IAN
RSA
INTERMEDIARY
APPOINTMENT NOTE
Please complete and fax to 021 509 5572.
Please print in block letters using black or blue ink.
Please ensure compulsory Sections A and F are completed.
Sections B, C, D and E are specific to the products within your portfolio.
COMPULSORY SECTION
Specify at least one policy in the client’s portfolio for identification purposes only.
Contract, Policy or
Account number
SECTION A
Identity
number
PREFERRED SERVICE INTERMEDIARY ALLOCATION - APPLIES TO FULL PORTFOLIO
COMPULSORY SECTION (Non-completion of this section will result in no action being taken)
Client Details
Initials
Surname/Legal entity
First names
Registration number
(if applicable)
Passport number
(where no South African ID number is available)
Country of issue of
passport
Income tax number
(only applicable to income products)
At least one contact number
Work telephone Code
No.
Home telephone Code
No.
Cellphone number
Email address
New Intermediary Details
Intermediary code
Surname
Name
At least one contact number
Work telephone Code
No.
Home telephone Code
No.
Cellphone number
Email address
SECTION B
SERVICE FEE REALLOCATION
Applicable to:
• Max Investments Select Investment Plans and Greenlight Select Savings Benefit
• Investment Horizons Single Premium Investment Plans and Greenlight Single Premium Savings Benefit
Policy number
Asset remuneration
Policy number
(0-100%) of 0.57%
Old Mutual Life Assurance Company (South Africa) Limited. Reg No: 1999/004643/06
1
Asset remuneration
(0-100%) of 0.57%
IAN Intermediary Appointment Note OMMS 10.2013 L6141
SECTION C
MAX INVESTMENTS FOCUSSED AND FLEXIBLE PLANS: FUTURE REMUNERATION SCALE
Applicable to:
• Focussed Investment Plans
• Flexible Investment Plans (Once-Off and Scheduled)
A.CHANGE SCALING – complete this section if you would like to change the scaling and/or commission/fee split between upfront and as-and-when
commission.
This change will be effective on:
i)
ii) the next asset commission payment date for Flexible Investment Plans (once-off and scheduled).
the next premium due date for Focussed and Flexible Schedule Investment Plans;
Focussed Investment Plan
Commonly Selected OR
Remuneration
Other
(please specify)
as-and-when
(0-100%)
upfront
(0-50%)
The total of the as-and-when and upfront commission scaling must be 100% or less.
The above blocks represent the total of a maximum premium remuneration payable, i.e. 5%.
Flexible Investment Plan (Scheduled Investment)
Commonly Selected OR
Remuneration
Other
(please specify)
as-and-when
(0-100%)
VERY IMPORTANT:
If one of the above options are not selected, the application will not be processed.
Flexible Investment Plan (Asset Adviser Remuneration for Once-off and Scheduled Investments)
Commonly Selected OR
Remuneration
Other
(please specify)
as-and-when
(0-100%)
VERY IMPORTANT:
The Adviser Remuneration on future premium increases will be paid according to the same scaling selected above.
If one of the above options are not selected, the application will not be processed.
The remuneration selected above must reflect the commission percentage values.
B.CHANGE RECIPIENTS – complete this section if you would like to change the recipient(s) of all future commission.
NOTE: T
he intermediary(ies) selected below, to whom commission/fees will be paid in future, will replace all the existing
intermediary(ies) currently receiving commission/fees.
This change will be effective on:
i)
ii) the next asset commission payment date for Flexible Investment Plans (once-off and scheduled).
the next premium due date for Focussed and Flexible Schedule Investment Plans;
REMUNERATION DETAILS FOR YOUR FOCUSSED OR FLEXIBLE INVESTMENT PLAN
Name
Intermediary
code
Sales
centre
code
Remuneration
share
split %
Distribution
channel
External
ref no.
(if applicable)
Plan number
Intermediary
Intermediary
Intermediary
Indicate staff
or independent
contractor*
* Please note that the maximum remuneration payable to staff members or independent contractors equates to 40% of total remuneration payable.
Independent contractors, please refer to practice note and/or Independent Contractor (IC) booklet regarding remuneration sharing details.
Old Mutual Life Assurance Company (South Africa) Limited. Reg No: 1999/004643/06
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IAN Intermediary Appointment Note OMMS 10.2013 L6141
SECTION D UNIT TRUSTS SPECIFIC – ADVISER FEES
INITIAL ADVISER FEES
Confirmation of existing initial adviser fees paid on recurring investment instructions in your unit trust portfolio.
Please select one of the following:
1.
I wish to change the payment of the existing initial adviser fees to my new servicing intermediary as notified in this form on page 1.
2.
I wish to keep the adviser fee payment to the existing intermediary on record.
3.
I wish to stop all existing adviser fee payments on my existing recurring investment instruction in my unit trust portfolio.
TO CHANGE RATE OF INITIAL ADVISER FEE
An initial adviser fee has been agreed upon, with my new servicing intermediary, as follows (subject to the maximums of each unit trust, stipulated on the specific
unit trust fund in the fund factsheet).
Note: The applicable adviser fee amount is deducted prior to the purchase of units.
(incl. VAT) for equity/asset allocation unit trusts and recurring contributions into the Old Mutual Unit Trusts Retirement Annuity Fund
%
(max. 3.42% incl. VAT)
% (incl. VAT) for fixed income unit trusts (max. 0.68% incl. VAT)
ANNUAL ADVISER FEE (AAF)
1. Old Mutual Unit Trusts Standard Investments
I instruct you to deduct an annual adviser fee of
A
from
.
% (max. 1.14% p.a. including VAT) of my
Fund (one unit trust only)
Standard Unit Trust Portfolio.
(unit trust account number)
OR
B
proportionately across all my unit trusts
2. Old Mutual Unit Trusts Retirement Fund Investments
I instruct you to deduct an annual adviser fee of
A
from
.
% (max. 1.14% p.a. including VAT) of my
Fund (one unit trust only)
Retirement Annuity Unit Trust Portfolio.
(unit trust account number)
OR
B
proportionately across all my unit trusts
3. Old Mutual Unit Trusts Preservation Fund Investments
I instruct you to deduct an annual adviser fee of
A
from
.
% (max. 1.14% p.a. including VAT) of my
Fund (one unit trust only)
Preservation Fund Unit Trust Portfolio.
(unit trust account number)
OR
B
proportionately across all my unit trusts
* This annual fee is calculated as a percentage of the value of your unit trust product portfolio. The Old Mutual International Growth Fund of Funds,
Old Mutual Albaraka Equity Fund, Old Mutual Income Fund A3 and Old Mutual Balanced Fund A3 are excluded as they may pay a trail fee out of their
annual service fee. The annual adviser fee is deducted monthly, through the sale of units within each unit trust. This is thus a capital gains tax event. Where
investments are held in more than one class in the same unit trusts, the fee will be deducted from the class open to new business (unless the closed unit trusts
class is stipulated above). You will receive confirmation of the implementation of this fee, any adjustments made to the annual percentage or to the unit trusts,
as well as the cancellation thereof. This fee is based on an agreement between the client and the intermediary. You need to take into account whether your
intermediary is VAT registered. Old Mutual Unit trusts is not a party to the agreement and will cancel the fee on the written instruction of either party. The fee
will further be cancelled by a change in servicing intermediary. Old Mutual Unit Trusts will change any erroneous instructions received, but will not rectify
prior payments based on erroneous instructions.
4. Old Mutual Unit Trusts Living Annuity
Please deduct an annual adviser fee* of
.
% (max. 1.14% p.a. including VAT) of my Old Mutual Unit Trusts Living Annuity’s market value
as at the investment start date and thereafter on the anniversary date.
* This annual fee is calculated as a percentage of the value of all your member-owned Old Mutual Unit Trusts Living Annuity (OMUTLA) as at your last
investment anniversary date. It excludes the Old Mutual International Growth Fund of Funds, Old Mutual Albaraka Equity Fund, Old Mutual Income Fund
A3 and Old Mutual Balanced Fund A3 as they pay a trail fee out of their annual service fee. This annual adviser fee is deducted from your scheduled
annuity payments after tax has been deducted and paid to your servicing intermediary. Payment of this fee starts on your next annuity payment. You will
receive confirmation of the implementation of this fee, any adjustments made to the annual percentage or to the unit trust, as well as the cancellation thereof.
This fee is based on an agreement between the client and the intermediary. You need to take into account whether your intermediary is VAT registered.
Old Mutual Unit Trusts is not a party to the agreement and will cancel the fee on written instruction of either party. The fee will further be cancelled by
a change in servicing intermediary. Old Mutual Unit Trusts will change any erroneous instructions received, but will not rectify prior payments based on
erroneous instruction.
Old Mutual Life Assurance Company (South Africa) Limited. Reg No: 1999/004643/06
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IAN Intermediary Appointment Note OMMS 10.2013 L6141
SECTION E
FAIRBAIRN CAPITAL, INVESTMENT FRONTIERS AND OLD MUTUAL WEALTH SERVICE FEE REALLOCATION
Please note: Fairbairn Capital, Investment Frontiers and Old Mutual Wealth selected products’ service fees will be VAT inclusive.
I hereby:
1.Acknowledge that only contracted and licensed intermediaries may be appointed and that my signature below confirms that I have seen which products
the intermediary is accredited to sell in terms of his/her FAIS license.
2.Cancel the appointment of my current servicing intermediary and appoint the above person as my contracted servicing intermediary for Fairbairn Capital,
Investment Frontiers and/or Old Mutual Wealth.
Please complete either A or B:
A
UNCHANGED FEES
B
The existing intermediary fees applicable will remain unchanged on my full Fairbairn Capital, Investment Frontiers and Old Mutual Wealth portfolio.
CHANGED FEES
I hereby acknowledge that the following new service fees (paying products only) will be paid to the newly appointed intermediary.
Please indicate below:
Policy number
Annual
intermediary fee %
for Standard Funds
(including
Investment Frontiers
and Old Mutual
Wealth)
Annual
intermediary fee
% for Elite Funds
(only applicable
to Fairbairn
Capital)
Policy number
Annual
intermediary fee %
for Standard Funds
(including
Investment Frontiers
and Old Mutual
Wealth
Annual
intermediary fee
% for Elite Funds
(only applicable
to Fairbairn
Capital)
3. I acknowledge that should any of these fee blocks not be completed, the existing fee percentage will apply.
SECTION F SIGNATURE COMPULSORY SECTION
I hereby acknowledge that the above intermediary, as appointed, is my preferred service intermediary.
Signed at
on this
day of
20
Signature of client
If this section is not signed and completed, no action will be taken.
Old Mutual is a Licensed Financial Services Provider
Old Mutual Life Assurance Company (South Africa) Limited. Reg No: 1999/004643/06
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IAN Intermediary Appointment Note OMMS 10.2013 L6141