REQUEST TO APPOINT INVESTMENT ADVISER
AND PAY CHARGE
Who is this form for?
This form is for applicants who wish to request RL360 appoint an investment adviser to their plan and to pay a charge.
Investment advisers may act on a discretionary or non-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 requesting RL360 to appoint 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 owners, trustees or authorised signatories.
Please complete in BLOCK capitals throughout.
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Our full privacy policy can be viewed at www.rl360.com/privacy or can be obtained by requesting a copy from our Data
Protection Ocer.
SECTION 1 INVESTMENT ADVISER APPOINTMENT
Applicant(s) to complete
Plan referenc
e:
I wish to request RL360 to appoint
Investment adviser company name
to act in the capacity of an investment adviser to my plan
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 assets 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 assets linked to my plan.
I confirm that all communications in relation to dealing instructions should be directed to my investment adviser.
I understand that any existing payment to my appointed Investment Adviser ceases and is replaced by this payment with
immediate eect.
I understand that, as a result of my request, RL360 may have to alter the Terms and Conditions of my contract to facilitate this
payment to my requested Investment Adviser. I request that all required changes are made to my Terms and Conditions and
they are eective immediately.
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. Dealing 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.
PIMS