number company name startin¯ or addin¯ to your royal ... · area code (daytime) telephone number...

startin¯ or addin¯ to yourRoyal Skandia Executive Bondfor the individual investorWe only sell our products through financial advisers as we believe it is important you receive independent financial advice. As it is you who chooses your financialadviser, you need to bear in mind that they are acting as your agent and not as an agent for Royal Skandia.

All references to Royal Skandia, we, us and our in this application form mean Royal Skandia Life Assurance Limited.

Royal Skandia account number

Name of financial adviser

Company name _____

Address ____________________________

___________________________________

___________________________________

Telephone number

Fax number

E-mail address

Royal Skandia only accepts business introduced by companies which have Terms of Business with us.

This application form is for individual applicants only. If you are a trustee or corporate applicant you should use the alternative application form which is available fromyour financial adviser. Please note this application form must not be used by applicants resident in Hong Kong, Singapore or the United States of America.

Before completing the application form, please make sure you receive and read through the relevant Key Features Document: key features of your Executive Investment Bond or key features of your Executive Redemption Bond.

For ease of reference we have used an arrow � to highlight certain facts and sometimes to let you know that you can find further information and explanations inthe guidance notes for starting or adding to your Royal Skandia Executive Bond – for the individual investor (referred to as the guidance notes). If the guidance notesare not attached to this application form please ask your financial adviser for a copy.

To complete this form:• use CAPITAL LETTERS only• use blue or black ink• specify choices as appropriate• complete all relevant sections; refer to the checklist at the back of this document for guidance• do not use correction fluid; any amendments should be crossed out and initialled by all applicants.Please note that we must receive your application form by post or courier, we are unable to accept faxed or e-mailed versions. Please ensure that you complete allrelevant sections. We will contact you regarding any missing information which will need to be provided to us in writing, and this may delay your application.

Royal Skandia bond number(if reserved or if adding to an existing bond)

Financial adviser details

Important information for you - the applicant

Completing the form

Additional investment

New investment

A Type of application

If this is an application for a NEW BOND, please indicate which type of bond you are applying for: (�)� Please refer to section A of the guidance notes which explain the difference between the two types of bond. THE TYPE OF BOND CANNOT BE CHANGED AFTER IT HAS BEEN SET UP.

Life assurance This is called the Executive Investment Bond.

Capital redemption This is called the Executive Redemption Bond.

If this is an application for an ADDITIONAL INVESTMENT, please provide your existing bond number:(you can find this in your policy documentation)

� Unless your details have changed, you only need to complete the full forename(s) and surname of each policyholder and life assured (if applicable) in section B and C. YOU MUST ALSO COMPLETE SECTIONS E, F, G, H (IF APPLICABLE) AND I.

June 2010

2

Applicant 1 Applicant 2 (if any)

B Details of all individual applicant(s)

In this section, please give details of all individual applicant(s). Applicants must be at least 18 years old and the maximum age is 89. The maximum age for a life assured is 89.If there are any further applicants, please photocopy this page, attach the details with this application form and tick here (�) �If additional pages are added, each separate page must be initialled by all applicants.

Full forename(s)

Surname

Title (�)

Other

Mr

Residential address(where you are currently living)

Postcode

Date of birth D D M M Y Y Y Y

Sex (�) Male Female

Occupation(if you have retired, please includeyour occupation before retirement)

Nationality

Dual nationality(if applicable)

Passport number/nationalidentity card number

Country of residence

Correspondence address �Please refer to section B

of the guidance notes.

Postcode

Telephone number includingarea code (daytime)

Telephone number includingarea code (evening)

E-mail address

If the applicant(s), or any other party connected to this application either now or in the past/future, could be classed as a politically exposed person (PEP), or connectedwith a PEP, please provide details. �For examples of what a PEP is please refer to section B of the guidance notes.

Is the applicant(s) also goingto be a life assured? (�)�You only need to complete this if you have selected life assurance, ie the Executive Investment Bond, in section A.

Mrs

Yes YesNo No

Miss

Other

Mr

Postcode

D D M M Y Y Y Y

Male Female

Mrs Miss

Please provide details of any existing Royal Skandia contracts you have or are making payments to (if applicable)

ALL APPLICANTS MUST COMPLETE AND SIGN THE DECLARATION IN SECTION I.

�ADDITIONAL DOCUMENTS ARE NEEDED TO EVIDENCE YOUR IDENTITY - PLEASE REFER TO SECTION B OF THE GUIDANCE NOTES FOR FURTHER DETAILS.

Type of contract

Policy number

Type of contract

Policy number

Previous name or alias �Please refer to section B of

the guidance notes.

Existing contracts

Politically exposed person

Reason for investment(for example, saving for retirement)

3

C Details of the life/lives assured (if different from applicant(s))

This section should only be completed if you have selected the life assurance option, ie the Executive Investment Bond, in section A. Please note you do not need tocomplete this section if the applicant(s) is going to be the only life/lives assured, if this is the case please just tick where indicated in section B.

The maximum age for a life assured is 89.

� Please refer to section C of the guidance notes which have more details on the life/lives assured. If there are any further lives assured, please photocopy this page, attach the details with this application form and tick here (�)�If additional pages are added, each separate page must be initialled by all applicants.

First additional life assured (if any) Second additional life assured (if any)

Full forename(s)

Surname

Title (�)

Other

Mr



Mrs Miss

Other

Mr

D D M M Y Y Y Y

Male Female

Mrs Miss

Nationality


Third additional life assured (if any) Fourth additional life assured (if any)

Full forename(s)

Surname

Title (�)

Other

Mr



Mrs Miss

Other

Mr

D D M M Y Y Y Y

Male Female

Mrs Miss

Nationality


D Charges and bond currency

E Investment details

� Before completing this section, please refer to section D of the guidance notes for important information about your chosen charging structure and choice of bond currency.

Charges

Please enter the reference code for your chosen charging structure:(Your financial adviser will be able to provide you with this code.)

Bond currency

Premium payment

I wish my bond to be valued in (�)

Please note if no currency is entered your bond currency will be pound sterling (£). THE BOND CURRENCY CANNOT BE CHANGED AFTER THE BOND IS SET UP.

� If you are paying your premium in a different currency to your chosen bond currency, please refer to section D of the guidance notes.

� Before completing this section, please refer to section E of the guidance notes for information about paying in your premium, ie your investment amount, and thenumber of bond policies.

� The premium payment must come from an account or transferred shares held in the name of the applicant(s). Cheques should be made payable to Royal Skandia Life Assurance Limited.

� The minimum initial investment amount is £50,000 (US$75,000, €75,000 or other currency equivalent) and the minimum additional investment is £5,000(US$7,500, €7,500 or other currency equivalent). Please remember to enclose either your cheque, copy of receipt of your electronic bank transfer payment (forbanking details see section E of the guidance notes) your asset transfer or share sale form (your financial adviser can provide you with the necessary details)with this application form.

Currency (�)

Amount to be invested

Payment method (�) Cheque Electronic bank transfer Asset transfer

4

Share sale (UK only)

Please enter the number of policies you would like:

THE NUMBER OF POLICIES CANNOT BE CHANGED AFTER THE BOND IS SET UP.

� We normally issue 12 policy schedules per contract. If you require more or less, please refer to section E of the guidance notes and insert the number required.

Number of policies – new contracts only

£ US$ € HK$ Other(state currency)


5

Bank account holder(name as stated on bank account)

Bank accountnumber/IBAN*

Sort code**(if applicable)

SWIFT or BIC code**(if applicable)

Bank name

Country

How long have you held this account? years months

F Source of funding

THIS SECTION MUST BE COMPLETED IN ALL INSTANCES, PLEASE NOTE THIS SECTION CONTINUES ON THE FOLLOWING TWO PAGES.

Source of funds

- -

Bank address

Postcode

** IBAN stands for international bank account number and is always used in conjunction with a bank identifier code (BIC).

** A sort code is used in the UK in conjunction with a bank account number. A SWIFT code is used outside Europe in conjunction with a bank account number. A BIC code is used in Europe in

conjunction with an IBAN.

� The premium payment must come from an account held in the name of the applicant(s)� Before completing this section, please refer to section F of the guidance notes for information about your payment and origin of wealth.

Address of employer oryour own company

Name of employer oryour own company

Website address ofemployer or your owncompany (if any)

Occupation

Last year's gross salary/income amount

Last year's bonus amount (if applicable)

THIS SECTION MUST BE COMPLETED IN ALL INSTANCES.

Please give details of your employer or your own company, if self-employed.

If you have retired, please include details of your employer or your own company before retirement. Please also enter your final year's salary/income and bonus, if any,before retirement.

continued

Employer details Applicant 1 Applicant 2 (if any)

Postcode Postcode

Country

Currency (�) £ US$ € HK$

Other(state currency)

£ US$ € HK$


Currency (�) £ US$ € HK$


£ US$ € HK$


6

continued

F Source of funding (continued)

Shares/investment/policy held for

Surrender penalty incurred (if any)

Total amount paid out Currency:(�)

Amount:

Sale of shares

Maturing investments

Policy claim

Replacement policy

Name of company that held yourshares/investment/policy (for example bank,stockbroker or insurance company)

Name of person who held the shares/investment/policy

Reason for policy claim or replacementpolicy (if applicable)

How were they sold? (ie bank, stockbroker orother agent, if applicable)

Description of shares sold (if applicable)

Date received

Full details of origin of wealth

PLEASE TICK THE DESCRIPTION OPTION(S) RELATING TO THE ORIGINAL SOURCE OF THE PREMIUM FOR YOUR BOND. YOU MUST FULLY COMPLETE EACHRELEVANT SECTION RELATING TO THE DESCRIPTION OPTION(S) YOU HAVE TICKED.

THIS SECTION MUST BE COMPLETED IN ALL INSTANCES

(�) Description Details required Your details

Regular income from employmentor

Details of last year’s income and bonusas declared under Employer details onthe previous pageRegular income from your

business (ie if self-employed)

Savings/investments held for

Amount of savings/investments

Account number

Name of financial institution/bank

Details of where funds are held:

Account holder (name as stated on account)

Currency:(�)

Amount:

Accumulated savings/investments

D D M M Y Y Y Y

£ US$ € HK$


£ US$ € HK$


years months

years months

F Source of funding (continued)

7

Full details of origin of wealth

Total sale amount Currency:(�)

Amount:

Sale of property/interest in company

Address of property/company sold (including postcode if applicable)

Date of sale D D M M Y Y Y Y

PLEASE TICK THE DESCRIPTION OPTION(S) RELATING TO THE ORIGINAL SOURCE OF THE PREMIUM FOR YOUR BOND. YOU MUST FULLY COMPLETE EACHRELEVANT SECTION RELATING TO THE DESCRIPTION OPTION(S) YOU HAVE TICKED.

(�) Description Details required Your details

� We may also require additional documentary evidence to support your application, particularly in relation to your country of residence and investment amount,before we can process it. Your financial adviser can establish if further documentary evidence is needed by completing part C in section J, or by contacting usbefore sending in your application form. For a list of the types of documentary evidence we may need, please refer to section F of the guidance notes.

Please enter what documentary evidence you areenclosing with this application form (if applicable).

Total amount Currency:(�)

Amount:

Other unearned income

Details (including reasons where applicable, howthe money was acquired, etc)

Origin of wealth (if ticked gift or other)

From which organisation or whom(state the relationship if applicable)

Date received

Inheritance

Loan

Gift

Compensation

Competition or gambling win

Other

D D M M Y Y Y Y

£ US$ € HK$


£ US$ € HK$


Name of company (if applicable)

Nature of business (if company sale)

Amount received:

G Investment choice

Investment choice

Security identifierSEDOL/ISIN(if known)

Security/Fund name – please enter names in full. If a Royal Skandiafund is chosen, please prefix the fund name with RS.

Accumulation/Income unit

requirement(if applicable)

Share class(if applicable,

for example

A, B or C)

Basecurrency ofsecurity/

fund(eg GBP, USD)

Investment % (whole %

numbers only)

TOTAL (must add up to 100%)

0758075 RS GBP Deposit N/A N/A GBP

HEAD OFFICE USE ONLY

Bond number Net premium amount

Please use this section to list the investment which your premium should be invested in. We have shown the Royal Skandia GBP Deposit Fund as an example.

� Before completing this section it is important you read through the information in section G of the guidance notes about who can manage your investment, whatinformation you need to provide us with in the table below and details of the investment restrictions which apply.

PLEASE NOTE IF WE DO NOT RECEIVE SUFFICIENT DETAILS, THIS WILL DELAY YOUR INVESTMENT.

� Please also note that if you are appointing an authorised custodian you do not need to complete the investment choice section below.

If you have ticked one or both of the above, you need to complete the relevant form(s); both are available from your financial adviser. Please enter which form(s) you areenclosing with this application form. (�)

Appointing a fund adviser to your Royal Skandia portfolio bond – for appointment of your fund adviser.

Request to transfer to an authorised custodian account – for appointment of your custodian.

Managing your investments

Would you like someone else to manage your investments? (�)

A fund adviser An authorised custodian

8

� Please remember to refer to section G of the guidance notes to make sure you provide us with all the information we need to invest your premium without delay.

In case we need to clarify the investment choice details above, please provide us with a contact name and telephone number.

Contact name

Telephone number includingarea code (daytime)

Telephone number includingarea code (evening)

Fax number

E-mail address

For bonds owned by two or more policyholders we will normally pay regular withdrawals to a bank account held jointly by all policyholders. However, we can also split theregular withdrawals equally between bank accounts held by each of the policyholder(s) if you request this below.

Please tick here if you would like the regular withdrawals split equally between two or more policyholders* (�)

* If you would like the regular withdrawals split equally between two or more policyholders, please copy this page, complete the payee details for each of the policyholders and make sure eachapplicant initials the additional page before sending the complete application form to Royal Skandia.

� Please note if the payee details below differ from the bank details you gave us relating to your original source of funds for your premium, as detailed in section F of thisapplication form, then we may need additional documentation. This may delay the payment you have requested.

Until further notice, I/we would like regular withdrawals to be made to:

Withdrawal amount

Payee details

H Regular withdrawals (optional)

Please complete this section if you wish to receive regular withdrawals from your bond.

� Please read section H of the guidance notes for important information about setting up regular withdrawal payments and any taxation which may apply. PLEASENOTE THAT THE MINIMUM PAYMENT FOR ANY REGULAR WITHDRAWAL PAYMENT, REGARDLESS OF FREQUENCY, IS £500 (OR OTHER CURRENCYEQUIVALENT).

� Additional investments: If this is an application for an additional investment into your existing bond and you wish to change the amount of withdrawal on yourbond, please enter the revised total withdrawal amount required. If this is a new request for withdrawals you can base a percentage amount on either youroriginal or total premium paid.

Date of first payment

If you would like us to pay regular withdrawals from specific assets held in your bond, please clearly indicate the percentage of each security/fund to be sold below.

Security/Fund name Percentage

� Please see section H of the guidance notes for more information on taking regular withdrawals from specific assets held in your bond.

Bank account holder(name as stated on bank account)

Bank accountnumber/IBAN

Sort code (applicable to UK accounts)

SWIFT or BIC code(SWIFT code needed for bank accounts outside Europe; BIC code needed for European accounts with an IBAN)

Bank name

Country

- -

Bank address

Postcode

9

Amount to be withdrawn each yearor

Percentage of premium to be withdrawn each year

Percentage to be based on your (�) original premium or total premium invested in the bond

Withdrawal frequency (�) Monthly Quarterly Half-yearly Yearly

Regular withdrawals to be paid in the following currency (�)


%

D D M M Y Y Y Y

continued

Personal Data Statement – Consent by each life assured and the applicant

Please note that if each life assured has not signed the application, the applicant confirms that he/she has obtained the consent of each life assured to this PersonalData Statement and is signing the application as his/her agent as well as applicant.

To: Royal Skandia Life Assurance Limited

I agree that you may use my personal data, including any sensitive personal data, (‘my data’) to process my application and to service my policy or policies (‘my policy’)for the purposes detailed below.

I understand and agree that:

• you may provide my data, by electronic or other means, to:

– other companies within the Skandia and Old Mutual groups of companies if you regard this as necessary to service my policy;

– my adviser and fund adviser;

– a third party to verify my identity in line with anti-money laundering or other requirements. This may involve carrying out checks with credit referencedatabases;

– reinsurers and other third parties who perform tasks for you to help you service my policy, including amongst other things, hosting my data, and the payment and reporting of any tax or levy. These third parties may be based in the United Kingdom or in countries outside the European Economic Area (EEA). I understand that these countries may not have laws to protect my data equivalent to those of the Isle of Man. However, I understand that you will ensure thatany such third parties agree to treat my data with the same level of protection as if you were dealing with it.

• to prevent and detect financial crime you may:

– share my data with other organisations, including law enforcement authorities;

– check and/or file my data with financial crime prevention agencies and databases.

• you and other companies within the Skandia and Old Mutual groups of companies may use my data for assessment, statistical analysis purposes and market research.

• my data may be made available to third parties where required or permitted by law, court order or regulation.

• on payment of a small fee, I am entitled to receive a copy of my data, subject to data protection law.

• I also have the right to require you to correct any inaccuracies in my data. In such circumstances please write to: The Data Protection Officer, Royal Skandia Life Assurance Limited, Skandia House, King Edward Road, Onchan, Isle of Man, IM99 1NU, British Isles.

10

I Declaration and application

I Declaration and application (continued)

1. I understand and agree that the contract I am applying to enter with Royal Skandia will be subject to Isle of Man law and that the Policy Terms and Conditions will bein the English language.

2. (a) If a bond number is not shown in section A of this form, I request that the amount shown in section E be invested as an initial premium for policies comprising aRoyal Skandia Executive Investment Bond or Executive Redemption Bond, and request Royal Skandia to issue the policies in my name, jointly with the otherapplicants, if any; or

(b) I request that the amount in section E be invested as additional premiums for the policies currently in force bearing policy numbers consisting of the bondnumber, as shown in section A of this form, followed by two or more digits.

3. I declare to the best of my knowledge and belief the statements made in this application, and any related documents, are true and complete and that I have notconcealed any material fact.

4. I confirm that each life assured (or parent where parental consent is required) consents to this application and agrees to my acting as their agent for the purpose ofthe information provided in this application.

5. I authorise and request Royal Skandia to effect the transaction detailed in section H and confirm that such payments will discharge Royal Skandia from all liabilitiesand claims arising from those regular withdrawals. I understand that this authority supersedes any authority previously given.

6. I confirm that I am not resident in Hong Kong or Singapore.

7. I confirm that I am not a resident of the United States of America. If I become resident in the United States of America, Royal Skandia may not be able to accept anyfurther premiums until after I cease to be a resident in the United States of America.

8. I understand that Royal Skandia accepts no responsibility for the consequences of sending documentation to the correspondence address entered in this applicationform, or to an address notified subsequently, and that Royal Skandia reserves the right to send correspondence to my residential address where regulations prevent itbeing sent to a third party.

9. I consent to my personal data being used in accordance with the personal data statement.

10. I confirm that I have received a copy of the key features of the Executive Investment Bond or key features of the Executive Redemption Bond and the ¯uidancenotes for startin¯ or adding to your Royal Skandia Executive Bond – for the individual investor and I have had the opportunity to read them when completingthis application form.

11. I may wish to invest into professional/non-retail type investment schemes and, if so, I will make sure that I have had the opportunity to read the offering documentsfor funds of this nature. Where I decide to invest in professional/non-retail type investment schemes, I accept the levels of risk associated with these, including therisk that the investment into such scheme could result in a loss of a significant proportion, or all of the sum invested.

I confirm that I am aware of the fees (if applicable) payable for the chosen investment(s) to be held in my policy. I understand that the fees exist partly to meetpromotion and distribution expenses of the product, including commission paid to a financial adviser and/or fund adviser.

Signature of Date

applicant 1

Signature of Date

applicant 2

Please enter the country in which this application form was completed.

This application must be completed by the applicant(s) unless you have asked your financial adviser to complete it.

Did you complete this application form yourself? (�)

If No, did a third party, such as your financial adviser, complete it on your behalf? (�)

By signing this declaration you confirm that you have read through the above declaration and, if a third party has completed the application form on your behalf, that allthe information provided in it is correct.

Yes

* If applicable. Please see section B of the guidance notes for more details.

Copies of the Policy Terms and Conditions and/or this completed application form are available on request.

No

Yes No

D D M M Y Y Y Y

D D M M Y Y Y Y

Signature of Date

applicant 3* D D M M Y Y Y Y

Signature of Date

applicant 4* D D M M Y Y Y Y

Please read the following declaration carefully.

Any omission or misstatement of a material fact in this application could affect the payment of benefits under the Executive Investment Bond or Executive RedemptionBond. A material fact is one which is likely to influence the assessment and acceptance of the application.

If you are uncertain whether a fact is material, you should give full details so that we can assess its possible significance. If you become aware of such a fact while we areconsidering your application, you should notify us immediately.

You should satisfy yourself that under any taxation, exchange control or insurance law to which you may be subject, you are able to effect the proposed contract.

Important information

Declaration – by the applicant/each applicant

11

Part A – Reason why documents are not provided (if applicable)

J Verification of customer identity – financial adviser/suitable certifier to complete


� Please note that we will not be able to set the bond live until this section has been completed and you have provided the necessary identification documentation.Please refer to section I of the guidance notes for more information on certifying documents.

Outlined below are the standard minimum requirements. In some circumstances we may need additional information.

We require one document from part A and one from part B. If neither document in part A is available, please provide the reason why and provide two formal documentsshowing appropriate personal details and verifiable reference numbers from part B.

Identification documentation should be current and valid. Evidence of address should be the latest available, but no more than three months old.

� Please tick (�) to indicate the identification you have supplied for each individual party to the bond. If a fund adviser has been appointed we may need to verifythe identity of the appointee.

12

1. Name

Capacity

Type of document Passport National identity card

Document reference

continued

Part A Individual whose identity is being verified

2. Name

Capacity


Document reference

3. Name

Capacity


Document reference

4. Name

Capacity


Document reference

5. Name

Capacity


Document reference

6. Name

Capacity


Document reference

13

J Verification of customer identity – financial adviser/suitable certifier to complete (continued)

These must be less than three months old 1 2 3 4 5 61. A recent utility, rates or council tax bill

(mobile/cell phone bills not acceptable)

2. A recent mortgage statement, giving the residential address

3. An extract from the official register of electors

4. A state pension, benefit or other government produced document showing benefit entitlement

5. A recent tax assessment document

6. A recent account statement from bank or credit card (store cards not acceptable)

7. Proof of ownership or rental of the residential address

Part B Individual whose identity is being verified

Part C Financial crime – risk rating

� Please refer to the origin of wealth guidelines (available from Royal Skandia) for information on how to complete the table below and section F of the guidancenotes for information about the documentary evidence we may need.

To prevent financial crime, Isle of Man authorised life companies may adopt a ‘risk-based approach’ when obtaining evidence of the origin of a client’s wealth. In order tospeed up the application process we have provided you with the table below to allow you to find out your client's risk rating before submitting the application form to us.We highly recommend that you complete the risk rating as it allows you to determine if you need to enclose further documentary evidence with the applicationform or not. If we do not receive the necessary documentary evidence with the application form, then it will take longer to process the business.

In order to decide what risk rating applies to your client’s investment you need to take into account the following factors:

(a) your client’s country of residence

(b) which country the premium is paid from

(c) which country your firm is regulated in.

(a) + (b) + (c) = total risk rating

Royal Skandia reserves the right to request further documentation if it is felt appropriate. Please note that each new application, or application for an additionalinvestment, will be reviewed individually.

If you are unsure about a particular application, please contact your Royal Skandia business consultant in the first instance, or alternatively contact Royal Skandia’sInternational Sales Support team directly on +44 (0)1624 655 009.

Applicant

Example

Client country ofresidence(a)

Switzerland (1)

Country of premiumfunding(b)

UK (1)

Country that you are regulated in(c)

UK (1)

Total risk rating

3

14

K Financial adviser/Suitable certifier declaration


� This method of certification is required for Isle of Man regulatory purposes.

Declaration by the financial adviser/suitable certifier

I declare that:

• I have verified the contents of the original documents where copies have been enclosed and confirm that they are true copies of the originals.

• I have taken reasonable steps to make sure that the funding is legitimate and in line with the client’s circumstances.

• To the best of my knowledge and belief, all the information provided in and with this application is true and complete and was obtained from the applicant(s) whois/are of good standing. I also confirm I will provide further information if required.

• I have not made any changes to the application form after the client has signed it.

I confirm that I gave advice concerning thisinvestment to the applicant(s) in Country

on

Date

Financial adviser stamp

Please enter allocation rate for this bond

Please enter fund-based commission (if applicable)

I confirm that, if applicable, all information provided was received directly from the applicant(s).

Regulatory body authorisation number (if applicable)

Regulator name

Royal Skandia financial adviser account number

Full name of introducer firm

Full name of financial adviser/suitable certifier

Signature of financial adviser/suitable certifier

%

%

D D M M Y Y Y Y

D D M M Y Y Y Y

www.royalskandia.comCalls may be monitored and recorded for training purposes and to avoid misunderstandings.

Royal Skandia Life Assurance Limited is registered in the Isle of Man under number 24916C. Registered and Head Office: Skandia House, King Edward Road, Onchan,Isle of Man, IM99 1NU, British Isles. Phone: +44 (0)1624 655 555 Fax: +44 (0)1624 611 715.Authorised by the Isle of Man Insurance & Pensions Authority. Authorised and regulated by the Financial Services Authority for business conducted in the UK. Some ofthe FSA’s rules do not apply to non-UK based insurers. FSA register number 142309. www.fsa.gov.uk/pages/register.

When printed by Skandia this item is produced on a mixed grade material, which uses a combination of recycled wood or paper fibre from controlledsources and virgin fibre sourced from well managed, sustainable forests.

SK6422/INT10-198/June 2010 00000

Skandia International is the divisional name for the international companies within the Skandia Group.

15

¯uidance notes for startin¯ or addin¯ to your Royal Skandia Executive Bond for the individual investor

A Type of application

General information

This product is not available in certain jurisdictions, such as the United States of America, its territories and possessions. Your financial adviser will be able to tell you ifyour country of residence and/or nationality fall into one of these jurisdictions.

UK AND JERSEY APPLICANTS PLEASE NOTE:If cancellation rights apply under UK or Jersey legislation, and are exercised during the cancellation period, any premium amounts paid will be refunded to the originalsource as stated in section F of the application form. The refund will be made less any deduction in respect of movements in investment prices and exchange ratefluctuations (where applicable) at the time the completed Cancellation Notice is received by Royal Skandia at its head office.

LIFE ASSURANCEA life assurance bond has one or more ‘lives assured’, which means the bond will come to an end when the person(s) who is assured dies. There is a choice of having one,two or more lives assured. Where there is more than one life assured, the bond will end when the last person whose life is assured dies.

CAPITAL REDEMPTIONA capital redemption bond does not have lives assured, therefore it will not come to an end on the death of a person. Instead it has a term of 99 years. It will continue tothe end of the term (the maturity date), unless it is fully cashed in before the 99 years come to an end. Each policy still in force at the maturity date has a guaranteedvalue of twice the premium amount you have paid (less any withdrawals), which will be paid to your beneficiaries.

Bond means the policy or group of policies issued to the applicant(s) following their application for an Executive Investment Bond or Executive Redemption Bond.

B Details of all individual applicant(s)

The applicant is the person who will own the bond. We will allow up to FOUR applicants in total to apply for an Executive Investment Bond or Executive RedemptionBond. If you would like to add any further applicants please copy and complete section B and, when initialled by ALL applicants, attach it with the application formbefore forwarding it to Royal Skandia.

PREVIOUS NAME OR ALIASPlease state any previous name(s) or any alias used in the box provided. This may include a previous surname before marriage/civil partnership or any other change ofname in the past. This section must be completed for regulatory purposes. If this does not apply, please leave this field blank.

CORRESPONDENCE ADDRESSIf it is not practical to send correspondence to your residential address (for example, if there is no recognised postal service in your country of residence), then you canprovide an alternative correspondence address to your residential address. We will accept a PO Box address. We can only accept one correspondence address for thebond.

POLITICALLY EXPOSED PERSONA politically exposed person is someone holding an important public position, or a person clearly related to them. Examples of these are:

• Heads of State or Government • Judicial or military officials • Senior politicians • Senior executives of publicly owned corporations• Senior Government officials • Important political officials.

ADDITIONAL DOCUMENTS TO EVIDENCE YOUR IDENTITY AND RESIDENCEIn line with our anti-money laundering requirements we need the following documents to support your application:

• Proof of identity – copy of your passport or national identity card. If these documents are not available please provide two formal documents carrying appropriatepersonal details and verifiable reference numbers (for example, bank statement, pension book or council tax bill).

• Proof of residence – copy of a utility bill or bank statement. This should be the latest available, but no more than three months old.

All documentary evidence, where the original document is not provided, must be certified by a suitable certifier (see section I of these guidance notes) as a true copy ofthe original, copies will not be accepted. Please note we are not able to return the documentary evidence to you.

In some circumstances we may need further documentation to support your application, for example in relation to your origin of wealth. Your financial adviser will beable to provide details on any additional needs by carrying out a short ‘risk assessment’ with you. We would encourage you to do this as without this furtherdocumentation, if applicable, the processing of your application may be delayed.

PREMIUM PAYMENTYou can pay your premium either by cheque, electronic bank transfer, asset transfer or by using our share sale service (available to UK residents only, please ask yourfinancial adviser for further details on this service). If you wish to pay your premium by cheque (please note cheque payments in currencies other than pound sterling (£)may take longer to clear and some non-UK banks may apply high charges), please enclose it with your application form. Cheques should be made payable to RoyalSkandia Life Assurance Ltd. If you wish to transfer the premium electronically, please enclose a copy of receipt of your electronic payment with the application or useRoyal Skandia’s Bank Instruction Letter. For electronic banking details please see below.

continued

16

C Details of the life/lives assured (if different from applicant(s))

In this section you should give the details of the life/lives assured in addition to the applicant(s), if you have selected the life assurance option in section A. If theapplicant(s) is going to be the only life/lives assured, then you do not need to complete this section, just tick where indicated in section B to confirm the applicant(s) isgoing to be the life/lives assured. There is no minimum age for a life assured.

We have a flexible approach to allow multiple lives assured (ie more than four) when applying for an Executive Investment Bond. If you would like to add any further livesassured please copy and complete section C and, when initialled by ALL applicant(s), attach it with this application form before forwarding it to Royal Skandia.

D Charges and bond currency

The charging structure and bond currency that you choose for your bond cannot be changed once the bond is established. It is therefore important that youconsider the following carefully before completing this section.

CHARGING STRUCTUREInvestors resident in the UK – please find full details about the charges applying to your charging structure in your personalised illustration, which forms part of thebond’s key features documentation. Please read these through carefully before completing this application form.

Investors resident outside the UK – please ask your financial adviser for a copy of the charging structure details recommended to you.

BOND CURRENCYYour regular Executive Investment Bond or Executive Redemption Bond valuations will be summarised in your chosen bond currency. This is also the currency in whichthe deduction of bond charges will be made, or charges applying when changing your investment choice.

CURRENCY CONVERSIONSIf you choose a bond currency other than that in which you make your investment, ie the premium amount you pay to us, you should be aware that we will notionallyconvert the premium amount into your chosen bond currency. This means we will not physically convert the premium amount; just apply the converted amount to yourbond. This currency conversion could expose you to exchange rate fluctuations. Any conversion that we make will be based on the closing ‘market mid-rate’* providedto us by a third-party currency rate provider on the working date before we receive your premium amount to our bank account. The converted premium amount will bethe amount which is shown in your policy schedules.

If additional currency conversions are required as a result of transactions within your bond, you should be aware that delays may occur. Please refer to the Policy Termsand Conditions for any charges which may apply.

* All currencies have a market rate. Any provider dealing with currencies will independently set different ‘buy’ and ‘sell’ rates, these include overheads and profit margins. The market mid�rate is

derived from the mid�point between the ‘buy’ and 'sell’ rates used in the global markets.

Other currency payments (SWIFT payments)

SWIFT code: NWBKGB2LXXX

Bank: National Westminster Bank, London

IBAN: (select as applicable, see below)

1. US dollar IBAN – GB05NWBK60730167544800

2. Euro IBAN – GB63NWBK60720267545858

3. Australian dollar IBAN – GB18NWBK60730167535836

4. Canadian dollar IBAN – GB80NWBK60730167521916

5. Danish krone IBAN – GB22NWBK60730167545270

6. Hong Kong dollar IBAN – GB52NWBK60730167555691

7. Japanese yen IBAN – GB40NWBK60730167538835

8. New Zealand dollar IBAN – GB26NWBK60730167576141

9. Norwegian krone IBAN – GB23NWBK60730167568823

10. Singapore dollar IBAN – GB53NWBK60730167598838

11. Swedish krona IBAN – GB69NWBK60730167554997

12. Swiss franc IBAN – GB14NWBK60730167541534

Payments should be made to Royal Skandia Life Assurance Limited’s accounts held with National Westminster Bank, London.

E Investment details

BANKING DETAILS

Sterling payments

From UK banks (CHAPS* payments)Sort code: 55-91-00Bank: Isle of Man Bank, East Region,

2 Athol Street, Douglas, Isle of ManBeneficiary: Royal Skandia Life Assurance LimitedIBAN***: GB94NWBK55910010939946

From non-UK banks (SWIFT** payments)SWIFT code: RBOSIMD2XXXSort code: 55-91-00Bank: Isle of Man Bank, East Region,

2 Athol Street, Douglas, Isle of ManBeneficiary: Royal Skandia Life Assurance LimitedIBAN: GB94NWBK55910010939946

*** CHAPS is an electronic bank�to�bank same day value payment made in the UK in pound sterling (£).

*** SWIFT is an acronym for Society for Worldwide Interbank Financial Telecommunications.

*** IBAN stands for international bank account number and is always used in conjunction with a bank identifier code (BIC).

17

E Investment details (continued)

IMPORTANT: • Please make sure that the applicant’s name and/or bond number (if reserved) is/are quoted in the payment field, referred to by the bank as SWIFT field 70, on the

electronic bank transfer form to ensure that correct details are sent to Royal Skandia. • Please note that when sending payments electronically spaces should be excluded from the IBAN numbers.• All bank charges, such as telegraphic transfer charges, are the responsibility of the applicant, not Royal Skandia.

NUMBER OF BOND POLICIESWe will automatically issue 12 policies if the number of policies has been left blank in the application form. If you would like a different number of policies to enhance thefuture flexibility of your bond, which you may have discussed with your financial adviser, then you need to take the following into account:• The minimum investment amount for each individual policy is normally £5,000 (US$7,500, €7,500 or other currency equivalent). However, to increase the flexibility

of the bond we automatically issue 12 policies, so for investments below £60,000 we have waived this minimum amount.• The investment amount for each policy will not necessarily be the same, this will depend on the amount of your investment. However, where possible your investment

will be spread equally across the number of policies you choose. If it is not possible to allocate the same amount across each policy, then the last policy will have adifferent amount. For example, if you invest £100,000 then you will receive 11 policies of £8,333.33 and one of £8,333.37.

• You can ONLY select more than 12 policies if the investment is over £65,000 (or other currency equivalent) as the minimum investment amount for each policy, seethe first bullet point above, has to be met. If your investment amount is below £65,000 (or other currency equivalent) and you choose 20 policies, for example, thenwe will automatically reduce the number of policies to 12.

• If you choose a number of policies which results in less than £5,000 (US$7,500, €7,500 or other currency equivalent) per policy, we will automatically reduce thenumber of policies to a level where a minimum of £5,000 (US$7,500, €7,500 or other or other currency equivalent) per policy is achieved. The exception to this isfor investments below £60,000, see the first bullet point above.

• The maximum number of policies we will allow without referral is 100.• You CANNOT change the number of policies once the bond has been established.

F Source of funding

As part of global efforts to prevent money laundering, all Isle of Man based companies have to collect additional information on origin of wealth for all investments. Thisshould not be viewed as questioning the quality of your investment. It is a safeguard that will benefit the industry as a whole and ultimately protect you as an investor.

The first step is to complete all the relevant information in section F of the application form. In some circumstances we will require documentary evidence before we canprocess your application form. Your financial adviser can establish if documentary evidence is needed by contacting us before sending in your application form to us. It isin the interest of all parties that you and your financial adviser make sure as early as possible what we need in order to avoid delays in starting your investment. Wealso recommend that you do not send us your premium payment until you have supplied us with all the information we require. The reason for this is that if we forany reason are unable to accept your application then we will return your payment to the source stated in your application form.The list below reflects what documentary evidence is required for each source of wealth; please state what evidence you are enclosing in your application form. In certaincircumstances, when an application form falls into a high-risk group for money laundering purposes, we may require further documentary evidence.

Description of source of wealth Documentary evidence required

Income from employment; or One of the following or equivalent:income from your business • original copy of recent payslip (or bonus payment); or

• recent accounts if self-employed; or• bank statement clearly showing receipt of most recent three months’ regular salary payments from named employer

Other unearned income All of the following:• appropriate supporting documentation• signed letter detailing funds from a regulated accountant

Investments One of the following:• investment certificates, contract notes or statements; or• confirmation from the relevant investment company; or• bank statements showing receipt of funds by investment company name; or• signed letter detailing funds from a regulated accountant or solicitor

Savings Copy of account statement(s) reflecting income or other source of savingsMaturing investments/ One of the following:Policy claim/Replacement policy • letter from previous investment company regarding notification of proceeds of claim; or

• closing statement from previous investment companyProperty sale One of the following or equivalent:

• signed letter from lawyer or regulated accountant; or• signed letter from estate agent (if applicable); or• copy of sale contract

Company sale One of the following:• signed letter from solicitor/lawyer; or• signed letter from regulated accountant; or• copy of contract of sale and sight of investment monies on bank statement; or• copies of media coverage (if applicable) as supporting evidence

Share sale One of the following:• legal sale document; or• copy of contract notes

Inheritance One of the following:• grant of probate (with a copy of the Will) which must include the value of the estate; or• the Will; or• signed letter from solicitor/lawyer

Loan One of the following:• confirmation letter from loan provider; or• recent loan statement

Gift All of the following:• identification on the grantor (even if it is not coming from their account); and• letter from grantor explaining the gift and source of their wealth; and• documentary evidence as to the grantor's source of wealth as detailed in this table

Compensation payment One of the following:• letter/court order from compensating body; or• signed letter from solicitor/lawyer

Competition or gambling win One of the following:• letter from relevant organisation (lottery head quarters, betting shop, casino); or• bank statement showing funds deposited by company name; or• copies of media coverage (if applicable) as supporting evidence

Other Refer to Royal Skandia

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IMPORTANT GUIDANCE NOTES ABOUT YOUR INVESTMENT CHOICE• We do not provide investment advice and have no responsibility for the performance of your selection of investments. It is for you and your financial adviser, or

fund adviser (if applicable), to choose the investments most suitable for you.• All investments required, other than Royal Skandia funds, must be recognised by us or specifically agreed by us as eligible to be purchased as a permitted

investment under the bond. • Any assets purchased in respect of your bond will be purchased at the open-market buying price as shown on the contract note used by the seller or stockbroker. • Any third-party charges relating to the purchasing of assets, such as bank charges, will be debited to your bond.• All assets are held in the name of Royal Skandia and all dealing and contract notes must be made and delivered in the name of Royal Skandia. If you have chosen our

authorised custodian facility please see the beginning of this section.• It is your responsibility to make sure money is readily available to meet charges or part surrenders/regular withdrawals, you can achieve this by holding cash in your

chosen bond currency.

G Investment choice

APPOINTING A FUND ADVISER OR AN AUTHORISED CUSTODIANYou can appoint a fund adviser and/or custodian to manage your investment within the bond.

Fund adviser – our form gives two options when appointing your fund adviser, depending on the level of authority they have. The first option is the ‘investment adviserauthority’ which means your fund adviser will discuss any proposed changes to the investment choice with you. This person must always obtain your prior writtenagreement before any changes to your investments are made, but you will authorise the fund adviser to submit investment instructions to Royal Skandia on your behalf.The second option is the ‘discretionary investment manager authority’. This option is for the ‘discretionary’ fund advisers who have the necessary permission from theregulator in the country they are operating in to manage your investments on your behalf. This person will be able to structure your investment portfolio and monitor itsperformance. The discretionary fund adviser will deal directly with us or an authorised custodian, if applicable, on your behalf. The discretionary fund adviser can changeyour investment choice without any prior consultation with you, but they must act in accordance with the investment agreement you make with them which states yourinvestment risk profile and limitations on investments. It is your responsibility to ensure that this person is carrying out investment instructions in accordance with yourinvestment agreement. We will accept all instructions from this person in good faith until you tell us otherwise. In certain jurisdictions it may be advantageous to appointa discretionary fund adviser.

An authorised custodian – will hold the assets on Royal Skandia’s behalf. You may already have a custodial arrangement which you are happy with and you can continueyour existing arrangement within the Executive Investment Bond or Executive Redemption Bond. Alternatively you can choose a custodian now. Your choice ofcustodian, whether it is your existing arrangement or a new one, will always be subject to our approval. Through this facility you or your fund adviser, if applicable, canissue investment instructions directly to the authorised custodian who will implement them. Your fund adviser could be associated with your authorised custodian forease of administration.

HOW DO I COMPLETE THE INVESTMENT CHOICE SECTION?• Security identifier* – if known, please provide a recognised security identifier for all security/fund purchase requests, such as a SEDOL or an ISIN number.

Your financial adviser can provide you with the relevant security identifier.

• Security/Fund name – please make sure you clearly state the full name of the security/fund and please do not use abbreviations. If you have chosen a Royal Skandiafund, please prefix the fund name with RS, and also refer to the note about the base currency of the security/fund below.

• Accumulation/Income unit requirement – if applicable, please state accumulation or income unit. The difference between accumulation units and income units isthat unit trusts with accumulation units reinvest any income from the trust’s investments in the trust rather than paying it out to its investors as dividends which is thecase for income units. If you give no instructions, and a choice of accumulation or income units is offered, we will invest in accumulation units. Where you havechosen income units any dividends will be reinvested into your bond.

• Share class – if applicable please include confirmation of required share class for example A, B or C.

• Base currency of security/fund – if known, please provide confirmation of the base currency of the requested security/fund. This can be abbreviated, for exampleGBP for pound sterling (£) or USD for US dollar. The Royal Skandia Executive Investment Bond and Executive Redemption Bond must invest directly into the basecurrency of funds.

• Investment % – please use whole percentages only, which must add up to 100% in the total box.

• Minimum investments – the minimum investment you can hold in any one asset is £5,000 (US$7,500, €7,500 or other currency equivalent). Please note that fundmanagers may set their own minimum investment levels that could be higher and you should be aware of these before submitting instructions.

• Transaction account – it is your responsibility to make sure money is readily available to meet charges or part surrenders/regular withdrawals, you can achieve this byholding cash in your chosen bond currency. If there are insufficient cash holdings in the bond, we will sell your investments in line with the Policy Terms and Conditions.

• If the information requested in a column does not apply then either leave it blank or state ‘n/a’ for not applicable.

• If you have not provided us with complete investment instructions, or if one or more of your selected fund(s) is not currently available, we will, in accordancewith the Policy Terms and Conditions, hold any part of your chosen percentage in the transaction account. Interest is credited at the quarterly valuation date inrespect of any credit balance and debited in respect of any debit balance. The transaction account is used to hold all money for the purchases of and proceeds fromthe sale of and any distributions from investment holdings. Charges applicable to the bond which are shown in your charges schedule and some third-party agent feesare also taken from the transaction account.

A delay in investing your premium may occur if the instructions are illegible, unclear or relate to an asset which is not normally permitted. Please note that we areunable to backdate transactions resulting from the delay caused in clarifying your instructions.

*Providing this information will remove the potential need to seek clarification and enable us to act upon your instruction more efficiently.

FUTURE INVESTMENT INSTRUCTIONSYou or your fund adviser, if applicable, should provide any future investment instructions on the dealin¯ instruction form and fax it to +44 (0)1624 615 535.The form is available from your financial adviser. If you have chosen our authorised custodian facility you need to send these instructions directly to your authorised custodian.

INVESTMENT RESTRICTIONSFor full details of investment restrictions, please refer to the Policy Terms and Conditions. The list below shows examples of the types of investment we mightaccept/refuse.

Permitted investments Non-permitted investments

Royal Skandia internal funds Commodities

Collective investment funds and unit trusts Options/derivatives

Various currency deposit Unlisted shares

External assets quoted on a recognised stock exchange Base shares or bonds

If you have any questions or need any clarification of these notes, terms and restrictions, then please contact our Dealing Admin team on +44 (0)1624 655 005 or e-mail us at [email protected], or alternatively contact your financial adviser.

19

H Regular withdrawals (optional)

Royal Skandia does not offer legal, tax or financial advice and cannot accept responsibility for any action taken or avoided on the basis of information provided by us.Any information provided is based on our understanding of the current law and practice and is subject to change in the future.

GENERAL CONDITIONS FOR SETTING UP REGULAR WITHDRAWALS• The minimum payment for any withdrawal, regardless of frequency, is £500 (or other currency equivalent).

• If this is an application for a new bond and you ask for a percentage of premiums to be withdrawn, this will be based on the initial premium. If this is an application foran additional premium into your bond, and you would like to either set up or amend existing regular withdrawals, then you can base the regular withdrawals either onthe total premium invested in the bond or the initial premium. Please state your choice in section H of the application form.

• Where the value of the units allocated to the bond at the date of the payment falls below the highest of 5% of the total premiums paid (after deduction of anyapplicable charges) or an encashment value of £10,000 (or other currency equivalent), we may stop your regular withdrawals. In line with the Policy Terms andConditions, to make sure your bond remains economically viable, we also reserve the right to automatically surrender your bond if it falls below these values. We willcontact you if the encashment value in your bond falls below £10,000 to give you the option to pay an additional premium, which is subject to our acceptance.

• It is your responsibility to make sure money is readily available to meet your regular withdrawals, you can achieve this by holding cash in your chosen bond currency.

• We will process regular withdrawals by cashing in part of all policies within the bond, in equal amounts, to generate your regular withdrawals.

• In the absence of alternative instructions from you, regular withdrawals will be met by cancellation of units in line with the Policy Terms and Conditions.

• Any dealings where we need to sell assets to meet your regular withdrawals may be subject to a dealing charge of currently £15 per transaction. The dealing chargeapplies to most charging structures and you can find details about it, if it applies, in the charges schedule which will be sent to you together with your policyschedules after your bond has started (if this is a new bond). The selling of external assets may also include third-party charges, such as bank charges, which will beincluded in the net amount going into your bond following the transaction. These third-party charges will be the responsibility of the applicant(s), not Royal Skandia.

If your regular valuation statement shows a debit balance in the transaction account, you should provide us with instructions to repay the ‘overdrawn’ debit balance atthe earliest possible opportunity. For more details please see the Policy Terms and Conditions.

TAKING REGULAR WITHDRAWALS FROM SPECIFIC ASSETS WITHIN YOUR BOND• You can ask us to pay the regular withdrawals from specific assets held in your bond. If you choose this option, you need to clearly indicate the percentage of each

security/fund you would like us to sell in order to achieve your specified regular withdrawals in section H of the application form. Please note that each transactionmay be subject to a dealing charge and sometimes also third-party charges; see the final bullet point in general conditions above.

• The relevant regular withdrawal payment date is the appropriate date for determining the price of the underlying units in the assets you hold and for givinginstructions to sell assets specified by you. The appropriate date may be deferred in circumstances described within the Policy Terms and Conditions.

• Should the value of the specific asset(s) you have specified fall to zero, then in the absence of alternative instructions we will sell your assets in line with the PolicyTerms and Conditions to meet future regular withdrawals.

• If you change your investment choice at a future date, and this affects the asset(s) you have specified, you must notify us of alternative assets to pay your regularwithdrawals from if you want to continue paying them from specific assets held in your bond. If you do not provide us with alternative instructions, we will sell yourassets in line with the Policy Terms and Conditions to meet your regular withdrawals. Please note that each transaction may be subject to a dealing charge andsometimes also third-party charges; see the final bullet point in the general conditions above.

WHAT ABOUT TAX?• We strongly suggest you contact your financial adviser before making a decision to take regular withdrawals, in order to make sure that this is the most

suitable withdrawal option for you and also to find out if this will have any tax consequences in the country of residence of the individual.

PAYMENTS• Payments will only be made to a bank account in the policyholder’s name; we will not accept requests to make payments to third parties other than those specified in

the exceptional circumstances below.

• In exceptional circumstances payments can be made to UK Financial Services Authority (FSA) recognised financial institutions, financial advisers/solicitors/accountants, who have the appropriate authorisation to handle client money. Please discuss such requests with Royal Skandia before submitting your form.

• Where the payment should be split equally between the bank accounts of each policyholder (applicable to bonds with joint or multiple policyholders only) and wehave not received details of both bank accounts, payments will be delayed. Please ensure you complete all the details required in section H of the application form.

• If you assign your bond your regular withdrawals will be cancelled. Please contact us for more details before you assign your bond into trust.

• Payments will be made in your bond currency (shown on your policy schedule), unless we are advised otherwise. Please note that a currency dealing charge may applyif you ask for payments to be made in a currency other than your bond currency if this is stated in the charges schedule which will be sent to you together with yourpolicy schedules after your bond has started (if this is a new bond). However, at the moment we do not apply the currency dealing charge.

• Your regular withdrawals will start on the next available date, and at the frequency you have requested, after your bond has started. Therefore, if you have asked foryour regular withdrawals on a monthly basis starting on 1 January and we received your application form and investment in December, but we were unable to startyour bond until the middle of January, then your first regular withdrawals will not be paid until 1 February.

• Payments will be sent to your bank account by BACS (bank automated clearing system) if you have asked for them to be made in pound sterling (£) to a UK bank andby telegraphic transfer in all other circumstances. Please note that Royal Skandia will pass on any bank charges incurred for sending the payment by telegraphictransfer. These charges will be deducted from the transaction account in the currency in which the payment is being withdrawn. In addition there may be third-partybank charges for the telegraphic transfer and these will be deducted from the payment by the third party. You should therefore be aware that you may get less thanyou requested.

• We will not pay regular withdrawals by cheque.

• Bank account details:

- Payments within the UK require a bank account number and sort code.

- All payments to banks within Europe now require a bank identifier code (BIC) and an international bank account number (IBAN).

- Payments outside Europe require a bank account number and a SWIFT code.

Please make sure you complete these details in section H as your payment may otherwise be delayed.

www.royalskandia.comCalls may be monitored and recorded for training purposes and to avoid misunderstandings.

Royal Skandia Life Assurance Limited is registered in the Isle of Man under number 24916C. Registered and Head Office: Skandia House, King Edward Road, Onchan, Isleof Man, IM99 1NU, British Isles. Phone: +44 (0)1624 655 555 Fax: +44 (0)1624 611 715.Authorised by the Isle of Man Insurance & Pensions Authority. Authorised and regulated by the Financial Services Authority for business conducted in the UK. Some of theFSA’s rules do not apply to non-UK based insurers. FSA register number 142309. www.fsa.gov.uk/pages/register.

When printed by Skandia this item is produced on a mixed grade material, which uses a combination of recycled wood or paper fibre from controlled sourcesand virgin fibre sourced from well managed, sustainable forests.

SK6422/INT10-198/June 2010 00000

Skandia International is the divisional name for the international companies within the Skandia Group.

I Financial adviser/Suitable certifier – verification of customer identity

As part of global efforts to prevent money laundering, all Isle of Man based companies have to verify the identity and address of all individuals party to a contract (forexample applicant(s), trustees, power of attorney).

Parts A and B in section J of the application form set out the various documents Royal Skandia is required to obtain by the Isle of Man Insurance and Pensions Authority.Please note that the requirements may change if the regulations are altered, in which case Royal Skandia may need further documentary evidence.

CERTIFYING DOCUMENTSUnless the documents provided are originals, they will all need to be certified by a suitable certifier. A suitable certifier can be any of the following:

• a regulated introducer, or authorised employee of a regulated introducer, that is based and regulated in a Schedule 2 country as defined in the Isle of Man Insuranceand Pensions Authority Guidance Notes (see www.gov.im/ipa); or

• a person appointed in writing by Royal Skandia (suitable certifier); or

• a solicitor, lawyer or advocate; or

• notary public; or

• an authorised representative of an embassy or consulate of the country that issued the identification document.

When certifying a document, the suitable certifier must include the following wording:

‘I hereby confirm that this document is a true copy of the original.’

The suitable certifier must also sign and print their name, state their company name, their position within the company and the date.

UK lasting powers of attorney and UK enduring powers of attorney can be certified by the settlor, a solicitor or a notary only.

APPLICANT CHECKLIST

You should use this checklist to ensure you have completed all sections of theapplication form. Any missing information may delay your application.

Section A – Type of application

If this is a new investment, have you indicated which type of bond you are applying for?

If this is an additional investment, have you provided details of your existing bond?

Section B – Details of all individual applicant(s)

Have you filled in the details of all individual applicants? (Each applicant must also sign the declaration in Section I)

If you are applying for an Executive Investment Bond and the applicant(s) is going to be a life assured, have you ticked this option?

Section C – Details of the life/lives assured (if different from applicant(s))

If you are applying for an Executive Investment Bond and the life/lives assured are different to the applicant(s), have you completed the details of all additional lives assured?

(You do not need to complete this section if you are applying for an ExecutiveRedemption Bond.)

Section D – Charges and bond currency

This section should only be completed for new investments.

Have you completed the code for your chosen charging structure?

Have you selected the currency you wish your bond to be valued in?

Section E – Investment details

Have you selected the currency and payment method for your premiumpayment?

Have you stated the amount to be invested?

(The minimum initial investment amount is £50,000, US$75,000, €75,000 orother currency equivalent. If you are paying by cheque, please make thecheque payable to Royal Skandia Life Assurance Limited.)

If this is an application for a new investment, have you entered the number of policies you would like?

Section F – Source of funding

This section must be completed in all instances.

Have you completed your bank details?

Have you provided your employer’s details (or if you are retiredyour employer before retirement)?

Have you provided full details of your origin of wealth?

Section G – Investment choice

If you have selected the option to appoint someone else to manage yourinvestments, have you completed either or both of the following forms?

• Appointing a fund adviser to your Royal Skandia portfolio bond

• Request to transfer to an authorised custodian account

Have you filled in the investment choice table?

(The investment choice is needed for all applications unless you are appointing an authorised custodian.)

Section H – Regular withdrawals (optional)

Have you selected the withdrawal amount, currency, withdrawal, frequency and the date of your first payment?

For additional investments only, have you selected if your withdrawal should be based on your original or total premium invested in the bond?

Have you completed the payee details?

Section I – Declaration and application

Has each applicant read the personal data statement?

Has each applicant read and signed the declaration?

FINANCIAL ADVISER/SUITABLE CERTIFIER CHECKLIST

Section J – Verification of customer identity

Have you completed parts A, B and C with the relevant details for each applicant?

Have you enclosed the relevant identification documentation with thisapplication form?

Section K – Financial adviser/Suitable certifier declaration

Have you completed all the details in this section?

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