of the
documentation issued by the fund manager for each fund.
Privacy and cookie policies
Our full privacy and cookie policies can be viewed at www.rl360.com/privacy or can be obtained by requesting a copy from our
Data Protection Ocer.
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 may
be brought in relation to it.
Cancellation
I am aware that I have the right to cancel my additional payment 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
additional payment I will need to complete the Cancellation Notice and return it to RL360.
I accept that RL360 can bring my plan to an end if I have failed to disclose any facts that may influence the decision to accept
this additional payment application.
I confirm that this additional payment form was signed in (give country)
Plan owner 1 Plan owner 2
Signed
Date (dd/mm/yyyy)
8
07 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 identity for the plan owner(s), and certification of their residential address, and
have, where applicable, attached suitably certified copies of both.
Signed
Date (dd/mm/yyyy)
OR01 a 07/19
RL360 Insurance Company Limited. 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.
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PAYMENT FORM ADDITIONAL FOR INDIVIDUAL PLAN OWNERS ORACLE (RL360)

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Completed 21 June 2021

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