ITC ARF - independent-trustee.com · retention and processing by ITC of any personal data about me for the purposes of providing the above and any ancillary services. I acknowledge

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ITC ARFAPPLICATION FORM

ITC ARF Application Checklist

Please ensure you have completed the following document before returning the completed application to ITC: Check

Completed ARF / AMRF Application Form - signed in all places

Please ensure you have included all the following documents before returning the completed application to ITC: Check

ID VerificationOne of the following:

a. Current (i.e. in date) and valid passport.Orb. Current, full and valid Driving Licence

Must be certified as a true copy of the original and dated by an Accountant,Solicitor, Garda or Regulated entity based in Ireland. Address VerificationOne of the following & less than 3 months old from the issue date: a. Utility Bill for your home address(electricity, gas, water, home phone or home broadband)Orb. Bank / Building society / financial institution statement(must be a full page statement and show activity on the account)

Must be certified as a true copy of the original and dated by an Accountant,Solicitor, Garda or Regulated entity based in Ireland.

Proof of PPS Number - a document from the Revenue Commissionersshowing your PPS Number (e.g. P60, P45, P21, etc.)

ITC will not be able to process your application until we have received all the above documents.

Eligibility

Terms of Engagement

Fax/Email Indemnity

Custody trust subscription

Certificate of source of investment for approved retirement fund

Certificate of source of investment for approved minimum retirement fund

Copy of pension/property adjustment order, if applicable

Copy of Annuity Policy, if applicable

ITC ARF

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Title First name

Surname Date of Birth

Marital status Gender

Application Form

PPS number

Personal Details

Approved Retirement Fund* Investment Amount €

Approved Minimum Retirement Fund*

*Subject to the calculation of allowable limits

Investment Amount €

Investment Type

Address

Email Address

Home Telephone Work Telephone

Mobile Fax

Where possible your correspondence will be issued to the email address provided above. If you would like to receive your correspondence in a format other than email, please confirm the method here:

Contact Details

Are you resident in the Republic of Ireland for tax purposes? Yes No

Background Details

ITC ARF

Spouse’s Date of Birth

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Pension ProviderNormal

Retirement Age

Policy Number ValueIn respect of previous or

current employment

To be transferred to ITC ARF

1. Y N

2. Y N

3. Y N

4. Y N

5. Y N

Value of Existing Pension Benefits (include all pension types e.g. Personal, Occupational, PRSA, ARF, etc.)

ITC ARF

Advisor Name Intermediary Agency Code

Advisor Company Name

Advisor Address

Advisor Fee Initial Set Up Fee € AMC %

Advisor Details

1. I require the statutory minimum drawdown (currently 4% / 5% / 6%)

or

2. I require the following gross income per annum €

Payable: Half Yearly

Payable: Quarterly

Payable: Monthly

Please indicate the gross level of annual income to be drawn from your ARF and how you would like it to be paid:

Are the benefits subject to a pension/property adjustment order? Yes No

If yes, please attach a copy of the order

The advisor fee will be added to ITC's Annual Management Charge.

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ITC ARF



Advisor Address


Advisor Details


or



Payable: Quarterly

Payable: Monthly





Bank Account Name

Address of Bank

BIC

IBAN

Bank DetailsPlease provide your bank details to allow us to make payment to you should you request a withdrawal of funds from your scheme.

Advisor Minimum Fee €

__________________________________ __________________

Signature of Advisor: Date:

The advisor fee will be added to ITC’s Annual Management Charge.

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ITC ARF



Advisor Address


Advisor Details


or



Payable: Quarterly

Payable: Monthly





Declaration

I hereby declare that, to the best of my knowledge, I am entitled, under the Taxes Consolidation Act 1997 (as amended), to invest in an ARF and/or an AMRF and that the investment made is from an approved source. I authorise any insurance company, QFM, pension scheme trustee or PRSA provider to give Independent Trustee Company Limited details of any pension arrangements, annuities and/ or ARF/AMRF investments applying to me.

Advisor’s Signature Name in capitals Date

By ticking this box I confirm I wish to receive any marketing communication from Independent Trustee Company Limited.

ITC ARF

Signature Name in capitals Date

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Consent to Marketing Communications:From time to time, we may wish to use the information you have provided for the purposes of providing you with additional information relating to the goods and services of ITC, its associated companies and / or carefully selected third parties. If you consent to our use of your data in these ways, please indicate by ticking this box:

Eligibility for ARF/AMRF

If you cannot answer ‘Yes’ to at least one of the following three questions you must invest €63,500 in an Approved Minimum Retirement Fund until age 75 or purchase an annuity with €63,500.

1. Are you currently receiving a guaranteed pension income for life of at least €12,700 per annum (this may include the single person’s State pension entitlement)? Yes No

If yes, please provide details:

State pension entitlement (single person entitlement only)

€

Other pension entitlements €

Pension Provider

Name

Address

Policy / Annuity Ref Number

2. Have you used at least €63,500 from any pension fund to buy an annuity?

Yes No


Purchase Amount €

Name of Qualifying Fund Manager

Pension Provider

ITC ARF

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Annuity Account Number

Please enclose a copy of your annuity policy

3. Do you have €63,500 invested in an Approved Minimum Retirement Fund?

Yes No


Purchase Amount €


Date of Investment (DD/MM/YYYY)

AMRF Ref Number

Terms of Engagement

Fax/ E-mail Indemnity

I hereby authorise Independent Trustee Company Limited to effect investments in investment vehicles/ products on behalf of my Approved (Minimum) Retirement Fund where the authorisation to proceed with the investmenthas been received via fax or e-mail.

ITC ARF

I confirm that I, in conjunction with my financial advisor, will make provision to ensure that at all times the ARF/ AMRF has sufficient liquidity at all times to make payments as they fall due e.g. the compulsory annual draw-down, fees, etc.

Where there is insufficient liquidity to meet the liabilities of the fund I agree to indemnify and hold harmless ITC against any claims or liabilities discharged on my behalf.

I confirm my instructions to Independent Trustee Company Limited (“ITC”) to act as the Qualifying Fund Manager for my Approved Retirement Fund (“ARF”) and/ or Approved Minimum Retirement Fund (AMRF”).

I acknowledge that the services will be provided in accordance with ITC’s Terms of Business, a copy of which has been provided to and read by me. I acknowledge in particular the provisions relating to data protection.

In accordance with the Data Protection Acts 1998 and 2003, I, as the data subject, consent to the collection, retention and processing by ITC of any personal data about me for the purposes of providing the above and any ancillary services.

I acknowledge that ITC does not provide investment advice and that if I require such advice I will be required to obtain such advice from my financial advisor.

I acknowledge that all monies contained in my ARF/ AMRF will be invested entirely in the Delta Fund. A series trust application for units in the Delta Fund is enclosed with this application.

I acknowledge that it may not be possible to transfer in specie any of the investments made through my ARF/ AMRF to another pension.

I acknowledge that it is my responsibility to obtain such professional advice as is appropriate in connection with the quality, suitability and appropriateness of any investment made through my ARF/ AMRF. I confirm that ITC does not have any responsibility for assessing the quality, suitability or appropriateness of any investment made through my ARF/ AMRF.

I confirm and acknowledge that any investment made through my ARF/ AMRF will be undertaken at my request and direction and agree to release, indemnify and hold harmless ITC from any and all liability in connection with or arising from any investment.


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Terms of Engagement



ITC ARF

I confirm that I, in conjunction with my financial advisor, will make provision to ensure that at all times the ARF/ AMRF has sufficient liquidity to make payments as appropriate e.g. the compulsory annual draw-down, fees, etc.




I acknowledge that all assets of my ITC ARF (AMRF) will be held by a unit trust or such other custodial vehicle as ITC in its absolute discretion may decide.

I acknowledge that ITC does not provide investment advice and that I will be required to obtain such advice from my financial advisor.

I acknowledge that it may not be possible to transfer in specie any of the investments made through my ARF/ AMRF to another ARF.




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Yes No


Purchase Amount €



AMRF Ref Number

Terms of Engagement



ITC ARF












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Client Portal - Consent

Access to the ITC Client Portal can be gained from the website, www.independent-trustee.com or by downloading the app to phone or tablet from the App Store.

I confim that

• I do not wish to receive reports, statements or projections as hard copy (by post)

• I wish to gain access to the ITC Client Portal and consent to receiving relevant scheme documentation, reports, statements and projections via my ITC Client Portal.


Yes No


Purchase Amount €



AMRF Ref Number

Terms of Engagement



ITC ARF












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/ /


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Yes No


Purchase Amount €



AMRF Ref Number

Terms of Engagement



ITC ARF












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Declaration




ITC ARF


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UNIT TRUST SUBSCRIPTION

If you wish to invest in non-exchange traded assets, typically bonds, bank deposits or direct property, or where funds need pre-clearing, we will open a separate bank account under the terms of the Custody Trust dated 25th April 2014, an Exempt Unit Trust, established pursuant to Section 731 (5) TCA97 (the “Trust”).

The terms of the Trust are available to view on the ITC website atwww.independent-trustee.com/resources/downloads.

This application form relates to all initial and subsequent subscriptions for Units in the Custody Trust made on behalf of your ITC ARF, as evidenced by the transfer of subscription monies into the appropriate Sub-fund account.

To be completed by ITC

Trust Reference

The Pension Investor

Representations and Warranties

The capitalised words and expressions used in this application form shall have the meaning ascribed to them in the Trust.

1. I confirm that having considered the Declaration of Trust and a specimen Supplemental Declaration of Trust in relation to the Sub-fund, this application is based solely on the Declaration of Trust and the Supplemental Declaration of Trust and I am not relying on any other information or representation.

2. I agree that all representations, warranties and declarations which I make or give here will apply with respect to future acquisitions of Units in the Trust as if repeated in full at the time of the future acquisition.

3. I hereby acknowledge and agree that the Trustee reserves the right at its sole discretion to accept or reject in whole or in part my application.

4. I acknowledge the right of the Trustee in its capacity as trustee of the Trust to issue such number of Units upon the transfer of initial or subsequent subscription monies into the account of the Sub-fund as the Trustee may in its sole discretion determine in accordance with the provision of the Declaration of Trust.

5. I further acknowledge and agree that the transfer of monies by me into the account of the Sub-fund will be deemed to be an irrevocable subscription for Units in the Trust.

6. I acknowledge the right of the Trustee in its capacity as trustee of the Trust, to redeem the Units in the event that the representations or warranties set out herein above are no longer accurate.

7. I acknowledge the right of the Trustee in its capacity as trustee of the Trust to compulsorily redeem Units in the event that such units are (i) held in breach of any law or requirement of any country or governmental authority; (ii) held in circumstances which in the opinion of the Trustee might result in the Trust incurring any liability for taxation or suffering any legal, pecuniary, regulatory or material administrative disadvantage which the Trust might not otherwise have incurred or suffered; or (iii) are held by a Unit holder who is not or

Declaration




ITC ARF


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cease to be a Pension Investor (as defined in the Declaration of Trust); or (iv) held in circumstances in the opinion of the Trustee which might result in the Series Trust or Trust being deemed to be a “unit trust scheme” as defined in Section 1(1) of the Unit Trusts Act, 1990; (v) held in the circumstances in the opinion of the Trustee might result in the Sub-fund or Trust being deemed to be an Alternative Investment Fund (as defined in the European Union (Alternative Investment Fund Managers) Regulations 2013).

8. I understand that during the Term of the Sub-fund, the redemption of Units shall be subject to restrictions which may adversely affect the ability to redeem Units.

9. I shall provide the Trustee with any additional information which it may require in connection with my tax status and authorise them to disclose such information relating to this application to such persons as it may be required for taxation, legal or regulatory purposes.

10. I acknowledge that it is envisaged that additional subscriptions for Units in the Trust shall be made in such an amount as shall be determined by me. Where additional subscriptions are not made and where, as a result, there may not be sufficient assets within the Series Trust to discharge its liabilities from time to time I acknowledge that this may result in the Trustee being obliged to sell or otherwise dispose of some or all of the assets of the relevant Series Trust.

Acknowledged and agreed by

Investor Signature Print Name Date

Certificate of source of investment for Approved Retirement FundNote: Before ITC can accept monies into an Approved Retirement Fund (ARF), we must receive this Certificate completed by the existing Qualifying Fund Manager, Pension Scheme Trustee or Life Assurance Company and signed by the appropriate person.

Applicant’s Name

PPS Number

Transfer Amount €

Origin of Funds

Existing ARF: If yes please complete section A Yes No

From a Pension Fund: If yes please complete section B Yes No

AWas this ARF set up prior to 06 April 2000? Yes No

Were drawdowns (including the imputed distribution) being taken from this ARF for the current year?

Yes No

If yes, please attach a schedule of drawdowns.

Are assets to be transferred in specie to the ARF? Yes No

If yes, please provide most recent valuation.

BName of Scheme/ Life Office

Revenue Approval/ Policy Number

CIs this ARF subject to a Pension / Property Adjustment Order?

Copy Pension / Property Adjustment Order attached?

ITC ARF

Yes No

Yes

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Certification (to be completed by current pension provider)

We certify the following:

i. The funds to which this certification relates comprise of assets to which the individual named in this application is beneficially entitled; and

ii. The assets to which this certificate relates derive from an approved source within the meaning of section 784B Taxes Consolidation Act 1997 (as amended).

ITC ARF

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Certificate of source of investment for Approved Minimum Retirement FundNote: Before ITC can accept monies into an Approved Minimum Retirement Fund (AMRF), we must receive this Certificate completed by the existing Qualifying Fund Manager, Pension Scheme Trustee or Life AssuranceCompany and signed by the appropriate person.

Applicant’s Name

PPS Number

Transfer Amount €

Origin of Funds

Existing AMRF: If yes please complete section A Yes No

From a Pension Fund: If yes please complete section B Yes No

A

Was this AMRF set up prior to 06 April 2000? Yes No

Were drawdowns (including the imputed distribution) being taken from this AMRF for the current year?

Yes No

If yes, please attach a schedule of drawdowns.

Are assets to be transferred in specie to the AMRF? Yes No

If yes, please provide most recent valuation.

B

Name of Scheme / Life Office

Revenue Approval / Policy Number

ITC ARF

Certification (to be completed by current pension provider)

We certify the following:

i. The funds to which this certification relates comprise of assets to which the individual named in this application is beneficially entitled; and

ii. The assets to which this certificate relates derive from an approved source within the meaning of section 784CTaxes Consolidation Act 1997 (as amended).

ITC ARF

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Independent Trustee Company Limited, part of the ITC Group, is regulated by the Central Bank of Ireland.

Please note that the provision of this product or service does not require licensing, authorisation, or registration with the Central Bank of Ireland and, as a result, it is not covered by the Central Bank’s requirements designed to protect consumers or by a statutory compensation scheme.

AR 101.5.4 Effective from May 2018

Independent Trustee Company Limited Harmony Court Harmony Row Dublin 2

Tel: (01) 661 1022 Fax: (01) 661 1024 Email: [email protected]

Independent Trustee Company Limited is regulated by the Financial Regulator.

ITC does not take any responsibility for loss or damage occasioned by any person acting or refraining from acting as a result of the contents of this brochure. This brochure is based on ITC’s current understanding of pensions law and revenue practice as at October 2007.

Registered in Ireland under Company Number 214999. Registered Office: Harmony Court, Harmony Row, Dublin 2. Vat Number IE 8214999


Independent Trustee Company Limited,Harmony Court, Harmony Row, Dublin 2.

Tel: (01) 661 1022Fax: (01) 661 1024Email: [email protected]

Independent Trustee Company Limited is regulated by the Financial Regulator.

ITC does not take any responsibility for loss or damage occasioned by any person acting or refraining from acting as a result of the contents of this brochure. This brochure is based on ITC’s current understanding of pensions law and revenue practice as at October 2007.

Registered in Ireland under Company Number 214999. Registered Office: Harmony Court, Harmony Row, Dublin 2. Vat Number IE 8214999


Independent Trustee Company Limited,Harmony Court, Harmony Row, Dublin 2.

Tel: (01) 661 1022Fax: (01) 661 1024Email: [email protected]

ITC ARF - independent-trustee.com · retention and processing by ITC of any personal data about me for the purposes of providing the above and any ancillary services. I acknowledge

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