DATA CAPTURE FORM - Old Mutual Wealth · • If you are sending payment for more than one application, we will need a separate payment for each one. SUBMIT THE APPLICATION ONLINE

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WITH THIS FORM YOU CAN:

• gather the necessary information and declarations from a client to input an ISA application online.• obtain the client’s authority for any associated fees. (You must retain this form in your records if it is being used to capture the client’s authority

for fees.)

This form cannot be used for:• Bed and ISA applications, for which there is a separate form.

We regularly update our forms; you can confirm that this November 2019 version is the latest by checking the literature library on our website www.oldmutualwealth.co.uk

Ours is a flexible ISA; any money withdrawn from the ISA can be paid back in within the same tax year without counting towards the annual personal ISA allowance.

NOTE

DATA CAPTURE FORM– Application for an ISA

FOR FINANCIAL ADVISER USE ONLY

*14748ISAQF*

COMPLETING THIS FORM

• More information about each section is in the Guidance Notes at the end of the form. • Ensure that all applicable sections are completed, as you may not be able to submit the application online if information is missing.• For dates, please use the format day/month/year.• Editable fields allow you to input information into this form electronically. You can reset the editable data fields by clicking the reset

button at the end.• References in this form to our ‘platform’ mean Old Mutual Wealth’s UK technology platform, which hosts collective investments, ISAs and

JISAs as well as bonds and pension products.

ADDITIONAL DOCUMENTS OR INFORMATION WE MIGHT NEED

These are on the Old Mutual Wealth Literature Library• Transfer authority – to be completed and signed by your clients if they are transferring investments to us. (Personalised versions can be

printed during the online application process.) The Guidance Notes clarify whether you need to send transfer authorities to us. • Direct Debit Instruction – for regular investments you will need to send us a signed paper Direct Debit instruction in some

circumstances; more information is in the Guidance Notes.• Confirmation of Verification of Identity (CoVI) – the online application process will capture all money laundering

requirements for individuals. However, the identity of any other parties paying for private investments will need to be verified using this form.

• Power of Attorney – if an attorney is acting on the client’s behalf, we will need the Power of Attorney document itself as well as our Power of Attorney Details form. You will also need to complete the attorney’s details in the ‘decision maker’ part of the online application. These details include the full name, date of birth, country of nationality and National Insurance Number (if the country of nationality is something other than UK, you will also need their passport number and its expiry date).

• Sample Signature form - If we do not already hold a specimen signature for your client, this form can be completed and sent to us for this purpose.

Other possible requirements, depending on the payment method and payer of the contribution:

• Payment by bank transfer or a signed cheque with a Remittance Advice Slip (for single lump sum investments).

• Third party payer details – if someone else is paying for the investment, you will need their name, address and date of birth to complete the application, as well as their bank details for regular investments.

• If you are sending payment for more than one application, we will need a separate payment for each one.

SUBMIT THE APPLICATION ONLINE

• Before starting the online application, you will need to use the button entitled ‘Add Client’ to `create’ the applicant if they are not already clients of yours with investments on our platform.

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Title

First name(s)

Surname

Date of birth

National Insurance (NI) number

OR The individual has never had an NI number

Mr Mrs Miss Other

2 CLIENT DETAILS

Correspondence address

Permanent UKresidential address

Second telephone number (optional)

Telephone number

Postcode

Email address

New investment OR Top-up this ISA

Postcode

Use the residential address for correspondence? Yes No – enter the correspondence address below

A C –ISA –

1.1 Network u If applicable Company name

1.2 Are you appropriately authorised to conduct this business? Yes - go to 1.3

Assigned adviser/Account to receive remuneration

1.3 Did you give financial advice to the client in respect of this application?

1 FINANCIAL ADVISER’S DETAILS

Yes No

No - you will be unable to submit this application

Does the client have an Additional Permitted Subscription (APS) allowance? Yes No


4 DECISION MAKER DETAILS

The ‘decision maker’ is the one making decisions concerning transactions on this investment. In most cases it will be the customer (ie the applicant) but sometimes other people could be authorised to make decisions. More information is in the Guidance Notes.

a) Who is the decision maker on this account?

Customer (ie the investor) – go to section 5 Others – go to b)

b) Is the decision maker

An individual? – go to c) An entity (eg a trust or company)? – go to d)

c) Please provide the individual’s details here:

First name

Surname

Date of birth

Country of nationality

Passport number and expiry date

Now go to section 5

d) Please provide the entity’s LEI code here:

LEI code

Now go to section 5

0 0

UK National Insurance Number

Other (please specify)

See *** at the end of section 3

3 TAX RESIDENCY DETAILS

a) Does the individual hold tax residency status* anywhere other than the UK? Yes - go to b) No - go to f)

b) Is the individual, or their spouse/civil partner, a Crown employee? Yes - go to f) No - go to c)

c) Country of tax residency* - go to d)

d) Tax identification type** - go to e)

e) Tax identification number** - go to f)

f) Country of nationality UK - go to h) Other (please specify) - go to g)

g) Passport number and expiry date*** - go to h)

h) Does the individual have a dual nationality? Yes - go to i) No - go to section 4

i) Second country of nationality UK - go to section 4 Other (please specify) - go to j)

j) Passport number and expiry date*** - go to section 4

*Country of tax residence Normally you are resident for taxation in the country in which you spend the majority of your time each year. However, some countries (eg the United States) may also treat an individual as resident for taxation based on their nationality or citizenship. As tax residence is determined by the country in which tax is paid, it is possible to be tax resident in more than one country.**Tax identification type/number If your country of tax residence is the UK or the Isle of Man your ‘tax identification type’ is your National Insurance number. If it is Guernsey, Jersey or Gibraltar it is your Social Security Number. If you are a US national/tax resident it is your US Tax Identification Number. For many European countries it’s your National ID Number; for Greece and Portugal it’s the Tax Identification Number; and for Italy it’s the Fiscal Code. If the tax identification type has an expiry date, this might also be needed when submitting the application online. For help to work out where you are tax resident, or if you are unsure about your tax identification type/number, please consult a financial adviser or the information at www.oecd.org/tax/automatic-exchange.*** Passport numberPassport numbers and expiry dates are required for most non-UK nationalities; for many European nationalities, the tax identification ‘type’ is required in the passport number field, see ** above.

u Enter the passport number and expiry date below.

If the individual has more than one country of tax residency, the additional details can be added after the application process, using the ‘edit client’ option.NOTE

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5 ADVISER ONGOING SERVICING FEE

£ %ORONGOING SERVICING FEE AMOUNT: each year

Payment frequency Monthly Half-yearlyQuarterly Yearly

Phased investment

This facility can be selected for each single investment and cash transfer.

6 CONTRIBUTION DETAILS

6.1 SINGLE PAYMENTS

a) Client single payment £

Payment method Cheque Debit card Bank transfer

Use this contribution for phased investment?

• Cheque and bank transfer details are in the Guidance Notes. • If you are sending payment for more than one application, we will need a separate payment for each one.

NOTE

b) Third party single payment

Third party’s details

Title

First name(s)

Surname/Entity name

Date of birth

Mr Mrs Miss Other

Address

Postcode

Use this contribution for phased investment?

Third party type Individual Corporate Trust Charity Club/Association

£

Payment method Cheque Bank transfer

NoYes u complete the details below

Phased investment start date

Tax-year ending 5 April

0 1 2 0

Phased investment period 3 6 12 monthsAdviser’s Initial fee

£ OR % up to two decimal places


Phased investment start date 0 1 2 0

2 0

Phased investment period 3 6 12 monthsAdviser’s Initial fee

£ OR % up to two decimal places

u this means payment by the applicant

To be subscribed towards the following:

Remaining personal ISA allowance Remaining Additional Permitted Subscription (APS) allowance

To be subscribed towards the following:

Remaining personal ISA allowance Remaining Additional Permitted Subscription (APS) allowance


6 CONTRIBUTION DETAILS (continued)

6.2a) TRANSFER - complete the details below

Ceding provider’s name

Date of the first subscription in the current tax year (if applicable) 2 0

Tax years to be transferred: Current tax year only Previous tax years only Previous and current tax years

Ceding provider’s address

YesAre you transferring a flexible ISA? No

ISA account number to be transferred

£Net subscriptions made into this ISA in the current tax year (if applicable)

£

• Use this contribution for phased investment?

• Current value*

Part 1 – Cash transfer

Full• Full or partial transfer Partial

Cash transfer – go to Part 1 Transfer type Re-register assets – go to Part 2

Part 2 – Re-register assets

£• Residual cash value*

• Assets to be re-registered u If the asset isn’t available for selection online, add the estimated value of the asset to the cash value above.

Asset name No. of units/shares


* For full transfers enter the estimated current value; for partial transfers, enter the amount to be transferred.

* This is the cash amount in the ISA, which is also to be transferred.



Phased investment period 3 6 12 months


continued


6.2b) TRANSFER - complete the details below

Ceding provider’s name

Date of the first subscription in the current tax year (if applicable) 2 0

Tax years to be transferred: Current tax year only Previous tax years only Previous and current tax years

Ceding provider’s address

YesAre you transferring a flexible ISA? No

ISA account number to be transferred

£Net subscriptions made into this ISA in the current tax year (if applicable)

£

• Use this contribution for phased investment?

• Current value*

Part 1 – Cash transfer


Cash transfer – go to Part 1 Transfer type Re-register assets – go to Part 2

Part 2 – Re-register assets

£• Residual cash value*

• Assets to be re-registered u If the asset isn’t available for selection online, add the estimated value of the asset to the cash value above.

Asset name No. of units/shares


* For full transfers enter the estimated current value; for partial transfers, enter the amount to be transferred.

* This is the cash amount in the ISA, which is also to be transferred.



Phased investment period 3 6 12 months

Total initial fee for cash transfers £ OR up to two decimal places%

Adviser ad hoc fee for re-registration £

6.2c) ADVISER’S FEES

you must request this separately online, once the account is open


b) Third party regular payment

A signed Direct Debit instruction will be required (containing the third party’s bank account details)

First collection date any day from 01 – 28 2 0

Regular payment Payment frequency£ Monthly Yearly

Title

First name(s)

Surname/Entity name

Date of birth

Mr Mrs Miss Other

Address

Postcode

Third party’s details

Third party’s bank details for the Direct Debit

Third party type Individual Corporate Trust Charity Club/Association

Entity registration number

Fee payment £ u this is the amount that will be deducted each time; it is not the total fee amount

c) Adviser initial regular fee

Payment frequency Monthly Yearly u this must be the same as the Direct Debit frequency

Number of fee payments u maximum 24 if monthly, 2 if yearly

IndividualBank account type Joint

Branch sort code

Name of bank account holder(s)

UK Bank/Building Society name

– –Bank/Building society account number

6.3 REGULAR PAYMENTS


a) Client regular payment

First collection date any day from 01 – 28 2 0

Regular payment Payment frequency£ Monthly Yearly

Client’s bank details for the Direct Debit

Branch sort code

Name of bank account holder(s)

Bank/Building societyaccount number


Individual I confirm that the bank account holder is the clientBank account type Joint

– –

Online Direct Debit Paper Direct Debit


7 ‘ASSUMED HOLDINGS’ FOR ILLUSTRATION PURPOSES

If your client already has investments and/or linked accounts on our platform, their value will be displayed in the online application process and automatically included in an illustration.

If you want to amend the value (eg so that the illustration can take into account any additional investments or forthcoming withdrawals), tick ‘Yes’ in the online application process.

You can record below any changes you want to make to the value displayed online.

£Decrease value displayed by:

8 ASSET SELECTION

Assets for single, cash transfer and regular payments

Discretionary Investment Manager (DIM) – Portfolio Fee

If the asset choice includes a DIM portfolio, you must record the related fee details here for your client to authorise.

9 DISTRIBUTION OPTIONS

State here how you wish us to handle any income we receive for assets in the ISA:

Reinvest in the ISA

Leave as cash in the ISA

Pay into the client’s bank account u You can record the bank details in section 11.

%PORTFOLIO FEE AMOUNT: each year

Frequency Monthly Half-yearlyQuarterly Yearly

Model portfolio(s) to which the fee relates

£Increase value displayed by:

Asset or Portfolio Name Inc/Acc

100%TOTAL 100%

Regular %Single/Cash transfer %

n/aCASH

For top-ups you will be given the option on screen to ‘use existing assets’ if required.


• ‘Family linking’ is where we can link your client’s investments with those held on our platform by eligible members of their family, for the purposes of calculating the Old Mutual Wealth Service Charge.

• More information about Family Linking and how to request this feature is in the Guidance Notes.

Family linking

10.2 Frequency

Jan Feb Mar

Apr May Jun

Jul Aug Sep

Oct Nov Dec

Monthly Yearly

OR

£

10.1 Choose one of the following if required

Regular withdrawals of a specific amount of money

Regular withdrawals of a percentage of the account value

State how much the client wants to receive EACH PAYMENT (minimum £25)

Nil RPI

% per yearState how much the client wants to receive EACH YEAR

First payment date 2 0 any day from 01 – 28

Annual escalation rate 5%

10 REGULAR WITHDRAWALS

Specific month(s) – tick below as required

12 OLD MUTUAL WEALTH SERVICE CHARGE

• The ISA will be on Charge Basis 3, which means it will be subject to the Old Mutual Wealth Service Charge.

10.3 Assets to be sold to meet regular withdrawals

Sell proportionally from all assets/portfolios

Sell the following assets/portfolios

%

%

%

OR

Individual JointBank account type I confirm that the bank account holder is the client

Branch sort code

Name of bank account holder(s) (ie the payee)

Bank/Building society account number


Reference u Optional

11 BANK ACCOUNT DETAILS

Any reference here will appear on the client’s bank statements. For a Building Society account, enter the roll number.

– –

u if applicable

TOTAL 100%


Quote reference

Account number

13 QUOTE REFERENCE AND ACCOUNT NUMBER

A C –ISA –

The declaration for the Individual Savings Account follows.

If subscribing using an ‘additional permitted subscription’ (APS), refer to the APS Eligibility Declaration which follows the declaration below.

The total amount you subscribe in a tax year to a stocks and shares ISA must not exceed the current maximum ISA allowance, plus initial fees as agreed with your financial adviser (you may only subscribe to one stocks and shares ISA in any one tax year).

1. On the basis of the details supplied in my application: a) I apply to subscribe for a stocks and shares ISA for the tax year indicated on my application and each subsequent year until further notice. I

understand that any Direct Debit instructions in this application will CONTINUE INTO SUBSEQUENT TAX YEARS unless I inform Old Mutual Wealth Limited (‘Old Mutual Wealth’) to the contrary.

b) I declare that:

i. all subscriptions made, and to be made, belong to me

ii. I am 18 years of age or over

iii. except where I am transferring a current tax year ISA, I have not subscribed and will not subscribe to another stocks and shares ISA in the same tax year that I subscribe to this stocks and shares ISA

iv. I have not subscribed and will not subscribe more than the overall subscription limit in total to any combination of permitted ISAs in the same tax year

v. I am resident in the United Kingdom for tax purposes or, if not so resident, either perform duties which, by virtue of Section 28 of Income Tax (Earnings & Pensions) Act 2003 (Crown employees serving overseas), are treated as being performed in the United Kingdom, or I am married to, or in a civil partnership* with, a person who performs such duties. I will inform Old Mutual Wealth if I cease to be so resident to perform such duties or be married to, or in a civil partnership* with, a person who performs such duties.

c) I understand that any money withdrawn from my ISA can be reinvested in the ISA within the same tax year without counting as a new subscription.

2. I authorise Old Mutual Wealth: a) to hold my cash subscription and ISA investments, interest distributions, dividends and any other rights or proceeds in respect of those

investments and any other cash

b) to make any claims to relief from tax in respect of ISA investments on my behalf

c) to sell units or shares in investments within my account to meet any charges or fees for my financial adviser or discretionary investment manager (if applicable)

d) to give effect to my instructions in accordance with the Terms and Conditions.

3. Contract notes – I understand that I will not receive contract notes relating to transactions involving the purchase or sale of investments which are carried out on a periodic basis in the manner agreed to in this application. Details of these transactions will be shown in the quarterly statement which will be sent to me. In particular, such transactions include:

– regular investments payable by Direct Debit

– phased investments

– rebalances carried out by my financial adviser or portfolio manager (if applicable)

– regular withdrawals

– dividend and rebate reinvestments

– sales of units to meet Old Mutual Wealth charges and fees for my financial adviser and discretionary investment manager (DIM) (if applicable).

4. Important documents – I have been given the opportunity to read and keep the following, and to have any questions concerning them answered to my satisfaction:

a) Terms and Conditions, to which I agree

b) Key Features Document

c) an illustration and information about the costs and charges associated with my investment

d) all available Key Investor Information Documents, Key Information Documents and information about rebates, in respect of my chosen assets.

5. Exchange traded instruments (ETIs) – Where the application includes instructions to invest into ETIs, I understand the additional charges that apply for transactions involving this type of asset as shown within the illustration.

14 CLIENT DECLARATION AND SIGNATURE

PAYMENTIf the payment method is:

• Bank transfer – payment must be made to our bank account, the details for which will appear on screen and are in the Guidance Notes.

• Cheque – please print the Remittance Advice Slip generated at the end of the application process and send it to us with the payer’s cheque.

• Debit card – at the end of the application process click ‘proceed to payment’ to input your client’s debit card details.

• Direct Debit – you might need to send us a paper Direct Debit instruction (see the Guidance Notes for section 6.3).

If you are sending payment for more than one application, we will need a separate payment for each one.

continued


6. Privacy information – I confirm that I have read Old Mutual Wealth’s privacy notice available at www.oldmutualwealth.co.uk/privacy concerning use of my personal information.

7. Facilitation of fees – If I have authorised fees for my financial adviser or DIM in respect of my application:

a) I authorise Old Mutual Wealth to deduct those fees from my investment and pay them to my financial adviser or DIM (as applicable).

b) I confirm that:

i. I have agreed any authorised fees with my financial adviser

ii. my financial adviser has explained the effect that selling units to pay fees from my investment will have on its future value.

c) I understand that:

i. the fees agreed will be met as follows (as applicable):

• Regular initial fees (Direct Debit), ongoing servicing fees, DIM portfolio fees and ad hoc fees - by deduction from cash in my account

• Initial fee (lump sum) – by deduction from my payment before the balance is invested into my choice of assets

• Initial fee (cash transfers) – by deduction from each cash transfer payment before the balance is invested into my choice of assets

ii. where fees will be met from cash in my account, if there is insufficient cash the shortfall will be met by selling proportionally from all funds in my account.

iii. if I authorise a servicing fee or DIM portfolio fee:

• as a percentage amount, the fee paid may go up or down depending on the value of the investment on the date the fee is calculated

• the agreed fee will be an annual amount, which will be divided by the payment frequency selected and paid to my adviser or DIM accordingly

• the servicing fee will apply to the entire account and will override any existing servicing fee on the account

• VAT may also be payable on DIM portfolio fees.

iv. regular initial fee payments:

• will be deducted at the same frequency as the Direct Debit collections, on a date based on the anniversary date of the account

• will be deducted for the number of payments I authorise, unless my Direct Debit is cancelled in which case the fee payments will stop. However, if I invest the maximum ISA subscription before the end of the tax year, I understand that my Direct Debit collections will be suspended until the start of the next tax year, but the fees will continue to be deducted until the required number of fees has been reached.

v. Fees will be paid in line with my account Terms and Conditions and subject to the limits outlined in Old Mutual Wealth’s Remuneration Guide for financial advisers.

vi. Old Mutual Wealth will confirm details to me of the fees applied to my account.

vii. I will need to reauthorise any increases to fees that have been previously agreed.

d) I understand that:

i. I can cancel an adviser ongoing servicing fee at least 10 working days before it is deducted, by contacting Old Mutual Wealth, but I cannot make changes to a discretionary management portfolio fee

ii. I cannot cancel a fee once it has been deducted, instead I would need to contact my financial adviser to discuss whether a refund is payable.

iii. if I cancel a fee, a pro rata payment may be made for the period up to the date of cancellation.

8. Tax information – I understand that, for regulatory purposes, Old Mutual Wealth is required to obtain information concerning my tax status.

a) I declare that:

i. I am resident for taxation in the country(ies) shown as part of this application and I am not resident for taxation elsewhere

ii. I am a national of the country(ies) shown as part of this application and I am not a national or a citizen of any other country

iii. I will inform Old Mutual Wealth if this changes in the future

iv. the information and the statements made in this declaration regarding my tax status are correct and complete, to the best of my knowledge and belief.

b) I understand that:

i. Old Mutual Wealth may need to contact me for further information regarding tax information

ii. if I am resident for taxation outside of the UK and/or a national/citizen of a country other than the UK, Old Mutual Wealth may need to share my information with the relevant tax authorities.

9. I declare that my application has been completed correctly and to the best of my knowledge and belief.

10. Share class conversions – If an asset manager launches a new version of an asset that I hold, which offers me better value, I understand that my account will benefit from automatic conversion to the newer version of the asset and I agree to such conversions.

* as defined in the Civil Partnership Act 2004

14 CLIENT DECLARATION AND SIGNATURE (continued)

continued


– Additional Permitted Subscription (APS)Important Information: you must read the following declarations carefully. You should ask your financial adviser if there is anything you do not understand.

APS Eligibility Declaration

1. On the basis of the details supplied in my application: a) I wish to subscribe from my APS allowance in respect of the deceased and wish to make my subscription to a Stocks &

Shares ISA as a cash lump sum as indicated in this application. b) I declare that: • all subscriptions made, and to be made, belong to me; • I am 18 years of age or over; • I was married to or in a civil partnership* with the deceased at their date of death and have evidence to support this

declaration that can be produced on request • I am the surviving spouse of the deceased • I was living with the deceased within the meaning of section 1011 of the income tax act 2007 at the date of the deceased’s

death (we were not separated under an order of a court or a deed of separation and were not separated in circumstances where the separation was likely to become permanent)

• the subscription is made under the provisions of regulation 5DDA of the ISA regulations (Additional Permitted Subscription) • the subscription is being made within three years of the date of death, or if later, 180 days of the completion of the

administration of the estate. • I am resident in the United Kingdom for tax purposes or, if not so resident, either perform duties which, by virtue of Section

28 of Income Tax (Earnings & Pensions) Act 2003 (Crown employees serving overseas), are treated as being performed in the United Kingdom, or the deceased performed such duties.

• I will inform Old Mutual Wealth Limited if I cease to be so resident, or to perform such duties. c) I understand that once a subscription to an APS allowance has been made, any future subscriptions under that APS

allowance MUST be made to this ISA manager and be accompanied by an APS Eligibility Declaration. d) I understand that any money withdrawn from my ISA can be reinvested in the ISA within the same tax year without counting

as a new subscription.2. I authorise Old Mutual Wealth: a) to hold my cash subscription and ISA investments, interest distributions, dividends and any other rights or proceeds in respect

of those investments and any other cash b) to make any claims to relief from tax in respect of ISA investments on my behalf c) to sell units or shares in investments within my account to meet any charges or fees for my financial adviser or discretionary

investment manager (if applicable) d) to give effect to my instructions in accordance with the Terms and Conditions.3. Contract notes – I understand that I will not receive contract notes relating to transactions involving the purchase or sale of

investments which are carried out on a periodic basis in the manner agreed to in this application. Details of these transactions will be shown in the quarterly statement which will be sent to me. In particular, such transactions include:

– regular investments payable by Direct Debit – phased investments – rebalances carried out by my financial adviser or portfolio manager (if applicable) – regular withdrawals – dividend and rebate reinvestments – sales of units to meet Old Mutual Wealth charges and fees for my financial adviser and discretionary investment manager (DIM)

(if applicable).4. Important documents – I have been given the opportunity to read and keep the following, and to have any questions

concerning them answered to my satisfaction: a) Terms and Conditions, to which I agree b) Key Features Document c) an illustration and information about the costs and charges associated with my investment d) all available Key Investor Information Documents, Key Information Documents and information about rebates, in respect of

my chosen assets.5. Exchange traded instruments (ETIs) – Where the application includes instructions to invest into ETIs, I understand the

additional charges that apply for transactions involving this type of asset as shown within the illustration. 6. Privacy information – I confirm that I have read Old Mutual Wealth’s privacy notice available at

www.oldmutualwealth.co.uk/privacy concerning use of my personal information.

continued



7. Facilitation of fees – If I have authorised fees for my financial adviser or DIM in respect of my application: a) I authorise Old Mutual Wealth to deduct those fees from my investment and pay them to my financial adviser or DIM (as

applicable).

b) I confirm that: i. I have agreed any authorised fees with my financial adviser ii. my financial adviser has explained the effect that selling units to pay fees from my investment will have on its future

value. c) I understand that: i. any initial fee I have agreed will be met by deduction from my payment before the balance is invested into my choice

of assets ii. where fees will be met from cash in my account, if there is insufficient cash the shortfall will be met by selling

proportionally from all funds in my account. iii. if I authorise a servicing fee or DIM portfolio fee: • as a percentage amount, the fee paid may go up or down depending on the value of the investment on the date the

fee is calculated • the agreed fee will be an annual amount, which will be divided by the payment frequency selected and paid to my

adviser or DIM accordingly • the servicing fee will apply to the entire account and will override any existing servicing fee on the account • VAT may also be payable on DIM portfolio fees. iv. regular initial fee payments: • will be deducted at the same frequency as the Direct Debit collections, on a date based on the anniversary date of

the account • will be deducted for the number of payments I authorise, unless my Direct Debit is cancelled in which case the fee

payments will stop. However, if I invest the maximum ISA subscription before the end of the tax year, I understand that my Direct Debit collections will be suspended until the start of the next tax year, but the fees will continue to be deducted until the required number of fees has been reached.

v. Fees will be paid in line with my account Terms and Conditions and subject to the limits outlined in Old Mutual Wealth’s Remuneration Guide for financial advisers.

vi. Old Mutual Wealth will confirm details to me of the fees applied to my account. vii. I will need to reauthorise any increases to fees that have been previously agreed. d) I understand that: i. I can cancel an adviser ongoing servicing fee at least 10 working days before it is deducted, by contacting Old Mutual

Wealth, but I cannot make changes to a discretionary management portfolio fee ii. I cannot cancel a fee once it has been deducted, instead I would need to contact my financial adviser to discuss

whether a refund is payable iii. if I cancel a fee, a pro rata payment may be made for the period up to the date of cancellation.8. Tax information – I understand that, for regulatory purposes, Old Mutual Wealth is required to obtain information concerning

my tax status. a) I declare that: i. I am resident for taxation in the country(ies) shown as part of this application and I am not resident for taxation

elsewhere ii. I am a national of the country(ies) shown as part of this application and I am not a national or a citizen of any other

country iii. I will inform Old Mutual Wealth if this changes in the future iv. the information and the statements made in this declaration regarding my tax status are correct and complete, to the

best of my knowledge and belief. b) I understand that: i. Old Mutual Wealth may need to contact me for further information regarding tax information ii. if I am resident for taxation outside of the UK and/or a national/citizen of a country other than the UK, Old Mutual

Wealth may need to share my information with the relevant tax authorities.9. I declare that my application has been completed correctly and to the best of my knowledge and belief.

10. Share class conversions - If an asset manager launches a new version of an asset that I hold, which offers me better value, I understand that my account will benefit from automatic conversion to the newer version of the asset and I agree to such conversions.

* as defined in the Civil Partnership Act 2004


www.oldmutualwealth.co.ukPlease be aware that calls and electronic communications may be recorded for monitoring, regulatory and training purposes and records are available for at least five years.Old Mutual Wealth provides you with access to its investment platform. Within this platform you can open an ISA, Junior ISA (JISA) and Collective Investment Account provided by Old Mutual Wealth Limited and a Collective Retirement Account and Collective Investment Bond provided by Old Mutual Wealth Life & Pensions Limited. Old Mutual Wealth Limited and Old Mutual Wealth Life & Pensions Limited are registered in England and Wales under numbers 1680071 and 4163431 respectively. Registered Office at Old Mutual House, Portland Terrace, Southampton SO14 7EJ, United Kingdom. Old Mutual Wealth Limited is authorised and regulated by the Financial Conduct Authority. Old Mutual Wealth Life & Pensions Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Their Financial Services register numbers are 165359 and 207977 respectively. VAT number 386 1301 59.

As part of the online submission you will need to make several declarations, as explained in the Guidance Notes.

15 FINANCIAL ADVISER’S DECLARATION

Client signature Date 2 0

Attorney’s signature (if applicable) Date 2 0as attorney

*14748ISAQX*

This completed form will be retained by your financial adviser, who will inform us of any fee(s) you have authorised. We will then confirm details in writing to you.NOTE



1 FINANCIAL ADVISER’S DETAILS

2 CLIENT DETAILS

3 TAX RESIDENCY DETAILS

5 ADVISER ONGOING SERVICING FEE

• During the online application process you will need to confirm that you are appropriately authorised to conduct the business, and whether you have provided financial advice in respect of the application.

• Before starting the online application, you will need use the button entitled ‘Add Client’ to create the applicant(s) if they are not already clients of yours with investments on our platform.

• You may not need to capture all of the detailed information if the client’s details are already held or to generate an illustration. To identify existing clients online, you can use all or part of the client name.

• Under HMRC regulations, we need the investor’s valid National Insurance number, or confirmation that the client has never had one.

• We cannot accept a residential address that is ‘care of’, which contains a PO Box number or which is the financial adviser’s address.

• We cannot accept a correspondence address that is the financial adviser’s address.

• Additional Permitted Subscription (APS) allowance – When an ISA investor dies, his or her surviving spouse is entitled to make an APS into an ISA, over and above the personal annual ISA allowance. If such an allowance applies, it will show on screen during the application process.

• Under HMRC regulations, an ISA investor must be:

– UK resident, or

– a Crown employee serving overseas, or

– the spouse/civil partner of such a Crown employee.

• If the individual has more than one country of tax residency, the additional details can be added after the application process, using the ‘edit client’ option.

• The fee is an annual amount which will be divided by the payment frequency selected and paid accordingly.

• Percentage fees can be entered up to two decimal places.

continued

These notes contain information relating to the sections in this data capture form.

If you have any questions, please refer to the online help options, or call us on 0808 171 2626.

DATA CAPTURE FORM – Application for an ISA

GUIDANCE NOTES FOR FINANCIAL ADVISERS

4 DECISION MAKER DETAILS • This section concerns the person or people who will be making the decisions concerning any Exchange Traded Instrument (ETI) transactions on this investment, or if ETIs are intended to be traded in future. Our default position is that the customer is the decision maker on the account. However if someone else is making decisions on their behalf, they should be noted in this part of the application process.

• In most cases it will be the customer (ie the applicant) but sometimes other people could be authorised to make decisions.

• Scenarios where we would deem someone other than the account holder to be the decision maker:

– Junior accounts where there is a Registered Contact/Guardian – we would always expect the Registered Contact/Guardian to be the decision maker

– Power of Attorney (POA) on the account and the attorney is making investment decisions on behalf of the customer

– Adviser acting in a discretionary capacity.

• We must be informed if the decision maker on the account changes. The information can be updated online within the customer record by selecting Manage Details, then Edit.

• If the decision maker is an entity, the LEI Code will be required. This is the Legal Entity Identifier, which is a global data reference system that uniquely identifies every legal entity or structure, in any jurisdiction, that is party to a financial transaction.

Where the investments include a discretionary portfolio, the discretionary manager will automatically be reported as the decision maker for transactions they initiate. However, if other assets are held, and someone other than the investor is the decision maker, the other party’s details should be entered in this section.

NOTE


7 ‘ASSUMED HOLDINGS’ FOR ILLUSTRATION PURPOSES

• We calculate the Old Mutual Wealth Service Charge on the projected value of all the client’s accounts and bonds on the platform. The illustration will assume that the value of any other investments included will be retained on the platform for the full duration of the illustration.

• The value of the client’s other holdings will be displayed online but can be amended for the purposes of the illustration, if required.

8 ASSET SELECTION

• Please make your clients aware that VAT will be added to the Service Charge for ISAs if they invest in a WealthSelect Managed Portfolio. Where other assets are held in addition to the MPS, the VAT will be calculated proportionally based on the proportion of the account value held in the MPS.

• You must make sure your clients have seen the latest Key Investor Information Document (KIID) or Key Information Document (KID) in respect of their chosen assets, where applicable. More information is on our website www.oldmutualwealth.co.uk/fund-info.

• You will also need to declare online that you have informed your client of the rebate information for the assets selected, where applicable, and that the client has seen the Costs and Charge Statement (which is part of the illustration/projection).

• Asset choice for single payments, cash transfers and regular payments – If you choose a Discretionary Investment Manager (DIM) model portfolio, provided you have the client’s authority, any related portfolio fee will be

applied automatically, deducted from your client’s investments and paid direct to the DIM. However, you must record the fee information in this section so that your client can authorise it when signing the form.

– If more than one Direct Debit is being paid into the ISA, the asset choice entered in this application will be applied to ALL of them.

6 CONTRIBUTION DETAILS

• Phased investment – This facility can be selected for each single investment and cash transfer. The investment will be held in cash within the ISA and phased into the asset selection each month for the number of months specified. You cannot phase back into cash, so cash will not be available as an asset choice for the related contribution.

• 6.1 Single payments

– Minimum single payment – £2,500 (does not apply to top-ups).

– Maximum investment – the maximum allowance for the tax year, as defined by HMRC (plus any initial fees agreed with your client).

– Cheque payments – must be payable to Old Mutual Wealth Limited and sent to us with a Remittance Advice Slip, which will be generated at the end of the online process.

– Electronic bank transfers you will need our bank details, which are:

Account name: Old Mutual Wealth Limited Bank name: NatWest Bank plc Sort code: 56-00-68 Account number: 42087058

Reference number – please quote the ISA account number on electronic transfers (the number will be generated online during the application submission process).

– Debit card payments - follow the instructions online. Your client must be with you when the debit card details are recorded. We cannot accept payment by debit card from third parties.

– If you are sending payment for more than one application, we will need a separate payment for each one.

• 6.2 Transfers

– You will need to complete details for each ISA manager (‘ceding provider’). You will only need to complete the address if the provider’s details don’t automatically appear and you therefore enter the details manually.

– Re-registration ‘residual cash value’ – this is the cash amount held by the ceding provider but you should include a value for any assets you have been unable to locate to re-register, otherwise the value will not be included in the illustration. If assets cannot be re-registered for any reason, they will be sold and the proceeds placed in cash within the ISA. They can then be switched into a revised asset choice.

– Under HMRC rules, if a current tax year ISA transfer is requested, it must be transferred in full.

– Any initial fee captured for cash transfers will only be applied to transfers requested as cash; it will not be applied to any cash proceeds transferred to us where an asset could not be re-registered. The initial fee will be paid from the largest transfer based on what you input. It is not based on the amounts we actually receive. If we do not receive the transfer, the fee will not be paid.

– If a fee is required for re-registration, you will need to request an ad hoc fee online separately.

– Transfer authority - personalised authorities can be produced during the online application process for your client to sign. You will need to send the authorities to us in some circumstances:

– If a transfer can be processed electronically* using an online transfer system (such as Altus), you do not need to send us a signed Transfer Authority form; you should therefore retain it in your records.

– For platforms or fund managers that do not use an online transfer system, you will need to send to us a signed Transfer Authority form.

*The transferring manager will be able to tell you if they use an online transfer system. If you are in any doubt, please send us the signed transfer form.

• 6.3 Regular payments

– A paper Direct Debit instruction must be completed if your client is not the only one required to authorise payments from the bank account, if a third party is paying the Direct Debits or if the client is not present when the application is submitted online.

– Minimum regular payment: £99 (monthly payments)/£600 (annual payments).

– Maximum regular payment: there is no maximum payment, provided the total contributed during the tax year does not exceed the allowance defined by HMRC (plus any initial fees agreed with your client)

– We will need at least 10 working days to set up the Direct Debit instruction. The start date cannot be more than 13 months away.

– Initial Regular fee – the fee stated will be deducted for the number of payments requested, for example if you select 12 payments of a £50 fee, a total of £600 will be deducted. Fee payments will be deducted at the same frequency as the Direct Debit collections, on a date based on the anniversary date of the account. If the maximum ISA subscription is reached before the end of the tax year, Direct Debit collections will be suspended until the start of the next tax year, however, the fees will continue to be deducted until the required number of payments has been reached.


• If the assets include a WealthSelect Managed Portfolio, VAT will be added to the proportion of the Service Charge related to the Managed Portfolio, as mentioned in the notes for section 8.

• ‘Family Linking’ is where we can link your client’s investments with those held on our platform by eligible family members, for the purposes of calculating the Old Mutual Wealth Service Charge.

• The Service Charge only applies to investments held on Charge Basis 3, but those on Charge Basis 1 and 2 can also be linked so that their values will be included to reduce the Service Charge rate.

• Linking investors has no effect on the Investor Charge deducted from Charge Basis 1 and 2 investments.

• To link your client’s investments to those of eligible family members, please use our Family Linking Request form, available from our Literature Library.

12 OLD MUTUAL WEALTH SERVICE CHARGE

• The quote reference and account number will be generated online; they can be written in section 13 for your records.

13 QUOTE REFERENCE AND ACCOUNT NUMBER

• This section contains the declaration that you will effectively make on your client’s behalf during the online process.

• The declaration is in two parts. The first relates to subscriptions made against the standard personal ISA allowance. The second part relates to subscriptions made against an ‘Additional Permitted Subscription’, if applicable.

• HM Revenue & Customs rules require us to send the client a statement confirming the personal information received and certain regulatory declarations. This is for the client’s own records. We will send the document including the declaration in section 14 once the application is submitted.

• The signature in this section is for your own records.

• However, we must also hold a valid signature for investors, to ensure any future instructions are not delayed whilst security checks are made. If we do not already hold a specimen signature for your client, the Sample Signature form, available from our Literature Library, can be completed and sent to us for this purpose.

• You must retain this form in your records if it is being used to capture the client’s authority for fees.

14 CLIENT DECLARATION AND SIGNATURE

10 REGULAR WITHDRAWALS

• For withdrawals requested as an amount of money, the amount requested will be paid for each regular withdrawal payment, the minimum for which is £25.

• For withdrawals requested as a percentage of the account value, the amount requested is an annual percentage. When the payment is due, we will calculate the percentage based on the value of the account at that time. We will then divide that amount by the number of payments requested, to calculate the amount to be paid at that time, which must equate to at least £25.

• If we receive the instruction less than 10 days before the requested start date, we cannot guarantee that it will take effect for that month.

• If the payment is to be met proportionally from all assets, this will include any cash and ETIs held within the ISA.

• If specific assets are nominated: – please note that we cannot sell units from individual assets held within a portfolio; only from the portfolio as a whole. – but there is insufficient value to meet the withdrawal, it will be met from available cash first, then any shortfall by selling proportionally across

remaining assets.

• If the assets to be sold include ETIs, they can only be sold in whole shares. Therefore, if the sale proceeds then exceed the regular withdrawal amount, the excess will be held as cash within the ISA. A Dealing Charge will also apply to each ETI sold; this charge will be deducted from the ISA.

9 DISTRIBUTION OPTIONS

• This section refers to income generated by the assets, including: – funds with income units – Exchange Traded Instruments (ETIs).

• Income generated by assets within a portfolio, will be handled in line with the preference of the portfolio provider.

• If income is reinvested into ETIs, a dealing charge will be incurred. Stamp duty and other costs may also apply.

• Income payments made to a client’s bank account will include any interest earned on cash.

• The bank account must be in the name of the client - we cannot make withdrawal payments to third parties.

• We will use the bank details provided for making any future withdrawal payments from the ISA, unless instructed otherwise.

11 BANK ACCOUNT DETAILS

• As part of the online application process, you will be required to make several declarations, including the following as applicable to your client’s application.

• Your authority to complete this application and acceptance of the declarations made on behalf of your client.

• CoVI relating to the applicant and any individual named in the online application*.

• Confirmation that your client: – agrees to being included in future share class conversions and understands the implications – has been informed of the rebate information for assets selected and has seen related Key Investor Information Documents (KIIDs) and/or Key

Information Documents (KIDs).

15 FINANCIAL ADVISER’S DECLARATION

continued


www.oldmutualwealth.co.ukPlease be aware that calls and electronic communications may be recorded for monitoring, regulatory and training purposes and records are available for at least five years.Old Mutual Wealth provides you with access to its investment platform. Within this platform you can open an ISA, Junior ISA (JISA) and Collective Investment Account provided by Old Mutual Wealth Limited and a Collective Retirement Account and Collective Investment Bond provided by Old Mutual Wealth Life & Pensions Limited. Old Mutual Wealth Limited and Old Mutual Wealth Life & Pensions Limited are registered in England and Wales under numbers 1680071 and 4163431 respectively. Registered Office at Old Mutual House, Portland Terrace, Southampton SO14 7EJ, United Kingdom. Old Mutual Wealth Limited is authorised and regulated by the Financial Conduct Authority. Old Mutual Wealth Life & Pensions Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Their Financial Services register numbers are 165359 and 207977 respectively. VAT number 386 1301 59.

• Confirmation that you have: – disclosed costs and charges to your client – read and agreed to the discretionary managed model portfolio declaration – read and agreed to the WealthSelect Managed Portfolio Service declaration.

• Declarations relating to payment by Direct Debit.

* If needed to verify the identity of any other parties, a link to the CoVI form will be available at the end of the online application process or can be downloaded from our Literature Library.

15 FINANCIAL ADVISER’S DECLARATION (continued)