apl copia - guernsey at retirement plan n for - overseas trust and pension · 4 copia guernsey...

APPLICATION FORM

COPIA - GuernseyRetirement Plan

COPIA Guernsey Retirement Plan 2

COPIA Guernsey Retirement PlanThe COPIA Guernsey Retirement Plan operates under the COPIA 2 Retirement Plan Deed. The COPIA Guernsey RetirementPlan is a Retirement Annuity Trust Scheme (RATS). The Trust Deed is administered by Overseas Trust and Pension Limited(OTAP) to meet the approvals afforded by Section 157A subsection (4) of the Income Tax (Guernsey) Law 1975, as amended.

Check listBefore sending us this Application Form, please complete the checklist below. Providing complete information is essential for us to proceed with prompt processing of your COPIA Guernsey Application Form.

• You have fully completed all relevant sections of the Application Form.

• Your Professional Adviser has completed all relevant sections of the Application Form.

• You have been provided with written information of all fees, expenses and running costs of your plan by your Professional Adviser.

• You have been provided with an illustration detailing how the annual charges could impact your investment by your Professional Adviser.

The following documents must be included with the Application Form, without this (where applicable) your application will not be processed:

• Certified copies of suitable client identification.

• Certified copies of suitable address verification.

• Any appropriate pension transfer documentation including signed discharge form(s).

• Benefit Application Form, if applicable.

• Completed Bank Instruction Letter as applicable on page 10.

Verification of your address & identity

Overseas Trust and Pension complies with local legislation and our own internal policies and procedures to ensure appropriate customer due diligence documentation is obtained on our clients. Please refer to the Customer Due Diligence Documentation guide.

Overseas Trust & Pension, PO Box 285, Elizabeth House, Les Ruettes Brayes, St Peter Port, Guernsey, GY1 4LX

Overseas Trust and Pension Limited is licensed by the Guernsey Financial Services Commission under the Regulation of Fiduciaries,Administration Businesses and Company Directors, etc (Bailiwick of Guernsey) Law, 2000. Overseas Trust and Pension Limited is registered in Guernsey Number: 55506

Investment Notices: Front-end charges may apply. Any mention of equities and bonds should not be taken as a recommendation to invest in them. We advise you to seek professional investment advice before taking any investment decision.

Past performance is not a reliable indicator of future results. Investment values and the income from them can go down as well as up,and may be affected by changes in rates of exchange. An investor may not receive back the amount initially invested.

FX rates shown within your Valuation are as at the date of the transaction.

Data Protection Statement: Overseas Trust and Pension Limited is the data controller in relation to any personal data suppliedby you in accordance with the Data Protection (Bailiwick of Guernsey) Law, 2001.


A. Personal detailsTitle (e.g. Mr/Mrs/Miss/Ms/Dr/Other) Forenames

Section 1 - Personal Details

Surname Gender Male Female Nationality

Date of Birth (dd mm yy) Place of Birth

Marital Status Home Telephone

Permanent residential address

Post Code Country

Work Telephone Mobile Telephone

Home Fax Work Fax

E-mail Address 1 E-mail Address 2

Guernsey Tax Reference Number

B. Address

Correspondence address (if different from residential address)

Post Code Country

C. Employment details

Occupation (e.g. engineer, banker, etc) Date of commencement of occupation

Name of Business

Business Address

Post Code Country

Nature of Business Position Held

What share, if any, do you own of this business? %

Are you Employed Self Employed Retired If retired, please state your last employment details in the section below.

COPIA Guernsey Retirement Plan4

D. Supplementary information required and source of fundsPlease state your reason for establishing a pension plan within the COPIA Guernsey Retirement Plan?(e.g. saving for retirement, no current occupational pension, as an additional scheme, long term financial planning etc)

Please state the main source and origin of funds? (e.g. inheritance, life savings, policy pay out, sale of assets, monthly salary savings, transfer of existing pension assets etc).We may request supporting documents re “source of funds”.

Do you have any other pension contract (approved or unapproved)? Yes No

If yes, please provide details of that pension contract including the amount of premiums paid annually, the provider and the policy number.

Is it a Guernsey Income Tax approved pension contract? Yes No

If yes, please provide details of which approvals the pension contract meets.

Are you intending to claim tax relief on the pension contract above? Yes No

Are you a member of any approved pension scheme other than the pension contract referred to above? Yes No

If yes, at normal retirement date will you receive the maximum benefit permitted by Guernsey Law? Yes No

Please indicate your average annual income £ / €/ US$ (delete as applicable)

Single contribution or Transfer

Regular contributions

A. Contribution informationNature of Contribution Amount Frequency of contribution

Establishment by single contribution(Minimum amount £20,000 or currency equivalent)

On Establishment or Transfer In£ / € / US$(delete as applicable)

or Establishment by single transfer in from an existing pension scheme(s)(Minimum amount £20,000 or currency equivalent

On Establishment or Transfer In£ / € / US$(delete as applicable)

Regular amount to be contributed(Minimum of £3,000 p.a. or currency equivalent) Please delete as appropriate

Monthly / quarterly / half yearly / annually

Notes. Please complete Bank Instruction Section 5.Transfers. Transfers from non-approved schemes will require the approval of the Guernsey Administrator of Income Tax.Ad hoc contributions. Ad hoc single contributions or transfers can be made at any time once your plan is established (Minimum amount of £1,000 or currency equivalent).Regular Contributions. The Guernsey Administrator of Income Tax sets a limit on the amount of tax relief that can be claimed by Guernsey residents; please consult your Professional Adviser for details.

B. Transfer informationIf you are transferring an existing pension scheme(s), please provide the pension provider(s) details below.Please note you will be required to complete closing fund transfer documentation for the transferring pension scheme.Please refer to your Professional Adviser for details. Transfers will be processed once your application for Membershiphas been accepted.Transfer 1

Provider’s Address

Pension Provider Contact No.

Post Code Country

Policy or Ref. Number

Type of Scheme (name, description etc.)

Amount of Transfer Value £ / c / US$ (delete as applicable)

Section 2 - Plan Information


Transfer 2 (if applicable)



Post Code Country







Post Code Country







Post Code Country




C. Benefit Date

I wish to take benefit immediately Yes No

If you intend to take benefit immediately, please ensure that this application is accompanied by a completed benefit form.Please state the future date on which you would intend to receive benefit from your plan. (Under current legislation thisdate will be between the age of 50 and 75, unless otherwise agreed by the Guernsey Administrator of Income Tax).

Benefit Date (dd mm yy) Age on Selected Benefit Date Years



D. Nomination of Named BeneficiariesNamed Beneficiaries – You can name beneficiaries who will receive benefit from your plan after your death. For Guernsey residents this is restricted to your spouse, dependents and relations. Please ensure when completing thissection that your nominations add up to a total of 100%.

A. Title (e.g. Mr/Mrs/Miss/Ms/Dr/Other) Forenames

Surname

Post Code Country

Residential address

Home Telephone Work Telephone

Mobile Telephone Date of birth (dd mm yy)

Beneficiary’s relationship to Member Percentage of distribution %

B. Title (e.g. Mr/Mrs/Miss/Ms/Dr/Other) Forenames

Surname

Post Code Country

Residential address




C. Title (e.g. Mr/Mrs/Miss/Ms/Dr/Other) Forenames

Surname

Post Code Country

Residential address




D. Title (e.g. Mr/Mrs/Miss/Ms/Dr/Other) Forenames

Surname

Post Code Country

Residential address




Important Notes

1. If there is insufficient space on the application form to detail all the Named Beneficiaries, please detail additional Beneficiaries on aseparate page, sign and attach to this application.

2. The Member may change the Named Beneficiaries at any time by submitting a written request to the Trustee and Plan Administrator.

3. Any specific instructions/requests should be provided under separate written cover in the form of a ‘Letter of Wishes’ addressed to the Trustee and Plan Administrator.


E. Investment ChoiceThe investments are managed by Kleinwort Benson.

You are strongly recommended to read and consider the contents of the relevant Fund Prospectus prior to completing this investment choice section.

The following sections need to be completed in conjunction with your Professional Adviser to ensure that your contributions are invested in line with your requirements.

Important Note:

• No more than 5 funds may be selected for investment at any one time

• The minimum contribution per fund is £100 per month (subject to the overall annual minimum of £3,000 p.a.)

Fund Name Currency Transfer In Allocation Lump Sum Allocation Regular Contribution (detail % or amount of Allocation (detail % or amount of lump sum to each (detail % or amount of contribution to each nominated holding) contribution to each nominated holding) nominated holding)

Sterling £ � KB Elite Multi Asset Conservative Fund

Sterling £ � KB Elite Multi-Asset Balanced Fund

Sterling £ � KB Elite Multi-Asset Growth Fund

Sterling £ � KB Elite International Equity Fund

Sterling £ � KB Elite International Bond Fund

Sterling £ � KB Elite Fixed Income Fund

Sterling £ Euro € US Dollars US$

� KB Elite Currency Fund


B. Professional Adviser – Commission Payment Choices – to be completed by Professional Adviser

This information is required by the Investment Manager to ensure commission entitlements are paid.

Fund Name KB Sales Charge Professional Adviser Total Sales Charge % AllocationCommission Up to 4.5% (To be deducted from Investment, (100% less total(Please specify) and must not exceed 5%) Sales Charge)

%

• Commission of up to 4.5% is available to a Professional Adviser on the amount invested.• On-going trail commission at applicable rate.• Investment allocation maximum of 99.5% and minimum of 95% of transferred funds or contributions invested.• No penalty charges on redemption.

0.5%1

%0.5%2

%0.5%3

%0.5%4

%0.5%5

Internal use only – To be completed by Overseas Trust and Pension

Membership Number (to be completed by OTAP) (Income Tax Plan Number)

Section 3 - Appointment of your Professional Adviser

A. Mandatory Professional Adviser Authorisation(A Professional Adviser can be your financial adviser, accountant, advocate etc)

In order to be a Member of the Plan, it is mandatory to have a Professional Adviser. Please enter the details of your nominated Professional Adviser. Please note it is only possible to have one appointed Professional Adviser to your planat any one time. Please notify the Trustee and Plan Administrater of any change to your appointed Professional Adviser.

Name of Professional Adviser

Post Code Country

Full Address for Correspondence

Name of Professional Advisery Firm

Broker Code (Internal Use Only)

Contact Tel Number Contact Fax Number


A. Applicant DeclarationI, the undersigned, apply for Membership of the COPIA Guernsey Retirement Plan (the “Plan”):

a. I agree to be bound by the “Conditions” as set out in Appendix One, and agree that such Conditions shall (in additionto the Trust Deed and Rules in force from time to time) be the basis of my agreement with Overseas Trust and Pension(OTAP) Limited as Trustee and Administrator of the Plan.

b. I understand that appropriate professional advice should be obtained concerning my financial affairs, and that OTAP does not provide such advice, and will not be held responsible for any advice obtained.

c. I confirm that I have received appropriate advice (financial, legal and/or tax) with regard to the suitability of the Plan forme, and I understand the implications of entering the Plan.

d. I understand that OTAP does not monitor Kleinwort Benson fund performance.

e. I confirm that OTAP is not involved in, or responsible for, my tax affairs (other than those reporting requirements required of Overseas Trust and Pension by HMRC in respect of my membership of the Plan), or those of any Named Beneficiary, and that I accept that the Named Beneficiaries concerned are responsible for, and will comply with, their personal tax responsibilities in any jurisdiction.

f. (i) I confirm that the assets transferred to the Plan do not represent the proceeds of criminal activity.

(ii) I will declare the source and origin of any contribution(s) to the Plan to OTAP prior to their receipt.

(iii) If no declaration is forthcoming, I understand that OTAP will decline such contributions being transferred to the Plan.

g. I confirm that I have been provided with written information regarding all fees, expenses and running costs of my plan.All fees and expenses will be due for settlement out of the assets of my plan.

h. If my initial contribution is made from a transfer out of an existing pension scheme, I confirm that I understand and accept that I may be giving up guarantees and/or benefits that have applied to that scheme and which may not be available to me from the Plan.

i. I acknowledge that OTAP have the right to change their published Contribution and Fee Schedule from time to time by giving one month’s notice. I declare that all information provided in this application form is true and complete.

Applicant to Sign and Date

Signature Print Name

Date

Section 4 - Declarations

B. Professional Adviser acknowledgement & declaration (This section is to be completed and signed by the Professional Adviser.)

I confirm that I have arranged or provided appropriate financial and tax advice with regards to the suitability of the Plan,together with the implications of becoming a Member, for the named applicant. Where I am not suitably qualified I haveensured that the applicant has received appropriate qualified advice and confirm the Plan is suitable for the applicant toenter into.Where the applicant is transferring funds out of an existing pension scheme into the Plan, I confirm that I have advisedhim/her on the advantages and disadvantages of such transfer.I confirm that I have carried out the required analysis, and have satisfied myself that the Plan is both cost effective andappropriate for the applicant.

Signature

Date

Name of Professional Adviser


i) To: The Manager

Please complete name and address of Bank Full Name(s)

From: (Name(s) and address(es) of account holder(s))

Address

Account Number

a) Single payment:Please transfer electronically, with immediate effect

The sum of (amount in figures)

£ / € / US$ (delete as applicable)

(amount in words) to the following account

Please accept the above instructions:

Signature 1

Date

Signature 2 (if applicable)

Date

Please return this completed form to Overseas Trust and Pension Limited together with the completed application form. Overseas Trust and Pension will arrange for it to be sent to Kleinwort Benson (Channel Islands) Investment Management Limited who will liaise with your Bank.

Section 5Bank Instruction letter – COPIA Guernsey Retirement Plan

Branch Reference (Sort Code)

Account Name

b) Regular contributionsPlease transfer electronically, with immediate effect/on the

Starting on the of every month quarter half yearly annual (please tick as appropriate)(indicate date i.e.15th)

The sum of (amount in figures)

£ / € / US$ (delete as applicable)

Please credit the following account: Account Name: KB (CI) FSL Client AccountBank: BNP Paribas Securities, Liberte House, 12-23 La Motte Street, St Helier, Jersey JE4 5RL Account Number: 10140200 (GBP) 10140210 (EUR) 10140220 (USD)Bank Swift Address: PARBJESHClient Reference:

CHAPS/BACS: To Sort Code: 60-95-06 (GBP payments)

Euro payments via: US Dollar payments via:BNP Paribas, Paris BNP Paribas, New YorkSwift: PARBFRPP Swift: BNPAUS3N

Reference*: Membership Number

* To be completed by Overseas Trust and Pension Limited

“Investor name or number”Please ensure this is quoted on the Standing Order payment

(amount in words) to the following account

Appendix One – Conditions of the COPIA Guernsey Retirement Plan

The COPIA Guernsey Retirement Plan (the “Plan”) is a Retirement Annuity TrustScheme (“RATS”). The Trust Deed is administered by Overseas Trust and Pension Limited to meet the approvals afforded by Section 157A subsection (4) of the Income Tax (Guernsey) Law 1975,as amended. Non-Guernsey residentMembers of the COPIA Guernsey Retirement Plan are afforded exemptionsallowed under Section 40 (ee) of the Income Tax (Guernsey) Law 1975, as amended.

1. MembershipPlan EligibilityTo be eligible to join the Plan, a Membermust be over the age of 18 but under theage of 75.

• The Plan is not open to US or Canadiannationals or residents.

• The Plan is not open to Jersey residents.

• The Plan in not open to UK residents unless they have a clear intention of leaving the UK.

Admission to Membership is subject to theapplicant having first completed and submitted to the Trustee and Plan Administrator an application form in theprescribed format, including any evidenceof age, health and/or marital status, as the Trustee and Plan Administrator mayreasonably require.

2. Transfers InWhen accepting funds, The Trustee andPlan Administrator will comply with any undertaking given by him to the GuernseyAdministrator of Income Tax or any otherrelevant tax authority, and will satisfy himself that acceptance of the transfer assets will in no way prejudice the Approval of the scheme or the Exemptionfrom Guernsey tax for non-Guernsey resident Members.

The Trustee and Plan Administrator will obtain all necessary information from theapplicant, including but not limited to:

• Details of any restrictions on commutation of the Transfer Assets for a lump sum;

• That part of the Transfer Assets which is derived from any voluntary contributions paid by the Member to the Transferor Scheme;

and

• That part of the Transfer Assets which is derived from contributions (other than voluntary contributions) paid by the applicant to the Transferor Scheme.

No in-specie transfers will be accepted.

The Plan accepts funds transferred fromother pension schemes together with cashcontributions.

It is possible to transfer applicants who arein full drawdown (or partially in drawdown)to the Plan, but it is not possible to effect atransfer once an applicant has attained theage of 75, or if they have already purchased an annuity from a life company.Benefits already received by the applicantat time of transfer will be taken into account when assessing the benefits receivable under the Plan.

3. Investment ChoicesFollowing the applicant’s appointment ofOverseas Trust and Pension as Trusteeand Plan Administrator, Overseas Trustand Pension will appoint Kleinwort Benson (Channel Islands) InvestmentManagement Limited (KBCIIML) as Invest-ment Manager to the Member’s plan tomanage the plan’s investments in line withthe defined investment management objectives.

A Member’s Professional Adviser will advise on the investment strategy most appropriate to the Member’s circumstances.

A Member may switch investment strategytwice per year free of charge.

Guernsey ResidentsGuernsey resident Members may choosefrom a number of investment funds available through KBCIIML range of OpenEnded Investment Funds.

The investment(s) selected for the Member’s plan must have regard to thecash flow requirements needed to makeregular benefit payments and to any conditions imposed by the tax authoritiesof the Member’s country of residence.

Where a Professional Adviser receivesremuneration from the provider ofinvestment services, such remunerationmust be disclosed to the Trustee and PlanAdministrator and the plan Member.

4. BenefitsLifetime Benefits – Options at SelectedBenefit DateThe options available to Members atSelected Benefit Date are set out below.For these purposes, Selected Benefit Dateis defined as follows:

Selected Benefit Date; means a date noearlier than age 50 or greater than age 75,on which the Trustee and Plan Administratoragrees with a Member that benefits become payable from the Member’s plan.

Lump SumA single lump sum payment is availableto the Member on reaching their SelectedBenefit Date. The payment will not exceed30% of the value of the Member’s plan, in accordance with Guernsey Income Taxregulations.

Any lump sum payments received prior totransfer will be taken into account whendetermining the level of this benefit.

IncomeRegular benefit payments must commence within one year of the lumpsum payment being made.

Once a Member has started taking income, they must continue to do so.

By age 75, a Member must secure anincome for life.

AnnuityA regular payment from the Member’s planfor the Member’s lifetime, or until theplan’s assets are exhausted. The annuitywill be calculated at a Selected BenefitDate with reference to the annuity tableson the GAD website. The annuity rate willbe subject to revision every three years bythe Trustee and Plan Administrator andpayments may be adjusted accordingly.

NotificationThe Trustee and Plan Administrator willnotify the Member of an upcoming benefitdate two months prior to the Selected Benefit Date.

Notice should then be submitted in writingby the Member to the Trustee and PlanAdministrator of the election of benefitsmade at least one month prior to SelectedBenefit Date.

The schedule of benefit options availableis detailed in the Benefit Option form.



Incapacity and Retirement BenefitsIf before attaining Selected Benefit Date a

Member either;

a) in the opinion of the Trustee and PlanAdministrator becomes Incapacitated

“Incapacitated” is defined as follows:

That as a result of:

Injury, Sickness, Disease, or Disability

the Member has already ceased to carryon their current occupation and is (and willcontinue to be) medically incapable (eitherphysically or mentally) of resuming theircurrent occupation.

Or

b) attains such other age (sooner than theage of 50) as is the age on which personsengaged in the same occupation as theMember customarily retire and in eitherevent is not in receipt of benefits otherwiseunder the Plan, the Trustee and PlanAdministrator may on the Member’s writtennotice, provide the Member with a lumpsum payable immediately and/or an income for life and will be paid in accordance with the limits detailed in theLifetime Benefits – Options at SelectedBenefit Date section.

Death BenefitsOn receipt of proof of the Member’s death,the Trustee and Plan Administrator will paya lump sum which is equal to the value ofthe Member’s plan in accordance with thefollowing provisions:

• Payment of the full value of the planwithin 2 years of death to the Member’sestate;

or

• Payment to one or more NamedBeneficiaries. (Named Beneficiaries can include the Member’s surviving spouse, dependants, relations and for Non-Guernsey Members only also includes any person who is not residentin Guernsey for tax purposes and who is a beneficiary under the Member’s last valid will or codicil).

Although the Member is not entitledto give specific instructions as to whoshould receive the lump sum benefit, the Member may make written nominations to indicate the person(s) they wish to be considered. The nomination can be changed from time to time;

or

• Payment to a new plan or plans for theprovision of pension benefits to NamedBeneficiaries. This option will be subject to minimum value restrictions.

If the Member dies leaving no survivingNamed Beneficiaries, the balance of theMember’s plan will be paid to the Member’s estate.

Any Beneficiary who becomes eligible toreceive a benefit under the Member’s planshall produce such evidence and information as may reasonably be requiredby the Trustee and Plan Administrator forthe purposes of the plan and for the payment of the benefit, and so that payment shall be conditional on the production of such evidence and information.

5. Transfers OutA Member may request the Trustee andPlan Administrator to transfer the valueof their plan to the persons having thenecessary powers to receive such assetsunder any retirement benefit scheme.

6. Governing LawThe Plan and these Conditions shall besubject to and interpreted in accordancewith the law of Island of Guernsey.

If there is any conflict or inconsistencybetween Appendix One of this Applicationform and the Trust Deed, the terms of theTrust Deed will prevail.

Overseas Trust & PensionPO Box 285, Elizabeth House, Les Ruettes Brayes, St Peter Port, Guernsey, GY1 4LX

Telephone: +44 (0) 1481 723030E-mail: [email protected]: www.trustandpension.com

Overseas Trust and Pension Limited is licensed by the Guernsey Financial Services Commission under the Regulation of Fiduciaries, Administration Businesses and Company Directors, etc (Bailiwick of Guernsey) Law, 2000. Overseas Trust and Pension Limited is registered in Guernsey Number: 55506

apl copia - guernsey at retirement plan n for - overseas trust and pension · 4 copia guernsey...

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