Investment Bond Administration
AXA Wealth, PO Box 6272
Basingstoke, RG21 6ZX
Investment Bond
Individual application form
(Simplified strategies)
What is this form for?
For an individual to apply for the Investment Bond (Bond) with:
§§The same investment strategy across all policies and
§§The same withdrawal strategy across all policies and funds
If you would like to apply for the Bond with differentiated strategies (different investment and/or withdrawal instructions across
policies), or if you are a Trustee, please contact your financial adviser for the appropriate form.
You should read the Key features of the Investment Bond before completing this form.
Notes for advisers:
Please ensure you fully complete all applicable information requested and supply all relevant additional
documentation. Incomplete or illegible applications will not be processed and will be returned.
You must have:
§§Completed a bankers draft, a BACS/CHAPS transfer or enclosed a cheque payable to AXA Wealth Limited.
§§Enclosed an Identity Verification Certificate for each owner. (Additional copies are available on request, or you can use a photocopy
of the relevant pages)
§§Enclosed a completed Adviser charges payment request form, if applicable.
Definitions
Bond and policy – The Investment Bond can be split into a number of policies, which are treated as separate policies within their
own right. When we use the word ‘Bond’ we are referring to the policies collectively and when we use the term ‘policy’ we are
referring to each individual policy that makes up your Bond.
OWNER DETAILS
Illustration reference number
Elevate customers only - to be completed by the first owner
The memo item functionality on Elevate provides a consolidated view of the indicative values of all financial products you hold. If
you tick yes, it will display the value of your initial investment in the Bond. Your adviser will need to update this for any changes in
fund allocation, value of unit holdings, withdrawals or additional investments.
Yes No
If yes, what is the account number you want the memo item to be set up under?
E
L
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LB1002 Januray 2016
Would you like the Bond set up as a memo item in your Elevate account?
Investment Bond: Individual application form (Simplified strategies)
First owner
Second owner
Title and full name
Male
Gender
Female
Male
Female
Permanent home address
(inc postcode). We will send all
correspondence to the first owner’s
permanent home address.
Country/countries of tax residence
and Tax Reference Number(s)
If a Tax Reference Number is
unavailable please confirm which of
the following reasons apply:
1.
1.
2.
2.
A. Country does not issue a tax reference
B. No tax reference required
C. Other (please specify)
A. Country does not issue a tax reference
B. No tax reference required
C. Other (please specify)
Enter the reason why (A, B or C)
Enter the reason why (A, B or C)
1.
1.
2.
2.
Nationality
/
Date of birth
/
/
/
Telephone number
Email address
Yes
Do you wish to be a life assured?
What is the nature of your relationship
to the lives assured? (tick all that
apply)
No
Yes
No
Spouse/civil partner
Spouse/civil partner
Parent/guardian
Parent/guardian
Grandparent
Grandparent
Other (please specify)
Other (please specify)
Occupation (please also specify
if self-employed or retired
Current gross annual income
£
£
2. LIVES ASSURED
If you are only assuring the lives of the owner(s), and you have ticked the relevant box in Q1, please go
straight to Q3. There must be at least one life assured. The maximum is four.
First life assured
Second life assured
Title and full name
Gender
Male
Female
Male
Female
Permanent home address
(inc postcode).
Date of birth
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/
/
/
/
Investment Bond: Individual application form (Simplified strategies)
Third life assured
Fourth life assured
Title and full name
Male
Gender
Female
Male
Female
Permanent home address
(inc postcode).
/
Date of birth
/
/
/
3. TOTAL INVESTMENT
How much do you wish to invest? £
The minimum amount is £15,000.
We accept payment by BACS and CHAPS. You can also enclose a cheque with this form payable to AXA Wealth Limited.
We will not charge you for BACS and CHAPS payments, although your bank or building society may.
Our details are as follows: Account name – AXA Wealth Limited
Account number – 36378739
Sort code – 60-00-01
Please make sure your reference number is ‘IB’ followed by your last name.
Which payment method are you using?
Cheque
BACS
CHAPS
Source of wealth
Please tell us where the money for this investment has come from by ticking all the applicable boxes. If the investment is £250,000
or over please complete the Investment Bond – Source of wealth details form.
Savings from employment income
Competition or gambling win
Property sale
Inheritance
Loan
Share sale
Existing investments
Compensation payment
Company sale or sale of your interest in company
Gift
Other (please specify)
4. NUMBER OF POLICIES
You can have up to 99 policies, as long as the value of each policy at the start of your Bond is at least £500.
§§The amount you invest will be split equally across the number of policies.
§§If it isn’t possible to allocate at least £500 to each policy, we will reduce the number of policies appropriately.
§§If an even split isn’t possible one of your policies will have an investment amount different to the others
How many policies would you like?
Maximum (up to 99) 20 (default)
Other (please specify)
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Investment Bond: Individual application form (Simplified strategies)
5. INVESTMENT OPTIONS
You can apply either Portfolio Rebalancing or Drip-feeding to your Bond but not both. If you don’t want either please move
to Q5.2.
5.1 Portfolio rebalancing or Drip-feed
Please select one option:
Portfolio rebalancing
Drip-feeding
Start date:
Duration:
/
/
years
months
(must be between the 1st and 28th)
(must be between one month and 10 years)
Frequency:
Frequency:
Monthly
Quarterly
Half-yearly
Annually
Monthly
Quarterly
Half-yearly
Annually
You can tell us in writing to stop Portfolio Rebalancing and Drip-feeding.
The first Drip-feeding switch will take place at your chosen frequency of your Bond.
5.2 Fund choices
Please list your selected funds and the percentage you wish to be invested per fund – please refer to the Investment Bond fund
list. If you have selected Drip-feeding, please also complete the third column to show the percentage you wish to have invested after
the investment allocation you require as an end position after the Drip-feeding period has finished.
If you need more space to list your fund choices, please use a photocopy of this page and attach it securely to this form.
Fund name
% at start
% at end of Drip-feeding
(whole % only)
Total
(if applicable, whole % only)
100%
6.WITHDRAWALS
You must complete this section if you are setting up a regular withdrawal strategy.
Do you wish to set up regular withdrawals?
Yes - please continue
6.1
No - please go to Q7
Withdrawal details?
Please enter a start date below. Payment will be made to your bank account approximately four working days after this date.
Start date:
/
Frequency:
/
Monthly
Quarterly
Half-yearly
(Must be between 1st and 28th)
We will make a payment to your bank account approximately four working days after this date.
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Annually
100%
Investment Bond: Individual application form (Simplified strategies)
6.2 Withdrawal strategy
Select one of the following to confirm how you want us to calculate each withdrawal amount:
Option 1:
% of all contributions, each year.
– This is the amount you want to withdraw each year, not the amount per withdrawal. It will be paid proportionately based on the
frequency chosen.
Option 2: fixed amount per withdrawal of £
Option 3:
% of the fund value at the date of withdrawal, per withdrawal.
6.3 Bank/building society details
Name and address of bank/building society (inc postcode)
Account/roll number
Sort code
–
–
Name of account holder
7. FINANCIAL ADVISER DETAILS & DECLARATION
Financial adviser name
FCA Individual reference number
Firm name
FCA authorisation number
Telephone number
Fax number
Firm/network address (inc postcode)
(Please detail your registered individual
local office address)
Position
Email address
If part of a financial adviser network, please specify
Agency number (previously issued by us, if known)
Did you give advice in relation to this application:
Yes - independent
Yes - restricted
No
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Investment Bond: Individual application form (Simplified strategies)
FINANCIAL ADVISER DECLARATION
§§We confirm that we will act as the financial adviser to this Bond.
§§During our time as financial adviser to this Bond, we will remain authorised and comply with the rules of the appropriate regulatory
bodies and act in accordance with the Terms of Business which exists between ourselves and AXA Wealth Limited. We will notify
AXA Wealth immediately if there are changes to our authorisation, including any disciplinary action taken
against us.
Please indicate which of the following regulatory authorisations you currently hold (tick all boxes that apply):
FCA Permissions
Discretionary capacity Advisory capacity
FCA permission Advising on Investments
FCA permission Advising on Investments
FCA permission Managing Investments
We confirm that only those advisers who are appropriately qualified and authorised by us to offer these services will be permitted to
advise in connection with this Bond.
Financial adviser’s signature
Date
/
7
/
8. OWNER DECLARATION
If this form is being completed by an attorney on behalf of an owner, we will need to see a copy of the power of attorney.
1. I/We are applying for the Investment Bond.
2. I/We as applicant(s) confirm that I/we have received a copy of the Key features document relevant to the Investment Bond.
It is understood that a copy of this completed application and the Policy provisions are available from AXA Wealth Limited on
request.
3. I/We understand that I am/we are entitled to receive a copy, on request, of the personal information held by AXA Wealth
Limited about me/us.
4. I/We understand that AXA Wealth Limited reserves the right not to accept this application, in which event my/our payment will
be returned.
5. I/We declare the information given in this application is, to the best of my/our knowledge and belief, correct and complete.
6. I/we agree to notify AXA Wealth Limited immediately in the event the information in this form changes.
Data protection
AXA Wealth Limited, a member of the AXA Group, will hold and use the personal information you provide to set up and administer the
Bond and for business analysis.
We may send this information in confidence for those reasons to companies within the AXA Group in the UK and other companies
acting on our instructions, including those outside of the European Economic Area.
By signing this form you consent to the use of this personal data for the reasons set out above. You also agree to AXA Wealth Limited
passing this information onto: (1) your professional adviser(s) as you notify to us from time to time; and (2) such
other third parties as may be necessary in connection with the provision and administration of the Bond including our professional
advisers.
Where the life/lives assured are not the applicant(s), by signing this form you declare that you have the consent of the life/lives
assured and any individuals associated with the Trust to provide us with their personal data and confirm that in doing so you have
complied with the relevant provisions of the Data Protection Act 1998.
We would like to use your contact details and share them with companies within the AXA Group (or other carefully selected
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Investment Bond: Individual application form (Simplified strategies)
companies) to enable us and them to send you information about other products and services. You may be contacted by post,
telephone or email.
If you do not wish us to do this please tick the appropriate box below your signature. Otherwise we will assume that you are happy to
receive this information and to be contacted in this way for the time being. You may change your mind at any time by writing to AXA
Wealth, Winterthur Way, Basingstoke, Hampshire, RG21 6SZ.
Financial Crime (verifying your identity to prevent Fraud & Money Laundering)
To verify your identity and prevent financial crime we may use and share your information with any company within the AXA Group,
with companies who work for us and with appropriate organisations.
We may also search, send your details to, and use information from third party verification service providers and financial crime and
credit reference agencies (Third Parties). This involves checking your details against databases these Third Parties use. AXA UK Group
and these Third Parties may keep a record of the search, the results of the search, any suspicions of financial crime and the details
may be used to assist other companies for verification and identification purposes. This search is not a credit check and your credit
rating should be unaffected.
By signing this form you are giving your consent to these activities which will make it easier for you to do business with us and help
prevent financial crime. For more information, please write to the Money Laundering Reporting Officer at AXA Wealth, Winterthur Way,
Basingstoke RG21 6SZ.
Name
7
Signature
7
/
Date
/
Please tick this box if you do not wish
us to send you information about other
products and services.
/
/
Please tick this box if you do not wish
us to send you information about other
products and services.
IDENTITY VERIFICATION CERTIFICATE
Private individual
Introduction by an FCA-regulated firm
1. Details of individual (see explanatory notes below)
Full name of customer
Date of birth
/
/
Current address including postcode
Previous address including postcode (if applicant has changed address in the last three months)
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Investment Bond: Individual application form (Simplified strategies)
2. Confirmation
I/we confirm that:
(a) the information in section 1 above was obtained by me/us in relation to the customer;
(b) the evidence I/we have obtained to verify the identity of the customer:
meets the standard evidence set out within the guidance for the UK Financial Sector issued by JMLSG; or
exceeds the standard evidence (written details of the further verification evidence taken are attached to this confirmation).
3. Details of introducing firm (or sole trader)
SignatureDate
/
7
/
Name:
Position:
Full name of regulated firm (or sole trader):
FCA reference number:
Explanatory notes
1. A separate confirmation must be completed for each customer (e.g. joint holders, trustee cases and joint life cases). Where a
third party is involved, e.g. a payer of contributions who is different from the customer, the identity of that person must also be
verified, and a confirmation provided.
2. This form cannot be used to verify the identity of any customer that falls into one of the following categories:
§§ those exempt from verification as being an existing client of the introducing firm prior to the introduction of the requirement
for such verification;
§§ those whose identity has not been verified by virtue of the application of a permitted exemption under the Money Laundering
Regulations; or
§§ those whose identity has been verified using the source of funds as evidence.
3. This confirmation must carry an original signature, or an electronic equivalent.
AXA Wealth, Winterthur Way, Basingstoke RG21 6SZ. Telephone number: 01256 470707. As part of our commitment to quality service and security, telephone
calls may be recorded.
The Investment Bond is provided by AXA Wealth Limited. AXA Wealth Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct
Authority and the Prudential Regulation Authority and is a company limited by shares. Registered in England No. 01225468. The registered office is 5 Old Broad Street,
London EC2N 1AD.
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