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ONGOING AdvIser Fee AuthOrIsAtION Individual Savings Account (ISA), Collective Investment Account (CIA), Collective Retirement Account (CRA) and Collective Investment Bond (CIB)

l Initial fees – for lump sums, direct debits and cash transfersl Ad hoc fees – for re-registration transfersl switch feesl servicing fees

*APAFA0100F*

July 2017

With this form you can:

– set up new fee instructions u�CRAs and CIBs on Charge Basis 1 will then convert to Charge Basis 2, switching off any existing commission

– amend existing fee instructions

– choose to convert to Charge Basis 3 u CRA only.

l Switch and servicing fees deducted from a: – CIB, will be deemed partial surrenders and count towards your 5% tax deferred allowance. – CIA, will be deemed disposals for cGt purposes unless they are deducted from cash deposit.

l The 5% tax deferred allowance on a CIB should be calculated using the net investment amount, ie after any initial fee has been deductedl The notes at the end of the form will help you complete it; they also explain how we will carry out your instructions.l Complete the details in each applicable section carefully; we cannot be held responsible for any consequences if they are incorrect.

Errors or omissions by you or financial adviser will not be corrected retrospectively.

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Complete the account/bond numbers and tick to indicate the products each number relates to.

Account/Bond number*

Account/Bond number*

Account/Bond number*

CIBISA CIA CRA

CIBISA CIA CRA

CIBISA CIA CRA

* If this instruction relates to a new account/bond please provide the online application number instead.

3 your invEstmEnts

Have you received financial advice in respect of the instructions given in this form? (tick)

If yes, please tick to confirm the basis on which the advice was given. Independent

Yes No

Restrictedu your financial adviser will help you answer this

If you do not complete this section, we will assume you have received advice on an independent basis.

2 financial advicE rEcEivEd

the fees authorised on this form will apply to Each of the investments you list below where available. if you wish different fees to apply to different accounts/bonds, you must complete a separate form for each one. notE

Account/Bond number*

CIBISA CIA CRA

1 full namEs of invEstors

Please tick/complete this form, as applicable, using BLOCK CAPITALS and blue or black ink.

Tel E-mail

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dIRECT dEBIT INITIAL FEE

%

%

%

direct debits paid by you, the investor:

direct debits paid by a third party:

direct debits paid by your employer: u CRA only

each direct debit

each direct debit

each direct debit

OR

OR

OR

£

£

£

SERvICINg FEEThis is an annual amount which will be divided by the payment frequency selected and paid to your adviser accordingly.

YearlyMonthly Quarterly Half-yearlyTick the frequency required

YesAdd vAT on top of the Servicing Fee?

l Any Servicing Fee you authorise here will apply to the entire account/bond and will override any existing Servicing Fee instruction on your account/bond.l If you change how often an existing servicing fee is paid, so that it is more frequent, the new frequency will not prompt a pro rata fee payment for your adviser for the

previous frequency. l We will only pay an ongoing adviser fee to your authorised financial adviser. If you are receiving discretionary fund management services from a third party, your

adviser may pay all or a proportion of the fee to the third party as payment for these services, and where relevant, to cover any associated vAT.

FuNd SWITCH FEE % from each switchOR£l Any Switch Fee you authorise here will override any existing Switch Fee instruction on your account/bond.

We will sell units to meet the Product/Service Charge and Adviser Servicing Fees (if applicable) as follows:l managed Portfolio service (mPs) investors – proportionally from all funds.l other investors – from the funds you choose below.

up to:

4 advisEr fEE dEtails u the notes accompanying this form explain how these fees will be met

5 convErtinG to charGE Basis 3 ucra only

6 Product/sErvicE charGE and advisEr sErvicinG fEE dEductions

%OR£ each year

Tick/Complete as required

%OR£ of the lump sum/transfer value

l For CRA only, a global Initial Fee applies, in respect of all lump sum and transfer payments included in the online application specified. The notes accompanying this form explain how the global Initial Fee will be met.

l If selected as a percentage, the fee will apply to the balance invested into your account after any immediate tax-free cash has been deducted, not the total lump sum/transfer payment.

u after deduction of any immediate tax-free cash

tick here if you wish to convert your cra from charge Basis 1 or 2 to charge Basis 3.

• Existing commission arrangements will not convert to fees when an account/bond converts from Charge Basis 1; if fees are required, please complete the relevant sections below as applicable.

• if you wish to cancel an existing fee instruction using this form, enter £0 or 0% in the boxes for the fee in question. it will be cancelled for the whole account/bond.

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u I SAs and CIAs are on Charge Basis 3 already. CIBs listed in section 3 cannot convert to Charge Basis 3; CIBs on Charge Basis 1 will automatically convert to Charge Basis 2 when this form is submitted.

SK8558/218-0214/March 2018 (W Ongoing Fee Form)

LuMP SuM/TRANSFER gLOBAL INITIAL FEE (CRA)

Largest fund Proportionally across all funds From the following fund(s) (in proportion to their bid values):

RE-REgISTRATION FEE (ISA/CIA) %£ of the value of the re-registered unitsOR

l This fee will be deducted as an Ad hoc Fee when re-registration of all the funds is complete; more information is in the notes accompanying this form.

CASH TRANSFER FEE (ISA/CIA) %£ of the transfer valueOR

l If the cash transfer fee is requested as a monetary amount, it will be deducted as an ad hoc fee; if requested as a % it will be deducted as an initial fee. More information is in the notes accompanying this form.

LuMP SuM INITIAL FEE (ISA/CIA/CIB) %£ of the lump sumOR

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thE dEclaration is madE By Each invEstor/siGnatory in rEsPEct of Each account/Bond dEtailEd in sEction 3.

a) i instruct old mutual WEalth to: i) deduct any fees detailed in this form from each of my accounts/bonds shown in section 3 and pay them to my financial adviser firm ii) stop commission payments to them where applicable in respect of these accounts/bonds.

B) i undErstand that: i) any current commission payments will stop immediately, and the agreed fee(s) will be paid in line with my account/bond Terms and Conditions ii) the fee(s) agreed will be deducted from my account/bond as outlined in this form iii) if vAT applies and if I have ticked ‘Yes’ to vAT in section 4, the amount of any Servicing Fee shown will be increased to include vAT at the rate

prevailing when the fee is deducted iv) if I select a percentage fee, the amount paid to my financial adviser firm will vary as follows: •ServicingFee–theamountmaygoupordowndependingonthevalueofmyaccountonthedatethefeeiscalculated •SwitchFee–willbebasedonthevalueoftheswitchproceeds •DirectDebitInitialFee–willchangeifmydirectdebitamountchanges v) I will need to reauthorise any future increases to fees vi) the adviser fee(s) will apply to ALL investments I hold in my accounts/bonds stated in section 3.

c) i confirm that: i) my financial adviser has explained the effect that selling units from my accounts/bonds to pay Adviser Charges will have on the future value of

my investment ii) any fee(s) authorised in this form in relation to a Collective Retirement Account are solely in relation to advice and/or services my financial adviser

has provided or will be providing in relation to that account and do not relate to any other advice or services my adviser has provided iii) I have the authority to approve instructions for each account/bond shown in section 3. iv) where the fees (other than initial fees) relate to my CIA or CIB, before I signed this form my financial adviser explained the tax implications of

Old Mutual Wealth deducting these fees.

d) i undErstand that: i) I can amend or cancel a Servicing Fee or Fund Switch Fee by giving at least 10 working days’ notice to Old Mutual Wealth ii) I cannot cancel a fee once it has been deducted from my account/bond; instead I would need to contact my financial adviser to discuss whether a

refund is payable in full or in part. iii) a servicing fee cannot be deducted or paid on a pro rata basis following cancellation.

Signature

Signature

Signature

Signature

/

/

/

/

/

/

/

/

2 0

2 0

2 0

2 0

date (dd/mm/yyyy)

date (dd/mm/yyyy)

date (dd/mm/yyyy)

date (dd/mm/yyyy)

Print full name

Print full name

Print full name

Print full name

Capacity u eg investor, trustee, signatory, attorney

Capacity u eg investor, trustee, signatory, attorney

Capacity u eg investor, trustee, signatory, attorney

Capacity u eg investor, trustee, signatory, attorney

*APAFA0100X*

7 dEclaration and authority

all investors/authorised trustees/authorised signatories for the accounts/bonds must sign below. notE

SK8558/218-0214/March 2018 (W Ongoing Fee Form)

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cra only - Please sign the following declaration if fees have been requested from a cra. I confirm that any fee(s) authorised in this form in relation to a Collective Retirement Account are solely in relation to advice and/or services I have provided or will be providing to the client in relation to that account and do not relate to any other advice or services I have provided.

Signature

/ / 2 0

date (dd/mm/yyyy)

Print full name Company name

*APAFA0100X*

send the completed form as follows:

l By post: to Old Mutual Wealth, Old Mutual House, Portland Terrace, Southampton SO14 7AY

l By email: send a scanned copy to ask@omwealth.com notE: We cannot accept photographs of instructions.

l By PrOMPt: our tool for financial advisers to upload documents direct to us; advisers can contact us for further details.

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 is the trading name of Old Mutual Wealth Limited which provides an Individual Savings Account (ISA) and Collective Investment Account (CIA) and Old Mutual Wealth Life & Pensions Limited which provides a Collective Retirement Account (CRA) and Collective Investment Bond (CIB).

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.

SK8558/218-0214/March 2018 (W Ongoing Fee Form)

8 for your financial advisEr

adviser fees will be subject to the limits outlined in our remuneration Guide.notE

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1. Can I authorise fees on this form for more than one account/bond?

• Yesyoucan,providedallofthefeesyouareauthorisingarethesameforeachaccount/bondyoulistinsection3.Ifyouwanttoauthorise different fees for your accounts/bonds, you must complete a separate form for each one.

2. how will fees be deducted from my account/bond?

• Initial Fee (Lump Sums) ISA/CIA/CIB – this fee will be deducted from the gross amount of your investment before the balance is invested into your choice of funds.

• global Initial Fee (lump sums and transfers) CRA – Any global Initial Fee selected will apply to all lump sums and transfer payments included in the online application specified. Where you have agreed the fee as a specific amount of money, we will deduct it from the first payment submitted for your application, up to 7% of the payment value. If the initial fee has not been fully met from the first payment, we will deduct the shortfall from the subsequent payments, up to 7% from each, until the fee is met.

• Cash Transfer Fee ISA/CIA – if the fee is requested as a percentage, it will be treated as an initial fee and deducted from each cash transfer payment before the balance is invested into your choice of funds. If the fee is requested as a monetary amount, it will be deducted as an Ad hoc Fee by selling proportionally from all funds in your account once all transfer payments have been received.

• Re-registration Fee ISA/CIA – by deduction of the required monetary amount as an Ad hoc Fee by selling units proportionally from all funds in your account once we receive confirmation that all re-registrations are complete. If the fee is requested as a percentage, we will convert this to the nearest monetary equivalent, based on the total value of the re-registered units, and deduct it when the entire transfer is complete.

• Initial Fee (direct debits) – this fee will be deducted from the gross amount of each of your direct debit payments before the balance is invested into your choice of funds.

• Fund Switch Fee – this fee is the maximum payable when you or your financial adviser switch funds in your account/bond. You or your adviser will need to stipulate the actual fee payable for each switch, up to this maximum limit, at the time a switch instruction is given. We will deduct the Fund Switch Fee from the proceeds of the sold funds then invest the balance into the new choice of funds. Note: Fund Switch Fees are not paid for: switches resulting from phased investment or automatic rebalancing; switches that have not been instructed as a result of financial advice; or switches made by the portfolio manager as part of the WealthSelect Managed Portfolio Service.

• Servicing Fee – this fee is paid regularly to your financial adviser by selling units as stated in section 6*. You state how much and how often it is to be paid. (if the frequency section is left blank, we will assume ‘monthly’). Where the fee is agreed as a percentage, the fee paid may go up or down depending on the value of your account/bond on the day the fee is calculated.

– When the fee is due, it will be calculated based on the annual percentage, then divided by the frequency selected and paid accordingly.

– Your financial adviser will tell you about the vAT treatment of this fee and how it might affect your payments. *If you do not specify a choice, and in the absence of any existing instructions, we will sell units:

CRA - proportionally from all crystallised funds in your account. Where there are insufficient crystallised funds, we will deduct units proportionally from your uncrystallised funds.

ISA, CIA & CIB – from your largest fund.

3. If I convert my CrA to Charge Basis 3, what effect will it have?

• IfyourCRAwaspreviouslyonChargeBasis1,anycommissionpaymentstoyourfinancialadviser(whereapplicable)willstop. • Allfundmanagerrebateswillbereinvestedintoyouraccount. • YouraccountwillbesubjecttotheChargeBasis3TermsandConditions. • ItwillnolongerbesubjecttotheInvestorCharge. • InsteadtheOldMutualWealthProductChargewillapply,whichisexplainedintheTermsandConditions. • YouraccountcannotsubsequentlychangetoadifferentChargeBasis.

Your financial adviser will be able to explain how this will affect your personal circumstances.

If selected as a percentage, the initial fee will apply to the balance invested into your account after any immediate tax-free cash has been deducted, not on the total lump sum/transfer payment.notE

ONGOING AdvIser Fee AuthOrIsAtION Individual Savings Account (ISA), Collective Investment Account (CIA), Collective Retirement Account (CRA) and Collective Investment Bond (CIB)

QuestIONs ANd ANsWersthese are for you to keep; please read them before completing and sending your instruction to us.

It is important that you complete the form with your current financial adviser. Please advise us if, after sending us the form, you then change your financial adviser.

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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 is the trading name of Old Mutual Wealth Limited which provides an Individual Savings Account (ISA) and Collective Investment Account (CIA) and Old Mutual Wealth Life & Pensions Limited which provides a Collective Retirement Account (CRA) and Collective Investment Bond (CIB).

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.

SK8558/218-0214/March 2018 (W Ongoing Fee Form)

QuestIONs ANd ANsWers (continued)4. What happens if I’ve make a mistake on the form?

• Ifyounoticethemistakebeforesendingustheform,eithercompleteanewformorcrossouttheincorrectdetailsandsignanychanges. • Ifwehavealreadyreceivedtheformandcarriedoutyourinstructions,wemightbeabletochangeorcancelthefee,subjecttocertain

restrictions; see Q5 for more information.

5. Can I change or cancel a fee once it’s been set up?

• Yes,subjecttotherestrictionsoutlinedinthenotesbelow.

6. Who has to sign the form?

• Allinvestorsnamedontheaccount/bond,includingtrustees/authorisedsignatories(whereapplicable).

7. What is required if the form is being signed by an attorney?

• Theattorneymustadd‘asattorney’afterhis/hersignature. • WeneedtoseetheoriginalPowerofAttorney,ifnotalreadysenttous.Wecanacceptacopyprovideditiscertifiedasatruecopyof

the original, in ink on each page by a solicitor or by you as the donor (ie the person giving the power). • Wealsoneedproofoftheattorney’sidentificationifnotalreadyprovided(contactusfordetailsofwhatdocumentswecanacceptas

proof).

8. What if I have more questions?

Your financial adviser should be your first point of contact. However, if you would like to speak to us, please call our Customer Contact Centre on Freephone 0808 171 2626 or email us at ask@omwealth.com and we will be happy to help.

notE – We need at least 10 working days’ notice to change or cancel a Servicing Fee or Fund Switch Fee.– We cannot change or cancel a fee once it has been deducted from your account/bond; instead you would need

to contact your financial adviser to discuss whether a refund is payable in full or in part.