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WITHDRAWAL/CLOSURE FORM

!Before you complete this form, it is important that you understand the following:– You may incur ‘early encashment charges’ – more information is in the accompanying ‘Questions and Answers’ document. – If your plan or bond has additional life cover or critical illness cover we make a charge for providing the cover on the 15th of each month. If

your withdrawal has not taken place before the 15th we will make a charge which will reduce the value of your bond/plan.– If you have a CAB, EAB, HIB, SDB or SIB and there is less than £501 left in your bond after we have deducted your withdrawal amount,

we will pay you the entire value and close your bond. – Any additional life cover on a bond could be reduced as a result of a withdrawal.– There are tax implications when making withdrawals • There are two ways to make a withdrawal from a life assurance bond/plan: – FULL surrender of INDIVIDUAL policies – PARTIAL surrender from ALL policies and there are different tax implications depending on the method you choose. The following website contains guidance from HMRC:

www.gov.uk/government/publications/gains-on-uk-life-insurance-policies-hs320-self-assessment-helpsheet • WE CANNOT ADVISE YOU WHICH METHOD IS BEST FOR YOUR PERSONAL CIRCUMSTANCES. • HMRC rules do not permit us to amend the basis on which a withdrawal was completed if the tax consequences were not what you

expected.

WITH THIS FORM YOU CAN:

• close your bond/plan

• make a withdrawal from your bond/plan

It can be used for the following:

Capital Accumulation Plan (CAP) The Skandia Plan (TSP) Skandia Endowment Plan (SEP)

Maximum Investment Plan (MIP) Permanent Protection Plan (PPP) Skandia Lifetime Plan (SLP)

Investment Bonds (SIB, CAB, SDB, HIB, EAB, APB, CIB*, FIB)

It cannot be used for: • any product that is not listed above • regular income withdrawals, for which you will need our ‘Regular Withdrawal Request’ form. Your financial adviser will be able to help

you with this. *CIB is the Capital Investment Bond, not the Collective Investment Bond, for which there is a separate form.

COMPLETING THIS FORM• Tick/complete this form, as applicable, using BLOCK CAPITALS and blue or black ink. For dates, please use the format day/

month/year.• Complete the details in each applicable section carefully; we cannot be held responsible for any consequences if they are incorrect.

Errors or omissions by you or your financial adviser will not be corrected retrospectively.• Please read the accompanying `Questions and Answers’ document; it will help you complete this form

and clarify any additional requirements.• If, in our view, your instruction is not clear, we will be unable to proceed until we have contacted you

for clarification and this could delay your request.

ADDITIONAL DOCUMENTS WE WILL NEED• Proof of the bank account ownership – if not already provided, for the bank account into which your money is to be

paid.• Proof of your residential address – if it’s different from the address on our records or it’s changed within the last

12 months.• Proof of identification (for you and any beneficiary to whom payment will be made) and

a sample of your signature – if not already provided by you or your financial adviser. • Trust documents – for trust investments, if the trustees signing the form differ from those on our records.

More information about what documents we can accept is in the Questions and Answers document – see Q4.

GIVING US YOUR INSTRUCTIONS• By post: send the form to ReAssure, Old Mutual House, Portland Terrace, Southampton SO14 7AY.

• By email: send a scanned copy of the form to ask@reassurelife.co.uk. NOTE: We cannot accept photographs of instructions.

WHEN WILL PAYMENT BE MADE?• We will pay proceeds within 5 working days of receiving an acceptable instruction. This allows sufficient time to validate

your request, send the instruction to the fund manager(s) and release the money to your bank account.• Payment will be made to a UK bank account using BACS, whereby the money reaches the bank account 3-5 working

days after it leaves us. See Q3 in the Questions and Answers document.

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NoYes

Full name(s) of plan holder/trust

Bond/Plan number (Please complete the number carefully because we cannot be held responsible for any consequences if it is incorrect)

1 BOND/PLAN DETAILS

At ReAssure, we are keen to improve our products and services and we value your feedback. We would be grateful if you could take a few moments to answer the questions below to help us understand your decision to sell your ReAssure investment.

Q1 Did you seek advice from a professional financial adviser before deciding to sell? (tick)

Q2 What is the main reason for deciding to sell your investment? Please tick one of the following Poor fund performance Customer service experience

Premium/charges too high or not as expected To invest in a different product

Money required for another purpose No specific reason

Q3 If you are going to use the money from this sale to invest in another product, is it: (tick)

• an ReAssure product?

• another company’s product?

It would help us if you state the name of the company here

Address of plan holder/trust

Postcode

Full names of other plan holders (if applicable)

(e.g. SIB001234567)

REASONS FOR SELLING (completion of this section is optional)

–

Tick below to indicate whom we should contact if we have any queries about your instruction:

If the address given above is a correspondence address for the bond/plan, tick here

Telephone number

u We will not share your contact information with other parties; it is just for our reference

Email address

My/Our financial adviser OR Me/Us using the contact details shown above

2 DETAILS OF ASSIGNEE (if applicable)

Assignee’s full name

Please give the details of the assignee - this means anyone to whom the ownership of the investment has been transferred (assigned) or with whom the policy schedules have been placed or are otherwise regarded as security (e.g. a bank). The authority in Section 7 must then be completed by the assignee. .

Assignee’s address

Postcode

RE0131/220-0131/March 2020

THE IMPORTANCE OF FINANCIAL ADVICEWhatever the reason for selling, we recommend that you consult your financial adviser before you do so. Your adviser will be able to explain your options, help you decide the most suitable route and advise you about any tax implications.

If your address has changed within the last 12 months, or is different from the one we have on our records, we will need proof of your new address, for instance a recent original household bill showing the new address, e.g. phone, electricity, gas or water (a mobile phone bill is not acceptable).

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3 TO CLOSE YOUR BOND/PLAN

YOU MUST COMPLETE SECTION 3 OR 4

Tick here to surrender (sell) your ENTIRE bond/plan u speak to your financial adviser about possible tax consequences NOW GO TO SECTION 5

4 TO MAKE A WITHDRAWAL

• There are different tax implications depending on the method you choose below.

• There may be early encashment charges.

• The minimum withdrawal payment is £50.

• The minimum value to be kept in a bond/plan to keep it open, after a withdrawal is made, is £501.

NOTE

NOW GO TO SECTION 5

NOW GO TO SECTION 5

SELECT THE METHOD FOR WITHDRAWAL

FULL SURRENDER OF INDIVIDUAL POLICIES

Complete ONE of the following three options

PARTIAL SURRENDER FROM ALL POLICIES

u not available for TSP or the SLP

u for MIPs this option is only available at the review date and provided premiums have been paid

OR

(A)

(Ai)

(B)

I want to sell the following individual policies:

u state the policy numbers, e.g. 1-20

I want to withdraw:

by selling from each policy, proportionally across the funds within the policies.

Investment Bonds only - If, including this withdrawal, you are taking more than 10% of the total contributions into the bond, and your bond has additional life cover we can:

• leave the cover at the current level

• reduce the cover by the same proportion as the total withdrawn in the current bond year

• reduce the cover by a different amount – please contact us for a projection on 0800 171 2600

Complete as applicable:

1. Please leave the cover at its current level

2. Please reduce my life cover by the same proportion as the total withdrawn, as detailed above

3. I have seen a projection and would like to reduce my cover to:

£

u If left blank, we will assume option 1.

OR

I want to sell individual policies to withdraw:

u We will calculate the number of policies to sell to raise at least this sum, based on the last known prices for your funds. If the sale prices are then higher on the day we sell the policies, it could mean that you receive more than requested; however, if the prices are lower on that day, it could mean that you receive less than requested.

However, if you want us to raise the EXACT AMOUNT shown, tick here

u We will then calculate the number of policies to sell and, if the sale of the policies does not raise the sum required, we will meet the shortfall by selling from each remaining policy (proportionally across the funds within the policies).

NOW GO TO SECTION 5

£

RE0131/220-0131/March 2020

(Aii)

£

u available for Investment Bonds only

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5 PAYEE DETAILS

Complete this section to tell us whom to pay (see the accompanying Questions and Answers for guidance). We will assume option i) if you do not state otherwise. u If there is more than one payee, please indicate how the proceeds are to be split (either as a percentage of the total proceeds or as a monetary amount).

(i) Pay the plan holder(s) u this includes payment to trustees as a whole and pension scheme trustees % OR £

(ii) Pay a beneficiary

• Beneficiaries must be at least 18 years old.

• If payment is to be made to more than two beneficiaries, please provide the same details for each additional beneficiary by using copies of this page; additional pages must be signed by those signing in section 7.

Please enclose proof of each beneficiary’s identification, as outlined in the checklist on page 6.

% OR £

1 Beneficiary’s full name

% OR £

2 Beneficiary’s full name

Beneficiary’s address

Beneficiary’s date of birth

/ /

(iii) Pay the following financial institution, financial adviser or solicitor u payment will be made into the payee’s Client Money Account

% OR £

Payee’s address

Payee’s name

Beneficiary’s address

Postcode

Beneficiary’s date of birth

/ /

RE0131/220-0131/March 2020

Postcode

Postcode

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7 AUTHORITY AND SIGNATURE(S)

The declaration and personal data statement are made by each person authorising the withdrawal/closure. I hereby:(a) authorise and request ReAssure to carry out the instructions detailed on this form(b) confirm that you have brought to my attention the importance of reading the accompanying ‘Questions and Answers’ before completing the form(c) (if not a trustee) confirm that I am entitled to the legal and beneficial interest in the investments to be sold

(if a trustee) confirm that no notice of assignment or mortgage affecting any beneficial interest has been received by the trustees(d) confirm that there is no bankruptcy order against the plan holder or beneficiary (if applicable)(e) confirm that the plan holder, or beneficiary (if applicable), is not an undischarged bankrupt and/or not deemed to be insolvent in accordance

with the meaning of the Insolvency Act 1986 or Enterprise Act 2002(f) (if payment is being made to a beneficiary) confirm that the beneficiary is entitled to receive payment under the terms of the trust(g) confirm that payment to the payee in section 5 will discharge ReAssure from all liabilities and claims arising from this transaction(h) accept that the instructions in this form will be carried out under the Terms and Conditions of the bond/plan.(i) I confirm that I have seen and read the privacy notice at www.reassure.co.uk/privacy-notice.

For trust investments, if the trustees signing this form differ from those we have on our records, we will need to see all trust documents showing the trustee changes before we carry out the request. The documents can be the originals, or copies certified as true copies, for example by your financial adviser or a solicitor.

6 PAYEE’S BANK DETAILS

If you selected options i), ii) or iii) in section 5, you must complete this section with the payee’s bank details.

Bank or building society name and address u must be in the UK

u if there is more than one payee, please use copies of this page to provide their bank details; additional pages must be signed by those signing in section 7.

Postcode

Branch sort code

– –

Name of account holder u the payee

Building society roll number u if applicableBank/Building society account number

RE0131/220-0131/March 2020

• We will only send a cheque in exceptional circumstances; see Q3 in the accompanying Questions and Answers.NOTE

1. Signature Date D D M M Y Y

Print full name Capacity e.g. plan holder, trustee, signatory

Capacity e.g. plan holder, trustee, signatory

Capacity e.g. plan holder, trustee, signatory

Capacity e.g. plan holder, trustee, signatory

2. Signature Date D D M M Y Y

Print full name

3. Signature Date D D M M Y Y

Print full name

4. Signature Date D D M M Y Y

Print full name

u�Continue on a separate sheet if there is insufficient space here for all signatures

If we are paying plan holders, trustees or beneficiaries, we will need to see proof of the bank account ownership, if not already provided. Q4 in the Questions and Answers document explains what proof we can accept.

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CHECKLIST

Before you send us this form, make sure you have:

read the accompanying Questions and Answers

completed all applicable sections in the form

signed the form in section 7 and any additional pages to support sections 5 and 6

included any additional documents required (see Q4 in the accompanying Questions and Answers), for example: • Proof of your residential address if it has changed within the last 12 months or it is different from the address we have on our records. • Proof of identification for all bond/plan holders and any parties linked to the investment (e.g. attorneys, trustees or trust beneficiaries who

are receiving payment). • Proof of the bank account ownership. • Trust documents.

www.reassure.co.ukReAssure Life Limited, Registered Office: Windsor House, Telford Centre, Telford, Shropshire, TF3 4NB. Registered in England No. 1363932. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Firm reference number 110462.

RE0131/220-0131/March 2020

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WITHDRAWAL/CLOSURE FORMQUESTIONS AND ANSWERS

These are for you to keep; please read them before completing and sending your instruction to us.

1. Are there any tax implications if I make a withdrawal?

! Yes – the information below is also on page 1 of the form but it is important that you understand it:

• There are two ways to make a withdrawal from a life assurance bond/plan:

- FULL surrender of individual policies

- PARTIAL surrender from all policies

and there are different tax implications depending on the method you choose.

The following website contains guidance from HMRC: www.gov.uk/government/publications/gains-on-uk-life-insurance-policies-hs320-self-assessment-helpsheet

• WE CANNOT ADVISE YOU WHICH METHOD IS BEST FOR YOUR PERSONAL CIRCUMSTANCES.

• HMRC rules do not permit us to amend the basis on which a withdrawal was completed if the tax consequences were not what you expected.

We strongly recommend that you consult your financial adviser before making a decision to surrender from your bond.

2. Are there any early encashment charges? Not for the following products: TSP, MIP, PPP, SEP and SLP. For other products there could be early encashment charges; however they vary by product and can depend on the length of time you have held the

bond/plan. Details will be in your product terms and conditions. If you require more information, please contact us using the details shown in in Q10.

3. How long does it take to receive my money? We normally release the money within five working days of receiving an acceptable instruction (excluding the time it takes for the payment to reach

the bank). Payments will be made to a UK bank account* using BACS, whereby the money reaches the bank account three to five working days after it leaves us.

* We will send a cheque if we are unable to send payment to the bank for any reason. Cheques will then be payable to all bond/plan holders/trustees jointly if we are unable to pay the nominated payee.

4. Do you require anything in addition to this form? • Proof of your residential address if it is different from the address we have on our records. For example an original household bill (e.g.

phone, electricity, gas or water) dated within the last six months (mobile phone bills are not acceptable) • Proof of identification if not already provided by you or your financial adviser, for all bond/plan holders and any parties linked to the

investment (e.g. attorneys, trustees or trust beneficiaries who are receiving payment). Please enclose either a passport or a photo-card driving licence – either the original or a certified copy*.

• Proof of the bank account ownership If the money is going to the plan holder(s), trustees or beneficiaries. The proof can be an original or certified* copy of a voided cheque or bank account statement dated within the last six months. If you have online bank account statements, a printed copy certified* by your adviser as a true copy will suffice. For a trustees account the statement or void cheque must include the trustees names. If this isn’t included, we will ask for a letter from the bank to confirm the trustees names.

• For trust investments, if the trustees signing the form differ from those we have on our records, we will need to see all trust documents showing the trustee changes before we can carry out the request.

* Copies must be certified on each page in ink by a UK-based professional such as your financial adviser, solicitor, accountant, GP or bank manager (including the bank’s stamp). We cannot accept photographs of documents.

5. What happens if there’s a problem with my request? If, in our view, your instruction is not clear, we will be unable to proceed and we will typically contact you or your financial adviser. This could delay

your request.

6. Are there any limits when withdrawing from my bond/plan? • The minimum withdrawal payment is £50. • The minimum value to be kept in a bond/plan to keep it open after a withdrawal is made is £501.

RE0131/220-0131/March 2020

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www.reassure.co.ukReAssure Life Limited, Registered Office: Windsor House, Telford Centre, Telford, Shropshire, TF3 4NB. Registered in England No. 1363932. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Firm reference number 110462. RE0131/220-0131/March 2020

GLOSSARY/DEFINITION OF TERMS

QUESTIONS AND ANSWERS continued

7. Who can be paid the proceeds? • You, the plan holder – the payee will ordinarily be you, the plan holder; this is therefore the first option shown on the form. • Trustees – payments can be made to a trustee(s) into a UK bank account held in their capacity as trustee (e.g. Trustee of the John Smith Will

Trust); this is Option i) on the form in section 5. If there is no trustee bank account, please contact us. • Beneficiary of a Trust – we can pay a beneficiary provided he/she is at least 18 years old and we have proof of the beneficiary’s identity.

Payments will only be made to an account of a UK financial institution held in the name of the beneficiary. • A ‘Client Money Account’ – we can make payment to a ‘client money account’ of a financial institution, a financial adviser or a solicitor

provided they are authorised to handle client money. • Payment to another ReAssure Product – If you want to transfer the proceeds to invest in another of our products, you must submit your

application for that product at the same time as the withdrawal/closure form. There could be restrictions concerning the name in which the new product is held; you should therefore check with your financial adviser before choosing this option.

Please note that we will refer to the name of the plan holder or beneficiary on any payments we make.

8. Who has to sign the form?

• All plan holders including trustees and/or assignees (where applicable) must sign the form, as well as any additional pages sent to support sections 5 and 6.

9. What is required if the form is being signed by an attorney?

• The attorney must add ‘as attorney’ after his/her signature. • We need to see the original Power of Attorney, if not already sent to us. We can also accept a copy provided it is certified as a true copy of the

original, in ink on each page by a solicitor. • We also need proof of the attorney’s identification if not already provided (for details of what we can accept as proof, see Q4).

10. Will any further mortality charges (if applicable) be deducted?

• Mortality charges are taken when the sum assured exceeds the value of the plan/bond. To avoid further mortality deductions being taken from the encashment value on the 15th of each month, we need to receive the Withdrawal/Closure form and any additional requirements by 10am at least 2 working days before the 15th.

11. What if I have more questions?

Your financial adviser should be your first point of contact. However, if you would like to speak to us, please call our Customer Service Centre Freephone number on 0808 171 2600 or email us at ask@reassurelife.co.uk.

Some of the terms we use in the withdrawal/closure form are explained below:

BACS Bankers’ Automated Clearing System. This is the method we ordinarily use to make direct, electronic payments to banks.

Beneficial interest The right to benefit from a contract or trust. A beneficiary will have beneficial interest, unlike a trustee who has responsibility to hold the property in trust, but does not benefit from it.

Beneficiary Anyone who is entitled to receive assets or profits from property, for example an estate, a trust, or an insurance policy.

Client Money Account An account in which a company is authorised by the Financial Conduct Authority (FCA) to receive or hold money on behalf of a client. The money is then governed by specific rules issued by the FCA.

Early encashment charges Charges imposed for selling investments. Details will be in the Key Features Document and Terms & Conditions for the product.

Financial institution An organisation such as a bank.

Plan holder References to ‘plan holder’ in the withdrawal/closure form mean the bond/plan holder.

Surrender A full surrender will close the individual policy(ies) selected and sell all units in the policy(ies) concerned. A partial surrender (also known as a partial withdrawal) means that units will be sold across all policy(ies) in your bond.

Trustees Those who are holding property in trust on behalf of someone else.

ReAssure PO Box 37 Old Mutual House Portland Terrace Southampton SO14 7AY T: 0808 171 2600