CONDUCTOR PERSONAL PENSION PLAN
application form
AGENCY Use:
Agency Name
Agency No.
OFFICE USE:
Contract Type
Policy/Contract No.
Client No.
Please complete this application in BLOCK CAPITALS and tick any relevant boxes. Once you have submitted this application you may ask for a copy to be sent to you.
SECTION 1 PERSONAL DETAILS
Mr.
Mrs.
Ms.
Date of birth:
First name:
Occupation:
Surname:
Marital status:
Address:
Contact no:
Place of birth:
Mobile. no:
Country of residence:
E-mail address:
SECTION 2 PRODUCT DETAILS
PART A. ELIGIBILITY DETAILS
1 Are you self-employed or a partner acting in some trade, (Note 1)
profession or occupation?
2 Are you an employed person or holder of an Office of Employment? (Notes 2 & 3)
If you have answered yes to question 2 above:
2(a) do you have more than one employment? and,
(Note 4)
2(b) is your employment non-pensionable?
Yes
No
Notes:
1. t he income you receive from your self-employment, trade, profession or occupation
must be liable to tax under schedule D (case I or II) in the Republic of Ireland
2. t he income you receive from your employment or office of employment must be
liable to tax under schedule E in the republic of Ireland
3. if you are an owner director or an owner employee of an investment company, this
will not be considered as an employment or office of employment for this purpose.
4. y our employment is pensionable if you are a member of an occupational pension
scheme or PRSA in respect of that employment and your employer is making a
contribution to either.
PART B.POLICY DETAILS
Selected retirement age:(between 60 and 75)Policy effective date:
/
/
Regular contribution: Single contribution injection: (Minimum m750)
m
(Min. m2,500 per annum or m250 per month)
Frequency:
Stand alone single contribution:
(Minimum m5,000)
Are contributions to increase automatically?
Yes:
No:Transfer value:
m
m
m
Has a Pension Adjustment Order (PAO) been granted on any transfer value paid into the scheme. If yes, please attach a copy to this form: Yes:No:
AF239, May.‘13
PART C. FUND CHOICE
Passive Fund Management
G
Managed Funds
Consensus
%
Global Equity Funds
Indexed Global (Ex Euro) Equity
% Indexed Global 50/50 Equity
Indexed World Equity
%
Indexed Eurozone Equity
%
Indexed UK
% Indexed Emerging Markets
Indexed Eurozone Corporate
%
Indexed Eurozone Government
%
Physical Gold
%
Managed Funds
F&C Managed
Global Equity Funds
Regional Equity Funds
Regional Equity Funds
Fixed Interest Funds
Indexed US Equity
%
%
%
Indexed Eurozone Long Bond
%
%
New Ireland Managed
%
International Equity
%
Global High Yield Equity
%
European Equity
%
Eurozone High Yield Equity
%
Irish Equity
%
Explorer - Emerging Markets
%
Fixed Interest
% European Long Bond
%
European Corporate Bond
% Index Linked
%
Commodities
Optimum Yield
%
Property
Irish Commercial Property
%
UK Select
%
Cash
Cash
%
Deposit
%
Stewardship Ethical
% Protected Equity +
%
Insight Currency
% Market Neutral Equity
%
Global Bond
%
Advisory Trading Account
% Execution Only Account
Magnet Cautious
%
Magnet Stable
%
Magnet Portfolio
%
Magnet Adventurous
%
Compass Cautious
%
Compass Stable
%
Commodities
Active Fund Management
G
Fixed Interest Funds
Specialist Funds
C Specialist Equity Funds
Absolute Return Strategies
o
Self-Directed Investment Option
%
Portfolio Funds
Magnet Range
Magnet Range
C Compass Range
C Compass Range
% Compass Adventurous
Compass Portfolio
o
o
TheSelf
Self-Directed
Investment Option (SDIO) is only available for lump sums in excess of m15,000. For all regular contributions please select from the fund list
Directed Investment Option
Self
Directed
Investment
above. Please noteOption
that if your regular contributions build to m10,000 or more, you may switch this amount to the SDIO, provided you already have at least
m15,000 invested in it, through the same scheme. Self Directed Investment Option (Single Premium/Transfer Value) :
%
%
SDIO
SDIO
Fund Warnings:
1. P
erformance Fees: The growth of the Insight Currency fund will be subject to a 20% monthly performance fee which only applies when the growth
rate exceeds 7% p.a. The Market Neutral Equity fund will be subject to a performance fee of 10% of any growth achieved above cash returns
(specifically 3-month EURIBID). The Magnet Range may include some of these funds.
2. The price protection on the Protected Equity+ Fund, Series 3 fund is provided by Deutsche Bank AG.
3. The property fund managers reserve the right to place a withdrawal limit or/and to defer encashment for up to six months or such time as is
necessary to facilitate the sale of assets if required.
4. M
oney invested in the Deposit fund is placed with one or more Banks. The payment of interest and security of capital is provided by the Bank(s).
The Bank(s) and not Friends First are providing the security on the Deposit fund. Please refer to the Fund Factsheet.
SECTION 3 TERMS GOVERNING THE SELF-DIRECTED INVESTMENT FUND AND LIMITED POWER
OF DISCRETIONARY MANAGEMENT
AS THIS PRODUCT MAY ALLOW YOU TO INVEST IN THE FRIENDS FIRST SELF DIRECTED INVESTMENT FUND, THEN PLEASE CAREFULLY READ
THE ADDITIONAL INFORMATION SET OUT BELOW AND PLEASE ALSO BE SURE THAT YOU ARE HAPPY THAT YOU FULLY UNDERSTAND THE
NATURE OF THE FUND YOU HAVE SELECTED.
IF AFTER READING THIS INFORMATION YOU HAVE ANY UNANSWERED QUESTIONS PLEASE CONTACT YOUR FINANCIAL ADVISER BEFORE PROCEEDING.
HAVING SIGNED THE DECLARATION AT THE END OF THIS NOTICE AND BY CONTINUING WITH YOUR INVESTMENT IN OUR SELF DIRECTED
INVESTMENT FUND, YOU ARE CONFIRMING THAT YOU HAVE READ AND UNDERSTAND THE ADDITIONAL INFORMATION SET OUT BELOW
AND THAT YOU ACCEPT ALL OF THESE TERMS AND CONDITIONS SET OUT BELOW AS PART OF YOUR CONTRACT TERMS IN RELATION TO ANY
INVESTMENT INTO THE sdio FUND THAT YOU MAKE NOW OR IN THE FUTURE.
Additional Information for the Friends First Self Directed Investment Fund
The Investment Manager for the Friends First Self-Directed Investment Fund is Dolmen Stockbrokers (“Investment Manager”).
If you have selected the Friends First Self Directed Investment Fund and if Friends First have received the relevant contribution from you,
Friends First will open an account within our Fund with the Investment Manager to cater specifically for your policy only. In acceptance thereof;
I ACKNOWLEDGE AND UNDERSTAND:
• that the assets held in the account set up for my policy within the Friends First Self Directed Investment Fund are the assets of Friends First
Life Assurance Company Limited and/or Friends First Managed Pension Funds Limited (“Friends First”).
• that Friends First may change the Investment Manager at any time and that Dolmen Stockbrokers may cease to provide this service to
Friends First at any time, and that, in this event, I must inform Friends First of my selection of alternative investment options notified to me
as being available at that time and that if I do not make such a selection within the time period set out by Friends First that Friends First will
have the right to make the selection on my behalf.
• that all of the contributions received by Friends First from me and forwarded to the Investment Manager as instructed by me on my
Application Form or on any subsequent written instructions will be held in the account set up for my policy in cash deposits (non interest
bearing) until such time as I have executed and returned to the Investment Manager all required documentation, and in respect of Execution
Only or Advisory Accounts, until valid instructions have been given to the Investment Manager to buy assets for the account in place of the
cash deposits.
• that Friends First is granting me, a limited power of discretionary management to receive information and advice from the Investment
Manager and to give instructions to the Investment Manager in relation to the assets in the account set up to cater for my policy. I may
also authorise another person, from time to time, to fulfil this role under this power granted to me, provided that person is authorised and
appointed by me in the form and format required by the Investment Manager.
• that the type of investments that the Investment Manager can enter in to for the account set up for my policy are limited to those permitted
by Friends First and that Friends First may vary the type of investments permitted from time to time.
• that Friends First and the Investment Manager are not liable for any loss caused to my policy as a consequence of:
- any information, advice or instruction given to me, or any other validly appointed person, by the Investment Manager.
- the performance of any assets bought by the Investment Manager for the account set up for my policy, acting on instructions received from
me, or from any other validly appointed person, or acting in execution of their role under a Discretionary Account.
• that before buying any assets for the account set up for my policy in place of the cash deposits (non interest bearing), the Investment
Manager will require me to complete to their satisfaction an Account Opening Document and any other such documentation required by
the Investment Manager.
• that before Friends First can forward contributions to or request the return of the value of contributions from the Investment Manager, a
reasonable time delay will be necessary to process any instructions received by Friends First to ensure that those instructions are completed
in accordance with Friends First’s business practises and with regulatory requirements imposed upon Friends First and that Friends First is
not responsible for any market opportunities foregone during this time delay.
• that before the Investment Manager can return the value of any contributions to Friends First, a reasonable time delay will be necessary
to process any instructions received by the Investment Manager to ensure that those instructions are completed in accordance with the
Investment Manager’s business practises and with regulatory requirements imposed upon the Investment Manager and that the Investment
Manager is not responsible for any market opportunities foregone during this time delay.
ADDITIONAL DISCLOSURE MATERIAL
In order to be eligible to select the Friends First Self-Directed Investment fund, you must have at least €15,000 available, after any set up
charges, for investment in this fund only. Except by virtue of a reduction in the value of the assets, you cannot reduce the amount to be held in
the account set up for your policy below €15,000.
The Investment Manager sets the charges (dealing commission, custody fees and any management fees, etc.) for the service they provide.
These charges are available on request and may only be changed if Friends First agrees to a change.
You should read the Investment Manager’s charges carefully and discuss any issues you have on this subject with your Financial Adviser.
Please visit the Fund Information page in our Investment Centre on www.friendsfirst.ie.
SUITABILITY AND RISK WARNINGS
The primary objective of your pension is to provide you with a retirement income or with a fund at retirement to purchase your retirement
benefits. You need to consider if investing in a Self-Directed Investment Fund, along with any other pension arrangements you may have, will
meet your pension objectives. In addition, you should also consider, amongst other issues, your risk appetite, the number of years you have to
retirement, the extent of diversification you have across all your pension arrangements, and your own personal and financial circumstances.
SECTION 3 T
ERMS GOVERNING THE SELF-DIRECTED INVESTMENT FUND AND LIMITED POWER
OF DISCRETIONARY MANAGEMENT (Continued)
SUITABILITY AND RISK WARNINGS (Continued)
You should also consider professional advice from a Financial Adviser in order to ensure that you can make an informed choice. Friends First is not
liable for any loss caused to your policy as a result of the performance of the investment funds in which you choose to invest.
Once invested in a pre or post retirement pension product, you will be restricted to taking your retirement benefits in a form allowed under that
product including, in a pre-retirement product, waiting until retirement before you can reap the benefits of your investments. In addition, there are
limits to the amount you can invest and accumulate within a pension product, and these limits need to be borne in mind so that you do not over
provide for your retirement and suffer additional tax charges.
The risk of loss when trading in equities can be substantial. You should therefore carefully consider whether such trading is suitable for you in the
light of your financial circumstances. In particular, you should consider whether such an investment is appropriate to provide you with a retirement
income or to fund for your retirement pension. In considering whether to trade or to authorise someone else to trade for you, you should be aware of
the following:
• If you purchase a security, you may sustain a substantial loss if the share price falls significantly.
• Under certain market conditions, you may find it difficult or impossible to liquidate a position quickly.
• If you instruct your Investment Manager to buy shares that are not denominated in Euros, you face a foreign exchange exposure risk.
• Unless you take steps to ensure that you have a well-diversified portfolio of securities, your portfolio is likely to have a higher level of risk than
the average balanced fund offered by life assurance companies.
If you decide to select a fixed term investment, you may not be able to redeem this investment prior to the set maturity date, which may significantly
delay the availability of your retirement benefits. Therefore, you should seriously consider the proposed timeframe for any investment relative to
when you think you might want to avail of retirement benefits.
If your investment in our self directed investment fund is part of a portfolio of occupational pension scheme investments linked to the same
employment, then you must take all of these retirement benefits at the same time. A fixed term investment, that cannot be redeemed, is likely to
prevent you from taking pension benefits from any of the pension investments that are connected with the same employment.
Important considerations for Investors in the Self Directed Investment Fund
Friends First does not assess either the appropriateness or the quality of the investments selected by you for inclusion in the fund, Friends First will
accept investments within the fund where it can satisfy itself that the investment can be administered appropriately within the Self Directed Fund
Service that it provides.
Friends First takes no responsibility for the additional charges for specific investments, the performance of investments in the fund or the extent
to which the investments you select meet your needs. We would therefore strongly recommend that you consider all appropriate factors before
committing to using the Self Directed Fund and in making any investment within it:
In particular we suggest that you consider all aspects pertinent to the decision to invest including but not limited to:
• you understand what returns are likely and what effect various factors (economic regulatory etc) will have on returns in the future,
• you ensure that you understand all of the aspects of the investments you are selecting including charges and penalties,
• you consider all risks pertaining to the investments you select. If you do not make any investment selections your funds remain in cash deposits
(non interest bearing) and you should consider any risks to cash deposits including security of the holding Bank and depreciation of the value in
real terms over time.
• you understand the risks of all investments you select. Friends First suggests that you consider factors including but not limited to liquidity,
security of 3rd parties, concentration, any gearing risk and properly understand the chances that your investments may not meet your investment
goals,
• you should ensure that you get and understand full and appropriate disclosures of risks, costs and commissions from your Financial Adviser(s),
• you understand how you will achieve an optimum risk return balance and how the investments you have selected compare from a value point of
view with alternatives,
• you understand why the benefits of the Self Directed Investment Option are worth the additional costs to you compared with other ways of
accessing the underlying investments (for example, through a pooled asset fund),
• you are clear on why you are investing in a Self Directed Fund. This type of fund is most suitable for people who do not want to use pre
packaged investments or who have funds large enough to diversify their investments sufficiently or have specific expertise and views on specific
investments. It is of most value for policyholders who want to vary their investments.
• particularly where you are investing in structured products, it is the obligation of your Financial Adviser to provide specific information on risks for
certain investments you make – you should ensure that you get and understand this from your Financial Adviser,
• you understand the charges you are paying on the underlying investments (e.g. fees, fund management and investment charges and commissions
for advice, broking and sourcing) and that your Financial Advisers explain any implicit charges (e.g. guarantee cost and other deductions within
structured products),
• you are aware of the involvement of any parties advising on or supplying investments or investment services within your Self Directed Investment
Fund,
• you abide by any regulations requiring or limiting your investments by amount or type.
Signature of Policyholder:
7
Date:
7
SECTION 4 DECLARATIONS
PART A: DECLARATION UNDER REGULATION 6(3) OF THE LIFE ASSURANCE (PROVISION OF INFORMATION) REGULATIONS, 2001.
WARNING If you propose to take out this policy in complete or partial replacement of an existing policy, please take special care to satisfy
yourself that this policy meets your needs. In particular, please make sure that you are aware of the financial consequences of replacing
your existing policy. If you are in doubt about this, please contact your insurer or insurance intermediary.
Friends First policy number to be cancelled:
Declaration of Insurer or Intermediary:
I hereby declare that in accordance with Regulation 6(1) of the Life Assurance (Provision of Information) Regulations, 2001,
______________________________ (the client) has been provided with the information specified in Schedule 1 to those Regulations and that
I have advised the client as to the financial consequences of replacing an existing policy with this policy by cancellation or reduction, and of
possible financial loss as a result of such replacement..
Signature on behalf of Insurer
or Insurance Intermediary:
7
Date:
7
Date:
7
Name of insurer or insurance intermediary
Declaration of Client/Policyholder:
I confirm that I have received in writing the information specified in the above declaration.
7
Signature of Policyholder: PART B: POLICYHOLDER DECLARATION
I declare that I am entitled under the Taxes Consolidation Act 1997 to apply for an ARF/AMRF and that any investment is from an approved source.
• I submit this application, along with any subsequent information provided in relation to this application, verbally or otherwise, by me or the agent
acting in the sale of this policy, with a view to entering into a contract for the benefits set out herein.
• I understand that the policy will commence on the commencement date indicated on the policy or on such other date as notified by Friends First.
• I understand that terms and conditions will apply.
• I have read over the replies to all questions in this application and declare that to the best of my knowledge and belief, all information given is true
• I consent to Friends First, verbally or otherwise, seeking and receiving additional information from me or my agents where this information has not
been provided on the application or where further information is required in order to process the application and such information will be deemed
to be incorporated into this application.
• I undertake to inform Friends First of any change in my country of residence during the life of the policy.
• I understand that in the interest of customer service and to ensure the accuracy of records, telephone conversations between Friends First and me
may be recorded.
7
Signature of Policyholder:
Date:
7
PART C: Data Protection DECLARATION
Friends First Life Assurance Company Limited (“Friends First”) or its authorised agents may hold, use, disclose and process any information provided
by me, which shall include the information held within this application and any subsequent information, provided verbally or otherwise, during the
course of our relationship, in order to:
1. process, manage and administer my policy.
2. communicate with me by post, telephone or e-mail.
3. comply with legal and regulatory requirements.
4. disclose data to any policyholder, life assured, beneficiary, trustee, assignee, successors, company within the Eureko/Friends First group or to any
agent acting on my behalf, or to other disclosees as notified to the Data Protection Commissioner’s Office and maintained on the Public Register
available from that office.
I am aware that I have the right of access to my personal data and the right to rectify my data if it is inaccurate or has been processed unfairly.
Your personal data may also be used to send you details about other similar services available from Friends First Life Assurance Company Limited.
If you do not wish to avail of this service, please tick this box.
7
Signature of Policyholder: Date:
7
SECTION56 DIRECT
SELF-DIRECTED
INVESTMENT FUND TERMS
SECTION
DEBIT MANDATE
Signatures for Joint Accounts requiring two signatures:
Please insert your bank details, sign and date the mandate in the spaces provided.
1st Signature
1. Bank Details:
Name: Date:
Address:
2. Sort code:
2nd Signature
Account number:
Date:
In most circumstances direct debit mandates are only accepted on current accounts,
if you hold a different type of account please check with your bank.
5. Your instruction to the bank/building society:
• I instruct you to pay Direct Debits from my account at the request of Friends First
Life Assurance Company Ltd
• I confirm that the amounts to be debited are variable and may be debited on
various dates
• I shall duly notify the Bank in writing if I wish to cancel this instruction
• I shall also notify Friends First of such cancellation.
3. Name of account to be debited: Joint Account
1st Account Holder:
2nd Account Holder:
4. Name of account to be debited: Single Account
Account Holder:
The Direct Debit Guarantee:
•This is a guarantee provided by your own Bank as a member of the Direct Debit Scheme, in which Banks and Originators of Direct Debits participate.
• If you authorise payment by Direct Debit, then:
-Your Direct Debit originator will notify you in advance of the amounts to be debited to your account
-Your Bank will accept and pay such debits, provided that your account has sufficient available funds
-If it is established that an unauthorised Direct Debit was charged to your account, you are guaranteed a prompt refund by your Bank of the amount so charged
-You can cancel the Direct Debit Instruction in good time by writing to your Bank
Policyholder’s name, if different from name of account to be debited:
Originator’s ID number: Originator’s ref number:
9 9 0 4 5 7
Please return this mandate to:
Friends First Life Assurance Company Limited,
Premium Collection Department,
Cherrywood Business Park,
Loughlinstown,
Dublin 18.
Signature
Date:
(I confirm that only my signature is required on this account)
FOR
FORBROKER
BROKERUSE
USEONLY
ONLY
Regular Contributions - Initial & Renewal Options
Option
Tick to
Select
Renewal
(0% to 4%)
Fund Based
(0% to 0.75%)
Office use only
PEB
Initial
Max.*
Financed Option A
25%
E30,000
0.90%
A: ND: 7IC (I216)
Financed Option B
15%
E60,000
0.90%
B: ND: 8IC (I217)
Financed Option C
12.50%
E60,000
0.65%
C: ND: 9IC (I218)
AMC From*
*If the annual contribution for this contract exceeds the maximum shown, then you must select an alternative option
Single Contribution Financed Options
Option
Tick to
Select
Initial
(0% to 5%)
Max.
Fund Based
(0% to 0.75%)
AMC From*
Office use only
PSA
Financed Option A
n/a
0.65%
A: ND: 2SP (S286)
Financed Option B
n/a
0.90%
B: ND: 3SP (S288)
Regular/Single Contribution Non-Financed Options
Option
Tick to
Select
Initial
(0% to 5%)
Max.
Fund Based
(0% to 0.75%)
AMC From*
Office use only
PEB/PSA
Non-Financed Regular
n/a
0.40%
R: ND: 10IR (I219)
Non-Financed Single
n/a
0.40%
R: ND: 4SR (S306)
* The AMC shown represents the total management charge applicable on selection of the Consensus Fund, other funds can have higher charges that that shown. The AMC
does not include the policy fee or the rate of fund based commission selected.
Additional Information:
Friends First Life Assurance Company Ltd
Friends First House
Cherrywood Business Park
Loughlinstown
Dublin 18
www.friendsfirst.ie
Friends First Life Assurance Company Limited is regulated by the Central Bank of Ireland.
In the interest of customer service and to ensure the accuracy of our records calls will be recorded and monitored.