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Small Self Administered Pension (SSAP)Wealth Options Broker Platform Application

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Documentation Checklist

Fully completed and signed Applica on Booklet Client and Trustee

Bank Account Opening Mandate and Addendum signed by the Client

Bank Authorisa on le er to transfer funds

Cheque for Investment Amount Cheque to be made payable to ‘Client’s Name SSAP’

Signed and completed Declara on of Trust

Confirma on of Charges (inc. Pla orm, Pension and Advisors Charge)

Cer fied Copy of Proof of most revent P60

In order to comply with An -Money Laundering and Terrorist Financing regula ons Wealth Op ons and Conexim Advisors Ltd. require the following in order to verify your name and address. Please provide the documenta on as outlined below.

Cer fied Copy of 2 U lity Bills / Bank Statements Not more than 3 months old

Cer fied Copy of Photo ID Valid and in date driving licence or passport

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Note: These forms are only to be completed for an Investment on the Wealth Op ons Broker Pla orm.

Section A: Scheme & Employer Details

Section B: Member Details

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Proposed Retirement Age: (minimum retirement age is 60)

Name:

Registered Address:

Trading Address (if different):

Tel: Fax: Email:

Corporation Tax District:

Tax Number: Accounting Year End: / /

Date of Registration: / /

Proposed Date of Scheme Commencement: / /

Associated Employers: % Shareholding:

Auditors: PAYE TAX District:

Employer Details

First: Surname:

Please notify us of future change in address

Status: Married Single Widower Separated Divorced Civil Partnership

Home Address:

PPSN Number: Date of Birth: / /

Spouses / Dependants Name: Spouse’s Date of Birth: / /

Other Beneficiaries (if applicable):

Home Number: Work Number:

Mobile Number: Email:

Date of Joining Company: Normal Retirement Age:

Remuneration (inc BIK): Pension Adjustment Order: Yes No

Section C: Existing Pension Bene its

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Pension Provider

PRSA/Personal Company Pension

Policy Number Is this pension in respect of Current or Previous

Employment

Current/Transfer Value

Transfer to SSAPS – Y/N

Section D: Introducer Details

Company:

Address:

Work Number: Mobile Number:

Fax Number: Email:

Contact Name:

Section E: Proposed Scheme Trustees

The beneficiary and Wealth Options Trustees Ltd as Pensioneer Trustee.

Section F: Registered Administrators

Member Trustee Investment DeclarationI confirm that Wealth Options Trustees Limited act in the capacity of Pensioneer Trustee and Registered Administrator only and that my financial advisor is my investment manager. Wealth Options Trustees Limited act in a signatory capacity only and all investment decisions are that of the Member Trustee alone.

Member DeclarationI acknowledge that my SSAP set up will commence when Wealth Options Trustees Limited has received and accepted a fully completed application form and SSAPS set up fee. My SSAP will be submitted to the Revenue Commissioners for approval when all documentation, information and fees requested have been provided to Wealth Options Trustees Limited.

Trustee Training DeclarationWith effect from the 1st February 2010, trustees are required to complete trustee training within six months of their appointment. Where the scheme commenced before this date, training must be completed by the 31st January 2012. After initial training – trustee training will be required at least every two years. I will keep a record to show that the appropriate training has been completed.

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Signature Required

Signature Required

Please note that the provision of this product does not require licensing, authorisa on, or registra on with the Central Bank and, as a result, it is not covered by the Central Bank’s requirements designed to protect consumers or by a statutory compensa on scheme.

Payment of Fees

I wish to confirm that I agree to pay all annual administration fees in the future for my Small Self Administered Scheme.

Inital Set Up Fee of: €

Total Annual Charge %* (includes Platform, Pension and Advisor Charge - Payable in Advance) *Net Asset Value Please note that all fees may be subject to VAT.

Rabo Direct will pay a fee of up to 0.3% per annum of the account balance to Wealth Options Limited. This fee will be used for the administration of this bank account. This fee is only paid while there are funds in the account. This rate does not impact on the interest rate applied to your account.

We hereby apply to Wealth Options Trustees Limited to set up a Small Self Administered Arrangement on our behalf. We undertake to pay all fees due as agreed with our intermediary. We authorise any of the institutions mentioned above to provide the intermediary mentioned overleaf with relevant details on any policies held in our name. We declare that our intermediary can pass this information on to Wealth Options Trustees Limited.

Service Level Agreement

I acknowledge receipt of the Service Level Agreement and agree its contents.

Date:

(Employer)

For and on behalf of

(Name of employer or company) (Member Trustee)

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DECLARATION OF TRUST

THIS DECLARATION OF TRUST is made the day of 2014

BY whose registered office is situated at

(hereinafter called the "Principal Employer")

WHEREAS:

The Principal Employer (as defined below) has decided to establish under irrevocable trust a retirement benefits scheme to be known as the “ ” (hereinafter called the "Scheme") for the purpose of providing occupational retirement provision for its employee (hereinafter called “the Member”) in accordance with the provisions of the Scheme.

It is confirmed that the Scheme was established and shall operate for the sole benefit of the Member who is the only member of the Scheme.

The Trustees of the Scheme shall have discretion to invest the resources of the Scheme in accordance with the Rules of the Scheme.

The Occupational Pension Schemes (Investment) Regulations, 2005 (S.I. 593 of 2005) (hereinafter called the “Regulations”) which came into force on 23rd September 2005 and the provisions of Section 61B of the Pensions Act, 1990 as inserted by Section 36 of the Social Welfare and Pensions Act, 2005 permit the trustees of the scheme to borrow money for or on behalf of the Scheme.

The term “the Employers" shall include the Principal Employer and any and every Associated Employer or such one or more of them as the context shall determine or the circumstances shall require and "the Employers" in relation to the Member means that one or more of the Employers in whose service the Member is at the relevant time.

The term "Associated Employer" means any person or firm associated with or directly or indirectly controlled by the Principal Employer and which with the consent of the Principal Employer and of the Revenue Commissioners executes a Deed of Adherence whereby such person or firm adheres to and is included in the Scheme and whereby such person or firm agrees to be bound by the regulations governing the Scheme.

NOW IT IS HEREBY WITNESSED AND DECLARED AS FOLLOWS :-

1. The Scheme is hereby established by the Principal Employer under irrevocable trust and shall commence on the day of (hereinafter called "the Commencing Date") for the main purpose of providing relevant benefits as defined by S.770 of Chapter I of Part 30 of the Taxes Consolidation Act, 1997 as amended from time to time.

2. The parties hereto confirm that the Scheme shall be operated as a one-member scheme solely for the benefit of the Member,

3. Throughout this Declaration of Trust:

(i) a word or phrase appearing in parenthesis has the meaning of words immediately preceding it,

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(ii) words importing the male gender shall be construed as including the female gender and vice versa and words importing neuter gender shall be construed as including male and female genders except where the context otherwise requires,

(iii) words in the singular shall be construed as including words in the plural and words in the plural as including words in the singular except where the context otherwise requires.

4. The full provisions of the Scheme are set forth in the Rules of the Scheme (hereinafter called "the Rules") as attached in the Schedule hereto. The Scheme shall operate in accordance with the Rules, subject to the provisions of the Pensions Acts 1990 to 2005 (as may be amended from time to time).

5. (Member Trustee) and Wealth Options Trustees Limited, 1A Elm House, Millennium Park, Naas, Co. Kildare (The Pensioneer Trustee)

are hereby appointed as Trustees of the Scheme and shall hold all benefits payable under the Scheme in trust for the Member for whose benefit the said benefits are payable in accordance with the Rules. Power to remove any trustee and to appoint new or additional trustees of the Scheme shall be vested in the Principal Employer.

Any trustee of the Scheme shall have the right to retire from the office of trustee.

The approval of the Revenue Commissioners shall be sought and obtained prior to the removal of the Pensioner Trustee. The Principal Employer shall thereupon appoint another pensioner trustee or trustees in its place.

The number of trustees shall not be less than two save in such situations where the Principal Employer appoints a corporate trustee as trustee of the Scheme.

Any trustee who retires or is removed shall forthwith do all acts and things necessary to vest the assets of the Scheme in the continuing and/or new trustees. The Scheme must at all times have a Pensioner Trustee.

6. (1) The assets of the Scheme shall be held under the legal control of the Trustees or of a nominee for the Trustees and shall constitute a fund ("the Fund") to be held in accordance with the provisions of the Trust Deed and the Rules, such assets to include all moneys contributed by the Principal Employer and by the Members and by any other person or corporation and the investments and income thereof.

(2) The Trustees shall have the power to invest the assets of the Scheme in accordance with the Rules and shall invest all the moneys coming into their hands on account of the Scheme which are not required to discharge the expenses of the Scheme, to insure against contingent benefits or to provide for benefits then payable in, or on the security of, any stocks, shares, debentures, debenture stock, units in collective investment undertakings, property or other investments or applications of any kind, wherever situate, whether income producing or not, whether involving liability or not and whether or not authorised by law for the investment of trust moneys, or on whatever credit (with or without security) as the Trustees in their absolute discretion think fit, and may realise any investment or application and reinvest the proceeds in any other or others, so that the Trustees shall have the same full and unrestricted powers of investment and application and of varying and transposing investments and applications as if they were absolutely

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and beneficially entitled to the Fund upon terms that all sums payable under such contracts or policies shall as and when received by the Trustees be held by them upon trust for the purposes of the Scheme.

The Pensioneer Trustee shall be party to all financial transactions on the Fund and shall be a co-signatory on all bank accounts comprising part of the Fund.

7. The Trustees may borrow for the purposes of the Scheme, whether on the security of investments or otherwise, and may undertake on behalf of the Scheme any liability of the Scheme in relation to any investment or application of the fund and sign and execute any debenture, mortgage, charge, agreement, promissory or loan note, or other document in connection with any of the foregoing as if they were the absolute and beneficial owner of the fund or of any assets constituting the fund subject always to compliance regarding restrictions on investment laid down by the Revenue Commissioners in accordance with the Taxes Consolidation Acts and the Pensions Acts 1990 to 2005. The Trustees shall be entitled to exercise their power to borrow for the purposes of the scheme solely in accordance with all applicable rules on occupational pensions scheme borrowing as may be set out from time to time by the Revenue Commissioners in their Pensions Manual or elsewhere.

8. The assets of the Scheme shall be held under the legal control of the Trustees or of a nominee of the Trustees and shall constitute the Fund to be held in accordance with the provisions of the Deed and the Rules, such assets to include all moneys contributed by the Principal Employer and by the Member and by any other corporation together with the investments and income thereof.

9. The Trustees of the Scheme shall hold all benefits payable under the Scheme in trust for the Member (including successors, beneficiaries, heirs and assigns) for whose benefit the benefits from the Scheme are payable in accordance with the Rules of the Scheme.

10. The Trustee shall have the power to appoint a manager with responsibility for the management of the assets of the Scheme.

11. The Manager may be empowered to exercise, to carry out or to delegate to any other person in accordance with the terms of the Manager’s appointment the powers of investment set out in the Deed and such of the other powers and duties of the Trustees as the Trustees shall deem expedient including (without limitation) the calculation and provision of benefits in accordance with the Rules, the preparation of reports, accounts and valuations and the provision of information to the Member and others.

12. (1) The Scheme is a retirement benefits scheme, as defined by S. 771 of Chapter I of Part 30 of the Taxes Consolidation Act, 1997, capable of being approved by the Revenue Commissioners under S. 774 of the Taxes Consolidation Act 1997, and of being treated by them as an exempt approved scheme. Notwithstanding anything in this Declaration or the Rules, no benefit shall be provided under the Scheme which would exceed the maximum benefit permitted, or otherwise conflict with requirements imposed, by the Revenue Commissioners from time to time as a condition of approval under the Taxes Consolidation Act, 1997. Any benefit otherwise provided shall be reduced or varied as may be necessary to ensure that the maximum is not exceeded and that there is no conflict with the requirements. The Trustees shall comply at all times with any undertaking given to the Revenue Commissioners in order to obtain or retain approval.

(2) This Deed and the Rules are subject to the Pensions Act, 1990 and 2005 and shall take effect subject to any modification necessary to comply with it. The duties of the Principal Employer, any Associated Employer and the Trustees shall be

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regulated by, and carried out in accordance with, the Pensions Act, 1990 to 2005.

13. (1) No Trustee shall be responsible, chargeable or liable in any manner whatsoever for, or in respect of, any loss or depreciation of, or default upon any of the investments or bank or other deposits, annuities or policies in or upon which the Fund or any part of it may at any time be invested or deposited, or for any delay which may occur from whatever cause in the investment of any moneys belonging to the Fund, or for the safety of any securities or documents of title deposited by the Trustees for safe custody, or for the exercise of any discretionary power vested in the Trustees by this Deed or by the Rules, including any act or omission by any committee appointed by the Trustees or by reason of any other matter of thing except:-

(a) Wilful default on the part of the Trustees who is sought to be made liable, or (b) Negligence, in the case of a corporate trustee which is engaged in the

business of providing trustee services for a fee.

(2) Subject to Clause 13(1), the Trustees shall have the benefit of all indemnities conferred upon trustees generally by Statute or otherwise and the Principal Employer shall keep the Trustees indemnified against any actions, claims and demands arising out of anything lawfully done or caused to be done by them in the exercise of the powers and discretions vested in them by this Deed or the Rules and, to the extent that the Principal Employer fails to indemnify the Trustees, they shall be indemnified by the Associated Employers and, to the extent that the Associated Employers fail to indemnity the Trustees, they shall be indemnified out of the Fund.

14. The Scheme shall be wound up upon the happening of one or more of the following events

(1) On the failure of the Principal Employer to appoint, in accordance with Clause 4, a new Pensioneer Trustee within one month of the Pensioner Trustee having died, resigned or being removed from office,

(2) On the Employers failing to pay the Trustees (either jointly or severally) any sum or sums within such reasonable time as the Trustees shall require the same to be paid, or failing to observe and perform any other of their obligations under this Deed or the Rules or under any supplemental Deed or agreement, and (in either case) the Trustees, including the Pensioneer Trustee, then resolving to wind up the scheme.

(3) On the making of an Order or an effective resolution being passed for the winding up of the Principal Employer unless a new employer of some or all of the Members is willing to enter into an agreement as provided in the Rules for the purpose of continuing the Scheme,

(4) On the passing of an effective resolution by the Trustees of the Scheme expressing the intention to wind-up the Scheme.

(5) On the retirement of the member

(6) The Scheme cannot be wound up without the consent of the Pensioneer Trustee

15. The Trustees shall have power to appoint and to dismiss a manager of the Scheme and to arrange such appointment on such terms as to remuneration and otherwise as shall from time to time be agreed between the Trustees and the manager, with the approval of the Principal Employer. Such manager may be empowered to exercise, to carry out, or to

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delegate to any other person in accordance with the terms of the manager's appointment the powers of investment set out in this Deed and such of the other powers and duties of the Trustees as the Trustees shall deem expedient, including (without limitation) the calculation and provision of benefits in accordance with the Rules, the preparation of reports, accounts and valuations and the provision of information to members and others.The Manager shall act as administrator of the Scheme for the purposes of Chapter I of Part 30 of the Taxes Consolidation Act, 1997, and, if no manager is appointed, the Trustees shall so act or shall appoint some other person or persons or body corporate so to act.

16. The Principal Employer with the consent of the Trustees of the Scheme (if the Principal Employer is not at the relevant time the Trustee of the Scheme) may by supplementary declaration at any time amend any of the provisions of this Declaration of Trust and the Rules provided that no amendment shall be made which

(1) varies the main purpose of the Scheme namely the provision of relevant benefits as defined by S. 771 of the Taxes Consolidation Act, 1997 or results in loss of the approval of the Revenue Commissioners so long as the same shall be necessary for exemption or relief from taxation or shall otherwise be necessary or desirable,

(2) authorises the accrual or enjoyment of any benefits under the Scheme by the Principal Employer or any Associated Employer except in respect of any surplus remaining after termination of the Scheme,

(3) extends the operation of the Scheme beyond the Trust Period.

17. The Trustees may settle, compromise or refer to arbitration under the Arbitration Acts 1954 and 1980 any dispute or difference arising out of the Scheme or otherwise in connection therewith.

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IN WITNESS whereof these presents have been executed the day and year first above written

PRESENT when the Common Seal Seal of

was affixed hereto

____________________________ 1st Director

________________________ 2nd Director / Secretary

We the Trustees of the Scheme appointed by virtue of this Declaration of Trust hereby consent to act as Trustees.

Signed

___________________________________(Member Trustee)

PRESENT when the Common Seal Seal Of Wealth Options Trustees Limited (Pensioneer Trustee) was affixed hereto

___________________________________ Director

___________________________________ Director / Secretary

Signatures Required

Signature Required

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Section G: Managed Portfolios

Other Investment Requirements e.g. fund, ETFs, shares etc.

Fund / Share Name ISIN/SEDOL Amount

Off Platform Investments (Please complete a SSAP Investment Instruction form for any Off Platform Investment)

Investment Name Maturity Date Amount

Model Por olio Ultra Defensive Defensive Balanced Equity Focus Targeted EquityRisk Ra ng 2 3 4 5 6

Risk Rated Model Por olio Selec on:

Please ck one of the following op ons: Accumula on Version Distribu on Version

Passive Model Portfolios advisedby Morningstar InvestmentManagement Europe Ltd.

Model Por olio Cau ous Balanced Adventurous Adventurous Plus Income Risk Ra ng 3 4 5 6 4

Please note: Where you have omi ed to choose between the accumula on or distribu on version of a model por olio or fund, the accumula on op on will be chosen by default.

Amount: €

Please talk to your Financial Broker about the Por olios above. Please note that Dimensional Fund Advisors and Morningstar Investment Management Europe Limited do not offer model por olios directly to individual investors. Access to these por olios is restricted to a select group of Financial Advisory firms supported on the pla orm. Please see Model Por olio Guides for details of Risk Ra ng.

Risk Rated Model Por olio Selec on: Amount: €

Minimum Investment €20,000

Minimum Investment €20,000

The Model Por olios are risk weighted and designed to match par cular investment objec ves and a tudes to risk. Please select only ONE below.

Section I - Bene icial Owner Declarations

I (i) Declara onI declare that the informa on provided by me in this Applica on Form and in this Declara on is correct and I undertake to inform Wealth Op ons without delay and in wri ng should any of the informa on change.

I (ii) Receipt and Understanding of Terms of Business I have received the Terms rela ng to the Wealth Op ons Broker Pla orm, and have read them carefully. I understand that Wealth Op ons Ltd (”Wealth Op ons”), Conexim Advisors Ltd. ("Conexim"), Pershing Securi es Interna onal Limited (”PSIL”) and I are bound by the Terms if my applica on is accepted. I further note that the Terms may subsequently changeas set out in the Terms.

I (iii) Receipt and Consent of Order Execu on Policy I have received informa on regarding both Conexim and Pershing Security Ltd’s (”PSL”) Order Execu on Policy, and by signing this document I consent to having my orders executed as set out in those policies. Details of the Order Execu on Policy are available in the Wealth Op ons Broker Pla orm Terms of Business booklet.

I (iv) Express Consent to Execu on of an Order outside of a Regulated Market or MTFWhere I have requested Conexim to transmit an order for execu on in an instrument admi ed to trading on a Regulated Market (“RM”) or Mul lateral Trading Facility (“MTF”), then I acknowledge that PSL may execute such order outside an RM or MTF in accordance with PSIL’s Execu on Policy and I hereby give our express consent for such execu on.

I (v) Receipt and understanding of Summary Conflicts of Interest PolicyI have received and understand the enclosed summary Conflicts of Interest Policies from Wealth Op ons, Conexim and PSIL. Details of the Summary Conflicts of Interest Policy are available in the Wealth Op ons Broker Pla orm Terms of Business booklet.

I (vi) Fees, Commissions and ChargesI have received details of the fees, commissions and charges in rela on to investment in the Wealth Op ons Broker Pla orm and I have agreed to these. I confirm that Conexim has explicit permission to deduct such amounts from your account(s) to sa sfy any indebtedness to Wealth Op ons, Conexim or PSIL.

I (vii) Taxa onI acknowledge and confirm I understand that there can be no guarantee that the tax treatment or any tax advantage promoted as part of any investment or scheme will remain in existence. I acknowledge and confirm that Wealth Op ons or Conexim will not be responsible for assessing the personal tax implica ons of inves ng in any par cular instrument. I will always take independent professional tax advice before making an investment decision. Conexim will never act as a promoter or tax adviser in rela on to transac ons or schemes designed to enable a person to obtain a tax advantage, as defined in the Finance Act 2010. Should I knowingly receive a tax advantage from any par cular investment or series of investments, I hereby confirm and acknowledge that it is I, my tax advisor, or the promoter of any such scheme who is responsible for disclosing any such tax advantage gained under the mandatory disclosure regime introduced by the Finance Act 2010, or any applicable regime in place at any par cular me, and it is not the responsibility of Wealth Op ons or Conexim to iden fy or disclose any tax advantage gained from any such transac ons.

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Section H: Small Self Administered Pension Bank Account

Note: These details are required so we can transfer monies to you electronically from your accounts. Please note we cannot transfer monies to third party accounts.

(To be completed once SSAP working account is opened)

Account Name:

Name of Bank/Building Society:

Address of Bank/Building Society:

IBAN No:

Swi /BIC:

For internal use only

I (viii) W-8 BENI have received a copy of the W-8 BEN form and a document designed to assist in its comple on. I will be unable to trade in US Securi es un l a correctly completed W-8 BEN has been provided to Wealth Op ons / Conexim and this has been lodged with the appointed withholding agent. It is beneficial for clients who may be selling US securi es and possibly receiving income in the form of dividends from US securi es to complete this form, as it reduces the tax rate you would ordinarily be charged on such income or sales. This is facilitated by the double taxa on agreement in place between Ireland and theUnited States.

I (ix) Contract NotesI understand that within the Risk Rated Model Por olios, I will not receive trade confirma ons for each individual trade entered into, but instead will have the ability to query any transac on in my Wealth Op ons Broker Pla orm online client por olio. Conexim will receive all trade confirma ons on my behalf, and store these in a durable medium. As such, I waive the right to query any par cular detail on each trade confirma on, as provided for in Sec on 21.2 of the Terms of Business. Should you instead wish to receive trade confirma ons for each transac on entered into, please ck herePlease note if you hold an account outside of a model por olio, you will receive a contract note automa cally

I (x) I hereby consent to the provision of informa on to the Revenue Commissioners if required in rela on to this investment.

I (xi) I confirm that I wish to make this investment on an execu on only basis having received independent financial advice prior to the making of this investment. I understand that this means that the Providers will provide their services following my request and without having ascertained whether the service is suitable or appropriate for me. I confirm that I have received investment advice from my professional investment advisor or broker before making this investment and confirm that I have provided all the informa on requested by my investment adviser or broker to enable them to confirm that this investment is suitable for me and I confirm that I am instruc ng Conexim following this recommenda on OR I confirm that I have not received any investment advice before making this investment and that this investment decision is en rely at my own ini a ve and risk. I confirm that in either case I have requested the Providers to provide their services to me on an execu on only basis and that I do not wish to provide any financial or other personal informa on to the Providers to enable it to determine whether the service is appropriate for me. Where Conexim may rebalance investments within a model por olio I confirm that such rebalancing is based on the pre-authorised rebalancing instruc on as detailed in the in the Model Por olio Guides, which I have received a copy of, and that such rebalancing does not imply that Conexim is making an assessment of suitability or appropriateness for the purposes of providing services to me, and if any discre on is employed it is only to rebalance the por olio to remain consistent with the characteris cs for each model por olio as specified in the Model Por olio Guides. I understand that values can go down as well as up. I understand that if there is gearing (lending) involved in an investment there may be a higher degree of risk involved in that investment. All fees in the investment have been explained to me and I amsa sfied with the fees.

I (xii) If I decide to exercise my cooling off op on on an insured product, my fund will be refunded less the adjustment for any downward movement in the unit price from the date of the investment to policy cancella on date.

I (xiii) By signing this form I am indemnifying the Providers against any and all costs and claims incurred or suffered arising directly or indirectly out of the signing by the Providers of the Investment applica on and/or making the investment or otherwise in connec on with the investment.

I (xiv) Data Protec on Acts The informa on that you have provided will be treated as confiden al and retained by the Providers for the purposes of financial services or as required by law. You have a right to request a copy of the informa on we hold about you for which we may charge a small fee and to have any inaccuracies in your informa on corrected. Wealth Op ons may use the informa on you have provided for the purposes of providing you with addi onal informa on rela ng to the goods and services of the Providers, it’s associated companies and/ or third par es. The Providers may share informa on with its associated and affiliated companies and/ or carefully selected third par es, to enable those associated and affiliated companies and/ or carefully selected third par es, to contact you directly in rela on to their goods and services. If you do not agree to the Providers use of the informa on for such purposes, please ck the box provided.

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Section I - Consent to Terms

Before comple ng and returning this form please ensure that you have read and understood all informa on regarding your Wealth Op ons Broker Pla orm Account and the Services you intend to avail of, including reading and understanding the Model Por olio Guide, Terms of Business, Risk Disclosure No ce, Summary of Conflict of Interest Policy and the Order Execu on Policy. Please sign below to confirm your consent to the terms and condi ons outlined in this document and in the Wealth Op ons Broker Pla orm Terms of Business, and confirm that you are sa sfied that the investment you have requested is suitable for your needs and risk profile, and isconsistent with the le er/statement of suitability I have received from my broker/financial advisor.

Member Trustee Signature:

Trustee Signature:

Intermediary Declara onI declare that I have met the above named applicants and have explained the relevant investments on the Wealth Op ons Broker Pla orm to them and am sa sfied that it is suitable for their needs and risk profile. I can confirm that we have fully complied with An Money Laundering and Terrorist Financing Legisla on.

Financial Broker Name: Financial Broker Signature:

Financial Broker Firm: Date:

Signature Required

Section H: Charges

Total Annual Charge % * (includes Platform, Pension and Advisor Charge - Payable in Advance)*Net Asset Value. Please refer to the charges document for any additional charges

Trust / Pens ion Scheme Deta i l s

* Please fill out all boxes marked above.

RaboDirect Deposit Account A P P L I C AT I O N F O R MT R U S T / P E N S I O N

Name of Account:

Deposit Account Type:

Address line 1:

Address line 2:

Address line 3:

County:

Country:

Email Address:

Fax:

Revenue Reference Number: (where appropriate)

*

*

IRELAND

Post Code (Dublin only) :

*

*

*

*

(Please tick box) * Small Self Administered Pension (SSAP)OrPension Scheme / Other (please specify)

(Please tick box) *

Author ised S ignator ies

*

Name / Member Trustee :

Address line 1:

Address line 2:

Address line 3:

Date of Birth (dd - mm - yyyy) :

Authorised Signatory 1: X

*

*

*

Name :

Address line 1:

Address line 2:

Address line 3:



*

*

*

*

Signature Required



Author ised S ignator ies (co n t i n u e d )

Name :

Address line 1:

Address line 2:

Address line 3:



*

*

*

Name :

Address line 1:

Address line 2:

Address line 3:



*

*

*

Pens ioneer Trustee Deta i l s ( w h e r e a p p r o p r i a t e )

Name:

Address line 1:

Address line 2:

Address line 3:

Email Address:

Fax:

Telephone:

*

*

*

*

Authorised Signatory 1:

Authorised Signatory 2:

X

X

*

*

*

Mandate & Cer t i f icat ion



We confirm and certify that at a meeting of the trustees of the trust/pension scheme (the “Trust/Scheme”) on the following resolutions were duly passed and that they remain in full force and effect and have not been revoked:

(a) That RaboDirect be and is hereby requested and authorised to open such deposit accounts as may be deemed appropriate or necessary in relation to the Trust/Scheme and its customers provided that RaboDirect receives instructions to do so and those instructions are given to it in accordance with the signing instructions in this Application Form and the RaboDirect Pensions and Funds Terms and Conditions.

(b) That all arrangements between the Trust/Scheme and RaboDirect shall be operated in accordance with this Application Form and the RaboDirect Pensions and Funds Terms and Conditions, and that the Trust/Scheme has read, understood, agreed and accepted the content of these documents.

(c) That the RaboDirect Pensions and Funds Terms and Conditions were presented to the trustees of the Trust/Scheme and considered by them before being agreed as binding on the Trust/Scheme.

(d) That RaboDirect is authorised and entitled but not obliged to rely upon and act upon instructions given in accordance with this Application Form and the RaboDirect Pensions and Funds Terms and Conditions. All instructions given to RaboDirect must be signed by both (i) the pensioneer trustee or an authorised signatory on behalf of the pensioneer trustee and (ii) the member trustee / trustee or an authorised signatory for a trustee (the “Signing Requirements”).

(e) That these resolutions shall remain in force and shall constitute the Trust’s/Scheme’s mandate to RaboDirect until revoked by notice in writing to RaboDirect in accordance with the Signing Requirements.

(f ) That RaboDirect will be advised in writing in accordance with the Signing Requirements as soon as any changes take place to the trustees or authorised signatories or pensioneer trustee of the Trust/Scheme and that RaboDirect shall be entitled to act upon the information so given.

(g) That all representations, warranties, covenants and information given or made by the trustees of the Trust/Scheme and/or the pensioneer trustee in writing in connection with the arrangements between the Trust/Scheme and RaboDirect (whether set out in this Application Form or otherwise provided) shall unless otherwise confirmed in writing to RaboDirect in accordance with the Signing Requirements (and accepted in writing by RaboDirect) be deemed to have been given at the date of this Application Form and on a continuing basis for the duration of the arrangements between the Trust/Scheme and RaboDirect.

PLEASE PROVIDE THE AUTHORISED SIGNATORY LIST FOR THE PENSIONEER TRUSTEE TO RABODIRECT.

Certified to be a true and up-to-date copy: Trustee / Member Trustee Signature:

Trustee / Member Trustee Signature:

The Pensioneer Trustee/authorised signatory for the Pensioneer Trustee

The Pensioneer Trustee/authorised signatory for the Pensioneer Trustee.

X *

X *

X *

X *

Signature Required



Data Protec t ion

From time to time, RaboDirect would like to send the pensioneer trustee (the “Trustee”) information in relation to products or services by phone/post/email/SMS offered by RaboDirect or by the Rabobank Group that may be of interest to the Trustee. If the Trustee does not wish to receive such information, it should contact RaboDirect in writing. If the Trustee is happy to receive this information now, but changes its mind at a later date, it can notify us in writing.

Our address is: RaboDirect, FREEPOST F4006, PO Box 10152, Dublin 1.

Documents Requi red

Please provide the following:

Signed Application Form

Revenue Approval Letter (as appropriate) (certified copy or original)

Trust Deed/Policy Schedule/RAC (as appropriate) (certified copy or original)

In respect of each Trustee/Member Trustee:

A photocopy of your passport or driving licence that has been certified as a true copy by a bank, Garda, qualified accountant, solicitor or other relevant body.

And any ONE of the following (must be less than 6 months old):

An original utility bill (or certified copy)

An original car/home insurance certificate (or certified copy)

An original financial statement e.g. credit card/loan/savings statement (or certified copy)

An original document issued by Revenue/Dept of Social and Family Affairs (or certified copy)

Rabobank is licensed by the Dutch Central Bank. Terms and Conditions apply

ADDENDUM TO SELF ADMINISTERED SCHEME ACCOUNT MANDATE

To RaboDirect

Georges Dock House IFSCDublin 1

Self Administered Scheme Account Name:

Account No

To Manager of RaboDirect:

I/We hereby authorise a quarterly payment to be debited from the above mentioned account and the

amount transferred electronically to an account specified by Wealth Options Trustees Ltd. The amounts may

vary but will not exceed the agreed payment as per the Installation Questionnaire.

I/We will inform the bank or Wealth Options Trustees Ltd in writing if we wish to cancel this instruction.

I/We understand that if any payment is made which breaks the terms of this instruction, Wealth Options will make a refund.

Wealth Options Ltd is not giving the trustees any advice in relation to the pension bank account.

SIGNED ON BEHALF OF THE Self Administered Scheme

Member Trustee

Wealth Options Trustees Limited

Director

Director/Secretary

Signature Required

Private & Confidential Ms Olivia Hunt Rabo Direct Charlemont Place Dublin 2

Date:

Dear Olivia,

Re: _____________________ PRB

Account No. ________________

We would be grateful if you could transfer €_______________ to the following account:

Sort Code: 98-50-10

Account Number: 31911845

Account Name: Pershing Securities

Swift Code: ULSBIE2DXXX

IBAN: IE72ULSB98501031911845

Please quote reference:

Yours sincerely,

______________________ ______________________Wealth Options Ltd

Signature Required

SSAP

Member Trustee Wealth Options Trustees Ltd

Address: Unit 1C Elm HouseMillennium ParkNaasCo Kildare

Tel: Fax: Email: Website:

045 88 22 81045 88 22 [email protected]

Wealth Options Ltd. & Conexim Advisors Ltd. are regulated by the Central Bank of IrelandWealth Options Broker Platform is a trading name of Conexim Advisors Ltd. Wealth Options Ltd. Registered in Ireland No: 378600Conexim Advisors Ltd. Registered in Ireland No: 485863

Wealth Options distribute a range of financial services from leading product manufacturers exclusively to regulated intermediaries. Wealth Options do not distribute products directly to the public.

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