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WITHDRAWAL/CLOSURE FORM

• PleasereadtheaccompanyingQuestionsandAnswersdocument;itwillhelpyoucompletethisformandclarifywhetheranyadditionaldocumentsareneeded(forexampleproofofidentification).

• ProvidedwehavereceivedeverythingweneedatourHeadOfficebefore10am,transactionswillbebasedonthepricesonthefollowingworkingday.

• Wenormallypayproceedswithin5workingdaysofreceivingyourinstruction(excludingthetimeittakesforthepaymenttoreachyourbank).

• Completethedetailsineachapplicablesectioncarefully;wecannotbeheldresponsibleforanyconsequencesiftheyareincorrect.Errorsoromissionsbyyouoryourfinancialadviserwillnotbecorrectedretrospectively.

• If, in our view, your instruction is not clear, we will be unable to proceed until we have contacted you for clarification and this could delay your withdrawal/closure.

NOTE

! Before you complete this form, it is important that you understand the following:

–Youmayincur‘early encashment charges’–moreinformationisintheaccompanying‘QuestionsandAnswers’document

–Ifyourplanorbondhasadditionallifecoverorcriticalillnesscoverwemakeachargeforprovidingthecoveronthe15thofeachmonth.Ifyourwithdrawalhasnottakenplacebeforethe15thwewillmakeachargewhichwillreducethevalueofyourplan/bond.

–IfyouhaveaCAB,EAB,HIB,SDBorSIBandthereislessthan£501leftinyourbondafterwehavedeductedyourwithdrawalamount,wewillpayyoutheentirevalueandcloseyourbond.

–Anyadditional life cover on a bond could be reducedasaresultofawithdrawal.

–Therearetax implications whenmakingwithdrawals

• Therearetwowaystomakeawithdrawalfromalifeassuranceplan/bond:

– FULL surrender of INDIVIDUALpolicies

– PARTIAL surrender fromALLpolicies

andtherearedifferent tax implications dependingonthemethodyouchoose.

ThefollowingwebsitescontainguidancefromHMRC:www.hmrc.gov.uk/manuals/iptm/IPTM3510.htm www.hmrc.gov.uk/manuals/iptm/IPTM3560.htm

• WE CANNOT ADVISE YOU WHICH METHOD IS BEST FOR YOUR PERSONAL CIRCUMSTANCES.

• HMRCrulesdonotpermitustoamendthebasisonwhichawithdrawalwascompletedifthetaxconsequenceswerenotwhatyouexpected.

Whateverthereasonforsellingyourinvestment(s),westronglyrecommendthatyouconsult your financial adviserbeforeyoudoso.

Youradviserwillbeabletoexplainyouroptions,helpyoudecidethemostsuitablerouteandadviseyouaboutanytaximplications.

WITH THIS FORM YOU CAN*:

• closeyourbond/plan.....................................................................................................................................................section 3

• makeawithdrawalbysellingindividualnumberedpolicies...............................................................................................section 4Ai)

• raiseaspecificsumofmoneybysellingindividualpolicies...............................................................................................section 4Aii)

• raiseaspecificsumofmoneybysellingproportionallyacrossallpolicies..........................................................................section 4B

*theoptionsavailablewilldependontheproductyouhave

It can be used for the following:

CapitalAccumulationPlan(CAP) TheSkandiaPlan(TSP)

MaximumInvestmentPlan(MIP) PersonalProtectionPlan(PPP)

SkandiaEndowmentPlan(SEP) SkandiaLifetimePlan(SLP)

InvestmentBonds(SIB,CAB,SDB,HIB,EAB,APB,CIB*,FIB)

It cannot be used for:•anyproductthatisnotlistedabove•regularincomewithdrawals,forwhichyouwillneedour‘automaticwithdrawalauthority’form.*CIBistheCapitalInvestmentBond,nottheCollectiveInvestmentBond,forwhichthereisaseparateform.

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NoYes

Fullname(s)of policyholder/trust

Bond/Plannumber (Pleasecompletethenumbercarefullybecausewecannotbeheldresponsibleforanyconsequencesifitisincorrect)

1 BOND/PLAN DETAILS

(Ifyouraddresshaschangedwithinthelast12months,orisdifferentfromtheonewehaveonourrecords,we will need proof of your new address,forinstancearecentoriginalbillshowingthenewaddress,egphone,electricity,gas,wateretcbutnotamobilephonebill.)

AtOldMutualWealth,wearekeentoimproveourproductsandservicesandwevalueyourfeedback.Wewouldbegratefulifyoucouldtake afewmomentstoanswerthequestionsbelowtohelpusunderstandyourdecisiontosellyourOldMutualWealthinvestment.

Q1 Didyouseekadvicefromaprofessionalfinancialadviserbeforedecidingtosell?(tick)

Q2 Whatisthemainreasonfordecidingtosellyourinvestment?Pleasetickoneofthefollowing Poorfundperformance Customerserviceexperience

Premium/chargestoohighornotasexpected Toinvestinadifferentproduct

Moneyrequiredforanotherpurpose Nospecificreason

Q3 Ifyouaregoingtousethemoneyfromthissaletoinvestinanotherproduct,isit:(tick)

•anOldMutualWealthproduct?

•anothercompany’sproduct?

Itwouldhelpusifyoustatethenameofthecompanyhere

Addressofpolicyholder/trust

Postcode

Fullnamesofotherpolicyholders(if applicable)

2.

3.

4.

(egSIB001234567)

REASONS FOR SELLING (completion of this section is optional)

Pleasetick/completethisformusingBLOCKCAPITALSandblueorblackink

–

Tickbelowtoindicatewhomweshouldcontactifwehaveanyqueriesaboutyourinstruction:

Iftheaddressgivenaboveisacorrespondenceaddressforthebond/plan,tickhere

Telephonenumber

uWewillnotshareyourcontactinformationwithotherparties;itisjustforourreference

Emailaddress

My/Ourfinancialadviser OR Me/Ususingthecontactdetailsshownabove

2 DETAILS OF ASSIGNEE (ifapplicable)

Assignee’sfullname

Pleasegivethedetailsoftheassignee-thismeansanyonetowhomtheownershipoftheinvestmenthasbeentransferred(assigned)orwithwhomthepolicyscheduleshavebeenplacedorareotherwiseregardedassecurity(egabank).The authority in Section 7 must then be completed by the assignee.

Assignee’saddress

Postcode

SK5169/218-0351/May2018(HWithdrawal/Closureformnonpension)

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3 TO CLOSE YOUR BOND/PLAN

YOU MUST COMPLETE SECTION 3 OR 4

Tickheretosurrender(sell)yourENTIREbond/planu speaktoyourfinancialadviseraboutpossibletaxconsequences NOWGOTOSECTION5

4 TO MAKE A WITHDRAWAL

• Therearedifferenttaximplicationsdependingonthemethodyouchoosebelow.

• Theremaybeearlyencashmentcharges.

• Theminimumwithdrawalpaymentis£50.

• Theminimumvaluetobekeptinabond/plantokeepitopen,afterawithdrawalismade,is£501.

NOTE

Nowgotosection5

Nowgotosection5

SELECT THE METHOD FOR WITHDRAWAL

FULL SURRENDER OF INDIVIDUAL POLICIES

CompleteONEofthefollowingthreeoptions

PARTIAL SURRENDER FROM ALL POLICIES

u notavailableforTSPortheSLP

u forMIPsthisoptionisonlyavailableatthereviewdate andprovidedpremiumshavebeenpaid

OR

(A)

(Ai)

(B)

Iwanttosellthefollowingindividualpolicies:

u statethepolicynumbers,eg1-20

Iwanttowithdraw:

bysellingfromeachpolicy,proportionallyacrossthefundswithinthepolicies.

Ifyouaretakingmorethan10%ofthetotalcontributionsintothebondandyourbondhasadditionallifecoverwecan:

•reducethecoverbythesameproportionasyouarereducingthebondvalue

•leavethecoveratthecurrentlevel

•reducethecoverbyadifferentamount–pleasecontactusforaprojectionon08001712626

Iwouldliketoreducemylifecoverby thesameproportionasthefundvalue

Ihaveseenaprojectionandwouldliketoreducemycoverto:

£

u Ifyoudonotcompleteeitherboxwewillleavethecoveratthecurrentlevel.

OR

Iwanttosellindividualpoliciestowithdraw:

u Wewillcalculatethenumberofpoliciestoselltoraiseat leastthissum,basedonthelastknownpricesforyourfunds.Ifthesalepricesarethenhigheronthedaywesellthepolicies,itcouldmeanthatyoureceivemorethanrequested;however,ifthepricesareloweronthatday,itcouldmeanthatyoureceivelessthanrequested.

However,ifyouwantustoraisethe EXACTAMOUNTshown,tickhere (thisoptionisnotavailableforMIPs)

u Wewillthencalculatethenumberofpoliciestoselland,ifthesaleofthepoliciesdoesnotraisethesumrequired,wewillmeettheshortfallbysellingfromeachremainingpolicy(proportionallyacrossthefundswithinthepolicies).

Nowgotosection5

£


(Aii)

£

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5 PAYEE DETAILS

Completethissectiontotelluswhomtopay(seetheaccompanyingQuestionsandAnswersforguidance).Wewillassumeoptioni)ifyoudonotstateotherwise. u Ifthereismorethanonepayee,pleaseindicatehowtheproceedsaretobesplit(eitherasapercentageofthetotalproceedsorasamonetaryamount).

(i)Paythepolicyholder(s) u thisincludespaymenttotrusteesasawholeandpensionschemetrustees % OR £

(ii)Payabeneficiary

• Beneficiariesmustbeatleast18yearsold.

• Ifpaymentistobemadetomorethantwobeneficiaries,pleaseprovidethesamedetailsfor eachadditionalbeneficiarybyusingcopiesofthispage;additionalpagesmustbesignedbythosesigninginsection7.

• Pleaseencloseproof of each beneficiary’s identification,asoutlinedinthechecklistonpage6.

% OR £

1Beneficiary’sfullname

% OR £

2Beneficiary’sfullname

Beneficiary’saddress

Beneficiary’sdateofbirth

/ /

(iii)Paythefollowingfinancialinstitution,financialadviserorsolicitor u paymentwillbemadeintothepayee’sClientMoneyAccount

% OR £

Payee’saddress

Payee’sname

(iv)InvesttheproceedsinthefollowingOldMutualWealthproduct

• Submityourapplicationfortheproductatthesametimeasthisinstruction.

• Ifyouareinvestinginmorethantwoproducts,pleaseprovidethesameinformationforeachadditionaloneonacopyofthispage;additionalpagesmustbesignedbythosesigninginsection7.

% OR £

% OR £

Productname

1

2

Productnumber/applicationreferenceu ifknown

Beneficiary’saddress

Postcode

Beneficiary’sdateofbirth

/ /


Postcode

Postcode

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7 AUTHORITY AND SIGNATURE(S)

Thedeclarationandpersonaldatastatementaremadebyeachpersonauthorisingthewithdrawal/closure.Ihereby:(a) authoriseandrequestOldMutualWealthtocarryouttheinstructionsdetailedonthisform(b) confirmthatyouhavebroughttomyattentiontheimportanceofreadingtheaccompanying‘QuestionsandAnswers’beforecompletingtheform(c) (ifnotatrustee)confirmthatIamentitledtothelegalandbeneficialinterestintheinvestmentstobesold

(ifatrustee)confirmthatnonoticeofassignmentormortgageaffectinganybeneficialinteresthasbeenreceivedbythetrustees(d) confirmthatthereisnobankruptcyorderagainstthepolicyholderorbeneficiary(ifapplicable)(e) confirmthatthepolicyholder,orbeneficiary(ifapplicable),isnotanundischargedbankruptand/ornotdeemedtobeinsolventinaccordance

withthemeaningoftheInsolvencyAct1986orEnterpriseAct2002(f) (ifpaymentisbeingmadetoabeneficiary)confirmthatthebeneficiaryisentitledtoreceivepaymentunderthetermsofthetrust(g) confirmthatpaymenttothepayeeinsection4willdischargeOldMutualWealthfromallliabilitiesandclaimsarisingfromthistransaction(h) acceptthattheinstructionsinthisformwillbecarriedoutundertheTermsandConditionsofthebond/plan.i) Your personal information–IcanconfirmthatIhavebeenshownandhavereadtheprivacynotice.

Fortrustinvestments,ifthetrusteessigningthisformdifferfromthosewehaveonourrecords,wewillneedtoseealltrustdocumentsshowingthetrusteechangesbeforewecarryouttherequest.Thedocumentscanbetheoriginals,orcopiescertifiedastruecopies,forexamplebyyourfinancialadviserorasolicitor.

NOTE

1. Signature Date(dd/mm/yyyy)

Printfullname Capacityu egpolicyholder,trustee,signatory,attorney,assignee

/ /

6 PAYEE’S BANK DETAILS

If you selected options i), ii) or iii) in section 5, please complete this section with the payee’s bank details.

Bankorbuildingsocietynameandaddressu mustbeintheUK

u ifthereismorethanonepayee,pleaseusecopiesofthispagetoprovidetheirbankdetails;additionalpagesmustbesignedbythosesigninginsection7.

Postcode

Branchsortcode

– –

Nameofbank/buildingsocietyaccountholderu thepayee

Buildingsocietyrollnumberu ifapplicableBank/Buildingsocietyaccountnumber


continued

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• Ifwearepayingpolicyholders,trusteesorbeneficiaries,wewillneedtoseeproof of the bank account ownership,* ifnotalreadyprovided.

• Wewillonlysendachequeinexceptionalcircumstances;seeQ3intheaccompanyingQuestionsandAnswers.

NOTE

Tick as applicable Ihavepreviouslyprovidedproofofownershipofthisbankaccount

Iencloseproofofownershipofthisbankaccount

* TheQuestionsandAnswersdocumentexplainswhatwecanacceptasproofofownership–seeQ4.

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CHECKLIST

Beforeyousendusthisform,makesureyouhave:

readtheaccompanyingQuestionsandAnswers

completedallapplicablesectionsintheform

signedtheforminsection7andanyadditionalpagestosupportsections5and6

includedanyadditionaldocumentsrequired(seeQ4intheaccompanyingQuestionsandAnswers),forexample: •Proofofyourresidentialaddressifithaschangedwithinthelast12monthsoritisdifferentfromtheaddresswehaveonourrecords. •Proofofidentificationforallbond/planholdersandanypartieslinkedtotheinvestment(egattorneys,trusteesortrustbeneficiarieswhoare

receivingpayment). •Proofofbankaccountownership. •Trustdocuments.

Once completed, please send the form and any necessary documents to us at the address below – when we have carried out your instructions, we will send you details of the transactions including the value of the proceeds.

Old Mutual WealthHead OfficeOld Mutual HousePortland TerraceSouthamptonSO14 7AY

www.oldmutualwealth.co.ukCallsmaybemonitoredandrecordedfortrainingpurposesandtoavoidmisunderstandings.OldMutualWealthLifeAssuranceLimitedisregisteredinEngland&Walesundernumber1363932.RegisteredOfficeatOldMutualHouse,PortlandTerrace,SouthamptonSO147EJ,UnitedKingdom.AuthorisedbythePrudentialRegulationAuthorityandregulatedbytheFinancialConductAuthorityandthePrudentialRegulationAuthority.FinancialServicesregisternumber110462.VATnumber386130159.WhenprintedbyOldMutualthisitemisproducedonamixedgradematerial,whichusesacombinationofrecycledwoodorpaperfibrefromcontrolledsourcesandvirginfibresourcedfromwell-managed,sustainableforests.




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7 AUTHORITY AND SIGNATURE(S) (CONTINUED)

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2 0



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WITHDRAWAL/CLOSURE FORMQUESTIONS AND ANSWERS

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

1. Are there any tax implications if I make a withdrawal?

! Yes – the information below is also on page 1 of the form but it is important that you understand it:

•Therearetwowaystomakeawithdrawalfromalifeassuranceplan/bond:

- FULL surrender ofindividualpolicies

- PARTIAL surrender fromallpolicies

andtherearedifferent tax implicationsdependingonthemethodyouchoose.

ThefollowingwebsitescontainguidancefromHMRC:www.hmrc.gov.uk/manuals/iptm/IPTM3510.htm www.hmrc.gov.uk/manuals/iptm/IPTM3560.htm

• WECANNOTADVISEYOUWHICHMETHODISBESTFORYOURPERSONALCIRCUMSTANCES.

• HMRCrulesdonotpermitustoamendthebasisonwhichawithdrawalwascompletedifthetaxconsequenceswerenotwhatyouexpected.

Westronglyrecommendthatyouconsult your financial adviserbeforemakingadecisiontosurrenderfromyourbond.

2. Are there any early encashment charges? Notforthefollowingproducts:TSP,MIP,SEPandSLP. Forotherproductstherecouldbeearlyencashmentcharges;howevertheyvarybyproductandcandependonthelengthoftimeyouhaveheldthe

bond/plan.Detailswillbeinyourproducttermsandconditions.Ifyourequiremoreinformation,pleasecontactususingthedetailsshownininQ10.

3. How long does it take to receive my money? Wenormallyreleasethemoneywithinfiveworkingdaysofreceivinganacceptableinstruction(excludingthetimeittakesforthepaymenttoreach

thebank).PaymentswillbemadetoaUKbankaccount*usingBACS(Bankers’AutomatedClearingSystem),wherebythemoneyreachesthebankaccountthreetofiveworkingdaysafteritleavesus.

*Wewillsendachequeifweareunabletosendpaymenttothebankforanyreason.Chequeswillthenbepayabletoallbond/planholders/trusteesjointlyifweareunabletopaythenominatedpayee.

4. Do you require anything in addition to this form? • Proof of your residential addressifitisdifferentfromtheaddresswehaveonourrecords.Forexampleanoriginalhouseholdbilldated

withinthelastsixmonths(mobilephonebillsarenotacceptable) •Proof of identificationifnotalreadyprovidedbyyouoryourfinancialadviser,forallbond/planholdersandanypartieslinkedtothe

investment(egattorneys,trusteesortrustbeneficiarieswhoarereceivingpayment).Pleaseencloseeitherapassportoraphoto-carddrivinglicence–eithertheoriginaloracertifiedcopy*.

• Proof of the bank account ownershipIfthemoneyisgoingtothepolicyholder(s),trusteesorbeneficiaries.Theproofcanbeavoidedchequeoracertifiedtruecopy*ofyourbankaccountstatementdatedwithinthelastsixmonths.Ifyouhaveonlinebankaccountstatements,aprintedcopycertifiedbyyouradviserwillsuffice.

• For trust investments,ifthetrusteessigningtheformdifferfromthosewehaveonourrecords,wewillneedtoseealltrustdocumentsshowingthetrusteechangesbeforewecancarryouttherequest.

* Copies must be certified on each page in ink by a professional such as your financial adviser, solicitor, accountant, GP or bank manager (including the bank’s stamp).

5. What happens if there’s a problem with my request? If,inourview,yourinstructionisnotclear,wewillbeunabletoproceedandwewilltypicallycontactyouoryourfinancialadviser.Thismaymean

thatyourrequestwillbedelayed.

6. Are there any limits when withdrawing from my bond/plan? •Theminimumwithdrawalpaymentis£50. •Theminimumvaluetobekeptinabond/plantokeepitopenafterawithdrawalismadeis£501.


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www.oldmutualwealth.co.ukPleasebeawarethatcallsandelectroniccommunicationsmayberecordedformonitoring,regulatoryandtrainingpurposesandrecordsareavailableforatleastfiveyears.OldMutualWealthLifeAssuranceLimitedisregisteredinEngland&Walesundernumber1363932.RegisteredOfficeatOldMutualHouse,PortlandTerrace,SouthamptonSO147EJ,UnitedKingdom.AuthorisedbythePrudentialRegulationAuthorityandregulatedbytheFinancialConductAuthorityandthePrudentialRegulationAuthority.FinancialServicesregisternumber110462.VATnumber386130159.


GLOSSARY/DEFINITION OF TERMS

QUESTIONS AND ANSWERS continued

7. Who can be paid the proceeds? •You, the policy holder–thepayeewillordinarilybeyou,thepolicyholder;thisisthereforethefirstoptionshownontheform. •Trustees–paymentscanbemadetoatrustee(s)intoaUKbankaccountheldintheircapacityastrustee(egTrusteeoftheJohnSmithWill

Trust);thisisOptioni)ontheforminsection5.Ifthereisnotrusteebankaccount,pleasecontactus. •Beneficiary of a Trust–wecanpayabeneficiaryprovidedhe/sheisatleast18yearsoldandwehaveproofofthebeneficiary’sidentity.

PaymentswillonlybemadetoanaccountofaUKfinancialinstitutionheldinthenameofthebeneficiary. •A ‘Client Money Account’–wecanmakepaymenttoa‘clientmoneyaccount’ofafinancialinstitution,afinancialadviserorasolicitor

providedtheyareauthorisedtohandleclientmoney. •Payment to another Old Mutual Wealth Product–Ifyouwanttotransfertheproceedstoinvestinanotherofourproducts,youmust

submityourapplicationforthatproductatthesametimeasthewithdrawal/closureform.Therecouldberestrictionsconcerningthenameinwhichthenewproductisheld;youshouldthereforecheckwithyourfinancialadviserbeforechoosingthisoption.

Please note that we will refer to the name of the policy holder or beneficiary on any payments we make.

8. Who has to sign the form? • Allpolicyholdersincludingtrusteesand/orassignees(whereapplicable)mustsigntheform,aswellasanyadditionalpagessenttosupport

sections5and6.

9. What is required if the form is being signed by an attorney? •Theattorneymustadd‘asattorney’afterhis/hersignature. •WeneedtoseetheoriginalPowerofAttorney,ifnotalreadysenttous.Wecanalsoacceptacopyprovideditiscertifiedasatruecopyofthe

original,ininkoneachpagebyasolicitor. •Wealsoneedproofoftheattorney’sidentificationifnotalreadyprovided(fordetailsofwhatwecanacceptasproof,seeQ4).

10. What if I have more questions? Yourfinancialadvisershouldbeyourfirstpointofcontact.However,ifyouwouldliketospeaktous,pleasecallourCustomerContactCentreon

[email protected].

Someofthetermsweuseinthewithdrawal/closureformareexplainedbelow:

BACS Bankers’AutomatedClearingSystem.Thisisthemethodweordinarilyusetomakedirect,electronicpaymentstobanks.

Beneficialinterest Therighttobenefitfromacontractortrust.Abeneficiarywillhavebeneficialinterest,unlikeatrusteewhohasresponsibilitytoholdthepropertyintrust,butdoesnotbenefitfromit.

Beneficiary Anyonewhoisentitledtoreceiveassetsorprofitsfromproperty,forexampleanestate,atrust,oraninsurancepolicy.

ClientMoneyAccount AnaccountinwhichacompanyisauthorisedbytheFinancialConductAuthority(FCA)toreceiveorholdmoneyonbehalfofaclient.ThemoneyisthengovernedbyspecificrulesissuedbytheFCA.

Earlyencashmentcharges Chargesimposedforsellinginvestments.DetailswillbeintheKeyFeaturesDocumentandTerms&Conditionsfortheproduct.

EEA EuropeanEconomicArea.

Financialinstitution Anorganisationsuchasabank.

Policyholder Referencesto‘policyholder’inthewithdrawal/closureformmeanthebond/planholder.

Trustees Thosewhoareholdingpropertyintrustonbehalfofsomeoneelse.