For customers
Inheritance tax financial questionnaire
To be completed by the insured person(s).
Policy number
Please read these important notes before completing this questionnaire.
About this questionnaire
Additional information
–for inheritance tax (IHT) protection under your
Whole of Life policy where the sum insured is
higher than £3,000,000; or
•Please complete in BLOCK CAPITALS and in
ballpoint pen.
•You should complete this questionnaire:
–if you have gift inter vivos cover where the
sum insured is higher than £3,000,000.
•For sums insured between £3,000,001 and
£10,000,000, your financial adviser will need to
countersign this questionnaire.
•For sums insured higher than £10,000,000,
you’ll need to give us a copy of the inheritance
tax planning exercise from your accountant or
solicitor.
•If you can’t provide a copy of the inheritance tax
planning exercise, your accountant or solicitor
will need to countersign this questionnaire.
•We reserve the right to ask for this questionnaire
to be completed for lower sums insured.
•If you don’t answer the questions fully and
accurately, we may not pay a claim and the
whole policy may be cancelled, not just the
benefit under which you’re claiming.
1. Personal details of insured person(s)
First insured person (1st life)
Second insured person (2nd life)
Title
Title
Mr / Mrs / Miss / Ms / Other – please specify
Mr / Mrs / Miss / Ms / Other – please specify
­­Full forename(s)
­­Full forename(s)
Surname
Surname
Date of birth (dd/mm/yyyy)
Date of birth (dd/mm/yyyy)
2.Questions
2.1Do you have any existing cover (including death in service) or are you applying to another
provider for cover?
1st life
2nd life
Yes – complete the table below then go
to 2.2
Yes – complete the table on the next
page then go to 2.2
No – go to 2.2
No – go to 2.2
If any existing cover is being cancelled, please tell us the policy number.
1st life
Existing or
concurrent?
Life sum insured
Reason for cover
Is this being Company and policy
cancelled?
number
Page 2 of 5
2. Questions – continued
2nd life
Existing or
concurrent?
Life sum insured
Reason for cover
Is this being Company and policy
cancelled?
number
2.2Inheritance tax planning
You should answer the following questions.
1st life
2nd life
Joint
What are your total
assets?
£
£
£
What are your total
liabilities?
£
£
£
What’s your net
worth?
£
£
£
What’s the estimated
IHT liability?
£
£
£
How was the IHT
liability calculated?
Who calculated the
liability?
Who will the IHT
liability fall on?
Please tell us of any
reliefs that will be
available for the
mitigations of IHT,
for example business
relief.
Page 3 of 5
2. Questions – continued
2.3 Gift inter vivos to cover potentially exempt transfers (PETs)
You should answer the following questions.
If you need to give further details, please write the details on a separate piece of paper, put your
name and date of birth on it, sign and date it and attach it securely to this form.
What’s the amount of
the gift?
First gift
Second gift
Third gift
£
£
£
What’s the nature of
the gift?
What’s the date the
gift was made or
will be made?
(dd/mm/yyyy)
Who has the gift been
made to, or will be
made to?
Page 4 of 5
3.Declaration
This declaration applies to the insured
person(s).
Declaration – to be completed by counter
signatory
In this declaration, ‘I/me’ means the
insured person(s) and ‘you’ means Aegon.
I declare that the information supplied in this
form is, to the best of my knowledge, true
and complete.
I acknowledge this questionnaire forms
part of my application. To the best of my
knowledge the information and statements
made in this questionnaire are true and
complete. If the statements aren’t true and
complete and/or I don’t tell Aegon about
any changes before the policy starts then
it might result in loss or cancellation of
the protection. I confirm that I’ve read
any answers that I didn’t fill in and they’re
correct.
Date (dd/mm/yyyy)
Date (dd/mm/yyyy)
Print name
Position
Signature
7
7
Print name
Signature of 1st life
7
7
Date (dd/mm/yyyy)
Print name
Signature of 2nd life
7
7
Aegon is a brand name of Scottish Equitable plc. Scottish Equitable plc, registered office: Edinburgh Park, Edinburgh EH12 9SE.
Registered in Scotland (No. 144517). Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct
Authority and the Prudential Regulation Authority. Financial Services Register number 165548. An Aegon company.
www.aegon.co.uk © 2016 Aegon UK plc
IP 00272374 09/16