SIPP Dealing Account Application The SIPP Trustee and SIPP Administrator (if different) must complete and sign Sections A and E of this application form. The SIPP Member (the underlying beneficiary) must complete and sign Sections B and F. Where the SIPP Member wishes to appoint a third party to manage the SIPP Dealing account (a SIPP Manager), a separate Third Party Authorisation Form must be completed, to be signed by all parties to this application. Where no separate SIPP Manager is appointed, the SIPP Member will automatically be deemed to be the SIPP Manager. If the application relates to a SIPP account held on behalf of a minor, the person who will control the account should complete Sections B, D and F. Please see Section G for definitions of all of the roles mentioned. On acceptance of this application the SIPP Trustee, SIPP Administrator and SIPP Member (or person acting on behalf of a minor) will each be subject to Selftrade’s Terms and Conditions (the “Terms and Conditions”). Please complete all fields in this form (where applicable).
Section A
SIPP trustee and SIPP Administrator’s details
SIPP Trustee
SIPP Administrator
Name Address
Postcode Contact Person(s) Phone Number Email Address HM Revenue & Customs Ref. SIPP Plan Ref. Scheme Name (if applicable) All assets within the SIPP Dealing Account will be held on behalf of the SIPP Trustee (as the legal owner) in the name of our nominee as provided in our Terms and Conditions. Monies will only be accepted and remitted in accordance with the SIPP Trustee and/or SIPP Administrator’s instructions. The SIPP Trustee and SIPP Administrator may receive details of transactions and corporate actions although we will act upon the instructions of the SIPP Member or the SIPP Manager.
NOV/14
Section B
Member’s Details (or the person controlling the account for the minor whose details are shown in section D)
Selftrade Account Number (if applicable) Title
Mr X
Mrs X
Miss X
Ms X
Other
Last Names First Name(s) Date of Birth
D
D
M
M
Y
Y
Y
Y
Town and Country of Birth Nationality Dual Nationality (if applicable) Permanent Home Address
House no
Postcode
Home Telephone Number Mobile Telephone Number Work Telephone Number Email Address (1) Email Address (2) National Insurance Number
I have no National Insurance Number
Additional Country of tax residence (1) Taxpayer Identification Number (1) Additional Country of tax residence (2) Taxpayer Identification Number (2) Are you a United States Green Card holder?
Yes
X
No
X
X
Section C
Contract Notes and Alert Preferences
Does your employer need copies of your contract notes?
Yes
No
X
X
If so, please provide your employee details (including contact name, office address and postcode)
We may wish to offer you other products. If you do not wish us to do so, please tick the box.
X
We can send email or text message alerts to let you know when there are important secure messages in your inbox. Please indicate below if you would like to receive alerts, and ensure you have provided a valid email address and/or mobile number in Section A.
Section D Title
Email
Text Message
X
Child’s Details (if applicable) Master X
X
Miss
Last Name First Name(s) Date of Birth
D
D
M
M
Y
Y
Y
Y
If child’s address is different from the SIPP Member’s: Permanent Home Address Address
House no
Postcode
X
Section E
SIPP Trustee and SIPP Administrator’s declaration
We confirm that we are respectively the SIPP Trustee and SIPP Administrator acting on behalf of the SIPP Member detailed in Section B or, where applicable, Section D of this form. We confirm that we have received and agree to be bound by the Terms and Conditions. Please open a SIPP Dealing Account for the SIPP Trustee (which the SIPP Trustee will hold as trustee in respect of the SIPP Member). We each agree to be bound by the Terms and Conditions, as they apply to SIPP Trustees and SIPP Administrators respectively. We understand that Selftrade will treat the SIPP Trustee and no other person as its “client” for the purposes of the rules of the Financial Conduct Authority (FCA). We accept that you may in your absolute discretion decline this application without giving reasons and we acknowledge that Selftrade offers an execution-only investment service.
SIPP Trustee
SIPP Administrator
Signature(s)
Name(s) and Position
On behalf of D
Date
D
M
M
Y
Y
Y
Y
D
D
M
M
Y
Y
Y
Y
Unless already provided to us, please enclose: Trustee / Administrator identification, a copy of your latest annual Companies House return and your Certificate of Incorporation.
Section F
SIPP Member’s Declaration and Consent
Please read this section carefully before signing the Declaration I declare that the information I have provided on this form is, to the best of my belief, true. I accept that you may in your absolute discretion decline this application without reason being given. I acknowledge that Selftrade provides an execution-only investment service. I understand that Selftrade provides the SIPP Dealing Account to the SIPP Trustee as its client. I confirm that I have received and agree to be bound by the Terms and Conditions as they apply to SIPP Members. I declare that the SIPP Trustee and SIPP Administrator detailed in Section A of this form will act respectively as the SIPP Trustee and SIPP Administrator of my SIPP and that I have undertaken to invest within HM Revenue & Customs regulations. By signing I consent to you holding and using my information for the purposes set out in the Terms and Conditions.
Signature Date D
D
M
M
Y
Y
Y
Y
Selftrade may, from time to time, send you information regarding new products and promotions: if you prefer not to be informed of these please tick this box X
Where did you hear about us? Recommendation
X
Magazine
X
Outdoor poster
X
Internet Advert
X
Newspaper
X
Search Engine
X
Other
Section G
Notes
Account number and PIN: An account number and PIN will be issued to the SIPP Member. No separate PIN or account number will be issued by Selftrade to the SIPP Manager. You are reminded that, notwithstanding any disclosure to the SIPP Manager (where appointed) of your account number, PIN or any other personal details, you are, and continue to be, responsible for the confidentiality and use of them. In the event you cancel a SIPP Manager authority, i.e. if you cancel or change a SIPP Manager, you are reminded to change your PIN. Contract Notes and statements: Contract notes, statements and other confirmations relating to this SIPP Dealing account will, in accordance with the Terms and Conditions, be sent to the SIPP Member (and not the SIPP Manager). Definitions: In this form, ‘SIPP Administrator’ means the person(s) responsible for the maintenance and running of the SIPP; ‘SIPP Manager’ means the person appointed as such by the SIPP Trustee and the SIPP Member; ‘SIPP Member’ means the individual who has beneficial ownership of pension assets belonging to the SIPP in respect of whom the SIPP Trustee has opened the SIPP Dealing Account; and ‘SIPP Trustee’ means the person in whose name the SIPP Dealing Account is opened and who is the legal owner of the assets in the SIPP, which it holds until benefits are paid out. ‘We’, ‘Selftrade’, ‘us’ and ‘our’ means Selftrade which is a trading name licensed to Equiniti Financial Services Limited. Terms and conditions: Selftrade’s Terms and Conditions are available at www.selftrade.co.uk/important-information. Printed copies are available upon request. Supporting documentation required to verify your identity Child SIPPs Please include an original or certified copy of the child’s birth certificate. See below for certified copy requirements. Existing Selftrade customers (SIPP Member) Please indicate your account number in Section B. You do not need to provide any supporting documentation. New Selftrade customers (SIPP Member) We are required by law to confirm the identity of all individuals using our service. In order to help us establish your identity we will require two documents, one from each of the lists below. Both documents must show your full name and, between the two documents, must also evidence your date of birth and current residential address. Please note we are unable to accept documents which only show initials. Copies of any documents you provide will be retained by us and any original documents will be returned to you at the earliest opportunity. For primary documents in List A below, if you do not wish to send us the original document, you must send a copy which is certified to be a true copy of the original by a government department or an entity regulated by the Financial Conduct Authority (e.g. a bank). The person undertaking the certification must provide their contact details and you must advise them that we may contact them to validate their certification and/or conduct searches of electronic databases to validate their own identity. For supporting documentary evidence in List B, only original documents will be accepted. • Current full UK/EEA driving licence
• A second item from List A
• Current full signed passport
• Most recent HM Revenue & Customs tax notification (not a P45 or P60).
• Current EEA member state identity card
• Bank/building society/credit union statement or pass book – less than 3 months old • Utility bill or statement (not mobile phone) – less than 3 months old • Local authority council tax bill (valid for the current year) • Signed documentation from a regulated financial services firm which indicates a current relationship with the firm exists.
Checklist Sipp Member
X
SIPP Trustee/ Administrator
X
Ensure you have completed and signed sections B and F and, if appointing a SIPP Manager, completed and enclosed the Third Party Authorisation form. Check that all documentation, as shown in ‘notes’ above, is enclosed. Where your application relates to a minor, ensure you have completed section D and enclosed the documentation referred to above. Ensure you have completed and signed sections A and E. Check that the documents, as listed at the end of Section E, are forwarded with this application.
Next Steps Please return this form to: Account Management, Selftrade, PO Box 4923, Worthing, BN99 6SF Existing Customers We will notify you when your account has been opened. Your existing account number and PIN will enable you to access your new account. New Customers We will send you a welcome letter with your account number and other information about using the service. For security purposes we will send your PIN (Personal Identification Number) separately. We will also return your original supporting documentation under separate cover. If your application is unsuccessful we will return your documentation and cheque (if applicable).
Selftrade® is a trading name licensed to Equiniti Financial Services Limited whose registered office is Aspect House, Spencer Road, Lancing, West Sussex BN99 6DA. Equiniti Financial Services Limited is part of the Equiniti Group. Investment and general insurance services are provided through Equiniti Financial Services Limited, which is registered in England & Wales with No. 6208699 and is authorised and regulated by the UK Financial Conduct Authority. Equiniti Financial Services Limited is a member firm of the London Stock Exchange.
