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Documents

Title	Description	Insurer	Market	Language	Regime	Process	Excerpt
Utmost Worldwide Source of Wealth Questionnaire	Source of Wealth Questionnaire for providing details of a client’s wealth (for high risk clients/clients subject to enhanced due diligence). This questionnaire seeks to obtain information and documentation to establish the source of wealth for Utmost Worldwide Limited clients.	Hong Kong (HK), Singapore (SG), Switzerland (CH)	Utmost Worldwide	English (EN)	FOS	Making a change to your policy, New Policy	Source of Wealth Questionnaire for providing details of a client’s wealth (for high risk clients/clients subject to enhanced due diligence). This questionnaire seeks to obtain information and documentation to establish the source of wealth for Utmost Worldwide Limited clients. Operational Forms Utmost Worldwide Source of Wealth Questionnaire UWWS PR 00123
Current Financial Information Request Form	Current Financial Information Request Form for use with a Utmost Worldwide policy, to confirm your current taxation status, residence, and financial information.	Hong Kong (HK), Rest of the World, Singapore (SG), Switzerland (CH), United Kingdom (UK)	Utmost Worldwide	English (EN)	FOS	Making a change to your policy, New Policy	Current Financial Information Request Form for use with a Utmost Worldwide policy, to confirm your current taxation status, residence, and financial information. Operational Forms Current Financial Information Request Form UWWS PR 00119
Client Information and Change of Details Form	This form is intended for Utmost Worldwide Limited customers who wish to inform us of any changes to their personal details, such as name, specimen signature, address, email address or telephone number.	Hong Kong (HK), Rest of the World, Singapore (SG), Switzerland (CH), United Kingdom (UK)	Utmost Worldwide	English (EN)	FOS	Making a change to your policy	This form is intended for Utmost Worldwide Limited customers who wish to inform us of any changes to their personal details, such as name, specimen signature, address, email address or telephone number. Operational Forms Client Information and Change of Details Form UWWS PR 00106
Online Service Centre Registration (as an individual) Request (International)	This form should be used were you want to register (as an Individual) for access the Utmost Worldwide Online Service Centre (International)	Rest of the World	Utmost Worldwide	English (EN)	FOS		This form should be used were you want to register (as an Individual) for access the Utmost Worldwide Online Service Centre (International) Operational Forms Online Service Centre Registration (as an individual) Request (International) UWWS PR 00045
Online Service Centre Registration as Trustee Request (International)	This form is to be used to register for Trustee access our Online Service Centre (International)	Rest of the World	Utmost Worldwide	English (EN)	FOS		This form is to be used to register for Trustee access our Online Service Centre (International) Operational Forms Online Service Centre Registration as Trustee Request (International) UWWS PR 00044
Online Service Registration for Adviser Form	Online Service Registration Form should be used by Advisers/Managers in the global market to request access to the Utmost Worldwide Limited’s Online Service Centre.	Hong Kong (HK), Rest of the World, Singapore (SG)	Utmost Worldwide	English (EN)	FOS		Online Service Registration Form should be used by Advisers/Managers in the global market to request access to the Utmost Worldwide Limited’s Online Service Centre. Operational Forms Online Service Registration for Adviser Form UWWS PR 00043
Registration Request Form for the Online Service Centre (Singapore)	Registration Request Form to gain access to Utmost Worldwide Limited’s Online Service Centre, for individual applicants in the Singapore market	Singapore (SG)	Utmost Worldwide	English (EN)	FOS	Making a change to your policy, New Policy	Registration Request Form to gain access to Utmost Worldwide Limited’s Online Service Centre, for individual applicants in the Singapore market Operational Forms Registration Request Form for the Online Service Centre (Singapore) UWWS PR 00019
Transferring Assets to Your Bond/Account	Please use this form when transferring assets to your Plan/Bond/Policy. For use withformer Quilter International Products, not for use in Hong Kong.	Europe Expat, Rest of the World, Singapore (SG), Spain (ES), Sweden (SE), United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy, New Policy	Please use this form when transferring assets to your Plan/Bond/Policy. For use withformer Quilter International Products, not for use in Hong Kong. Operational Forms Transferring Assets to Your Bond/Account UWSQ PR 25131
Request Remuneration to Your Financial Adviser	Please use this form to pay an ongoing service fee or ongoing service charge to your financial adviser. For use withformer Quilter International Products only.	Rest of the World, Singapore (SG), United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy, New Policy	Please use this form to pay an ongoing service fee or ongoing service charge to your financial adviser. For use withformer Quilter International Products only. Operational Forms Request Remuneration to Your Financial Adviser UWSQ PR 25129
Doing business with Utmost International – Electronic Submissions in UK	The processes highlighted in this document apply to Utmost International Isle of Man Limited and Utmost PanEurope dac.	United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	New Policy	The processes highlighted in this document apply to Utmost International Isle of Man Limited and Utmost PanEurope dac. Operational Forms Doing business with Utmost International – Electronic Submissions in UK UWSQ PR 25126
Deferring a Policy Fund Entitlement	This form needs to be completed when a client requests to change their Policy Fund entitlements.	Middle East, Rest of the World, United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy	This form needs to be completed when a client requests to change their Policy Fund entitlements. Operational Forms Deferring a Policy Fund Entitlement UWSQ PR \| 25162
Additional Loan Agreement and Acknowledgement of Receipt of Loan by Trustees	This agreement is for use with the existing Loan Trusts offered by Utmost International.	United Kingdom (UK)	Utmost Wealth Solutions	English (EN)		New Policy	This agreement is for use with the existing Loan Trusts offered by Utmost International. Operational Forms Additional Loan Agreement and Acknowledgement of Receipt of Loan by Trustees UWSQ PR \| 25103
Portfolio Bond Minimum Residual Value	Published minimum residual values as at February 2021	Europe Expat, Hong Kong (HK), Middle East, Singapore (SG), Sweden (SE), United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	New Policy	Published minimum residual values as at February 2021 Operational Forms Portfolio Bond Minimum Residual Value UWSQ PR \| 21018
Appointing a Fund Adviser	This form can be used with Utmost International Isle of Man Limited orUtmost PanEurope dac a range of portfolio bonds available in all regions (except Hong Kong).	Middle East, Singapore (SG)	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy	This form can be used with Utmost International Isle of Man Limited orUtmost PanEurope dac a range of portfolio bonds available in all regions (except Hong Kong). Operational Forms Appointing a Fund Adviser UWSQ PR \| 20985
Appointing an Authorised Custodian – Wealth bond	Please use this form to request Utmost International Isle of Man Limited or Utmost PanEurope dac to appoint an authorised custodian. This form is only for use with the International Wealth Bond or European Wealth Bond.	United Kingdom (UK)	Utmost Wealth Solutions	English (EN)		Making a change to your policy	Please use this form to request Utmost International Isle of Man Limited or Utmost PanEurope dac to appoint an authorised custodian. This form is only for use with the International Wealth Bond or European Wealth Bond. Operational Forms Appointing an Authorised Custodian – Wealth bond UWSQ PR \| 20951
Request to Restrict Assets – Wealth Bond	Please use this form if you wish to request Utmost International Isle of Man Limited or Utmost PanEurope dac to restrict the assets to a International Wealth Bond or European Wealth Bond.	United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	New Policy	Please use this form if you wish to request Utmost International Isle of Man Limited or Utmost PanEurope dac to restrict the assets to a International Wealth Bond or European Wealth Bond. Operational Forms Request to Restrict Assets – Wealth Bond UWSQ PR \| 20912
Source of Wealth Questionnaire	This questionnaire seeks to obtain information and documentation from the adviser to establish the source of wealth of high-risk clients of Utmost International Isle of Man Limited and Utmost PanEurope dac	Not country specific	Utmost Wealth Solutions	English (EN)	FOS	Addition to your Policy, New Policy	This questionnaire seeks to obtain information and documentation from the adviser to establish the source of wealth of high-risk clients of Utmost International Isle of Man Limited and Utmost PanEurope dac Operational Forms Source of Wealth Questionnaire UWSQ PR \| 20888
Digital Signature Application Form – Non UK	Digital signature application form – not for use in the UK	Europe Expat, Middle East, Rest of the World, Singapore (SG)	Utmost Wealth Solutions	English (EN)	FOS	New Policy	Digital signature application form – not for use in the UK Operational Forms Digital Signature Application Form – Non UK UWSQ PR \| 20815
Request to Add or Remove a Life Assured Form	This form can be used to add or remove a life assured on your Utmost International Portfolio Bond.	Europe Expat	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy	This form can be used to add or remove a life assured on your Utmost International Portfolio Bond. Operational Forms Request to Add or Remove a Life Assured Form UWSQ PR \| 20814
Letter of authorisation for Authorised Custodian Account Form	This letter of authorisation permits an authorised third-party individual to make investment decisions in respect of the accounts opened by Utmost International Isle of Man Limited or Utmost PanEurope dac. with the authorised custodian.	Europe Expat, Middle East, Singapore (SG), United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy	This letter of authorisation permits an authorised third-party individual to make investment decisions in respect of the accounts opened by Utmost International Isle of Man Limited or Utmost PanEurope dac. with the authorised custodian. Operational Forms Letter of authorisation for Authorised Custodian Account Form UWSQ PR \| 20660
Data Subject Access Request Form	This form is for you, or someone you have authorised to represent you, to request a copy of the personal information we hold for you.	United Kingdom (UK)	Utmost Wealth Solutions	English (EN)		Making a change to your policy	This form is for you, or someone you have authorised to represent you, to request a copy of the personal information we hold for you. Operational Forms Data Subject Access Request Form UWSQ PR \| 18031
Authorised Custodian Internet Service Request Form	This form can be used to request access to the view only internet service provided by the authorised custodian.	Europe Expat, Middle East	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy	This form can be used to request access to the view only internet service provided by the authorised custodian. Operational Forms Authorised Custodian Internet Service Request Form UWSQ PR \| 17990
Portfolio Bond Transaction Account Overdraft Limit	The published overdraft limit of transaction accounts for applicable portfolio bonds.	Europe Expat, Hong Kong (HK), Middle East, Rest of the World, Singapore (SG), Sweden (SE), United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	New Policy	The published overdraft limit of transaction accounts for applicable portfolio bonds. Operational Forms Portfolio Bond Transaction Account Overdraft Limit UWSQ PR \| 14355
Portfolio Bond Withdrawal / Surrender Form	Surrender and Withdrawal Request Form for Portfolio Bond	Europe Expat, Hong Kong (HK), Middle East, Rest of the World, Singapore (SG), Sweden (SE), United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	Surrender or Claim	Surrender and Withdrawal Request Form for Portfolio Bond Operational Forms Portfolio Bond Withdrawal / Surrender Form UWSQ PR \| 13485
Failed Regular Withdrawal Form	This form is to be completed where a regular withdrawal has not been paid due to insufficient value in the nominated asset.	Singapore (SG)	Utmost Wealth Solutions	English (EN)		New Policy	This form is to be completed where a regular withdrawal has not been paid due to insufficient value in the nominated asset. Operational Forms Failed Regular Withdrawal Form UWSQ PR \| 12576
Tax Declaration and Self Certification for Entity Investors	For Use with Utmost Worldwide, Utmost PanEurope and Utmost International Isle of Man products. You have been asked to complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for Entity investors such as, companies, corporate trusts or foundations.	Finland (FI), France (FR), Hong Kong (HK), Italy (IT), Mexico (MX), Middle East, Portugal (PT), Singapore (SG), Spain (ES), Sweden (SE), Switzerland (CH), United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy, New Policy	For Use with Utmost Worldwide, Utmost PanEurope and Utmost International Isle of Man products. You have been asked to complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for Entity investors such as, companies, corporate trusts or foundations. Operational Forms Tax Declaration and Self Certification for Entity Investors UWSQ PR \| 12415
Tax Declaration and Self Certification for Individual Investors	For Use with Utmost Worldwide, Utmost PanEurope and Utmost International Isle of Man products. You have been asked to complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders, persons authorised to sign on behalf of the policyholder, for example their Power of Attorney or court appointed Deputy, and individuals linked to the trust where Utmost International Trustee Solutions Limited are the appointed trustee.	ASIA, Europe Expat, Finland (FI), France (FR), Germany (DE), Hong Kong (HK), Italy (IT), Mexico (MX), Middle East, Peru (PE), Portugal (PT), Singapore (SG), Spain (ES), Sweden (SE), Switzerland (CH), United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	Addition to your Policy, Making a change to your policy, New Policy, Surrender or Claim	For Use with Utmost Worldwide, Utmost PanEurope and Utmost International Isle of Man products. You have been asked to complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders, persons authorised to sign on behalf of the policyholder, for example their Power of Attorney or court appointed Deputy, and individuals linked to the trust where Utmost International Trustee Solutions Limited are the appointed trustee. Operational Forms Tax Declaration and Self Certification for Individual Investors UWSQ PR \| 12373
Request for Utmost to Appoint a new/additional Discretionary Asset Manager	This form should be used for International Wealth Bond or European Wealth Bond policyholders only, who would like to change their discretionary asset manager. This form should be used where you have not requested Quilter International to restrict the asset range.	United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy	This form should be used for International Wealth Bond or European Wealth Bond policyholders only, who would like to change their discretionary asset manager. This form should be used where you have not requested Quilter International to restrict the asset range. Operational Forms Request for Utmost to Appoint a new/additional Discretionary Asset Manager UWSQ PR \| 12370
Amendment to Wealth Interactive, Policyholder Online Service Terms	This form allows Trustee Policyholders to request online access for their Clients/Members.	Singapore (SG)	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy	This form allows Trustee Policyholders to request online access for their Clients/Members. Operational Forms Amendment to Wealth Interactive, Policyholder Online Service Terms UWSQ PR \| 11729
Amendment to Wealth Interactive, Policyholder Online Service Terms (Providing Limited Access)	This form allows Trustee Policyholders to request online access for their Clients/Members.	Singapore (SG)	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy	This form allows Trustee Policyholders to request online access for their Clients/Members. Operational Forms Amendment to Wealth Interactive, Policyholder Online Service Terms (Providing Limited Access) UWSQ PR \| 11544
Nominated asset for regular withdrawals	To ensure regular withdrawals are paid, you must select one or more asset from which the payment will be made. Alternatively, the Transaction Account can be selected to fund withdrawals. Please tick the appropriate box below	Europe Expat, Middle East, Singapore (SG), United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	New Policy	To ensure regular withdrawals are paid, you must select one or more asset from which the payment will be made. Alternatively, the Transaction Account can be selected to fund withdrawals. Please tick the appropriate box below Operational Forms Nominated asset for regular withdrawals UWSQ PR \| 10347
Deed of Absolute Appointment in Favour of one or more Discretionary Beneficiaries (Manx Law)	This deed is for guidance only and may be considered suitable where an Utmost International Isle of Man Limited orUtmost PanEurope dac discretionary trust subject to Manx Law has been used.	United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	New Policy	This deed is for guidance only and may be considered suitable where an Utmost International Isle of Man Limited orUtmost PanEurope dac discretionary trust subject to Manx Law has been used. Operational Forms Deed of Absolute Appointment in Favour of one or more Discretionary Beneficiaries (Manx Law) UWSQ PR \| 09637
Cheque Processing Form	This form is to be used when Wealth Interactive status is awaiting payment.	United Kingdom (UK)	Utmost Wealth Solutions	English (EN)		New Policy	This form is to be used when Wealth Interactive status is awaiting payment. Operational Forms Cheque Processing Form UWSQ PR \| 09466
Request to Appoint a Discretionary Asset Manager (on an Advisory or Discretionary Authority)	Please use this form to appoint a discretionary asset manager on an advisory or discretionary authority.	Europe Expat, Middle East, United Kingdom (UK)	Utmost Wealth Solutions	English (EN)		New Policy	Please use this form to appoint a discretionary asset manager on an advisory or discretionary authority. Operational Forms Request to Appoint a Discretionary Asset Manager (on an Advisory or Discretionary Authority) UWSQ PR \| 08887
Change of Financial Adviser	Please use this form if you wish to appoint a new or remove a financial adviser. If you remove a financial adviser this will stop all correspondence or information in respect of your policy going through that financial adviser.	Europe Expat, Hong Kong (HK), Middle East, Rest of the World, Singapore (SG), United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy	Please use this form if you wish to appoint a new or remove a financial adviser. If you remove a financial adviser this will stop all correspondence or information in respect of your policy going through that financial adviser. Operational Forms Change of Financial Adviser UWSQ PR \| 05271
Discounted Gift Trust Declaration of Continuing Good Health Form	This declaration should be completed by the settlor to confirm that their health has not changed since the date of the original application toUtmost Innternational Isle of Man Limited, Utmost International Trustee Solutions Limited orUtmost PanEurope dac.	United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy	This declaration should be completed by the settlor to confirm that their health has not changed since the date of the original application toUtmost Innternational Isle of Man Limited, Utmost International Trustee Solutions Limited orUtmost PanEurope dac. Operational Forms Discounted Gift Trust Declaration of Continuing Good Health Form UWSQ PR \| 04612
Intermediary Registration Application QINTL IOM and QII	Intermediary Registration Application IOM and QII – for non UK intermediaries only	United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	New Policy	Intermediary Registration Application IOM and QII – for non UK intermediaries only Operational Forms Intermediary Registration Application QINTL IOM and QII UWSQ PR \| 02230
Portfolio Bond Endorsement Request Form	This form can be used to endorse highly personalised bonds and bring into the UK regulations as well as reduce tax implications.	Europe Expat, Hong Kong (HK), Singapore (SG), Sweden (SE)	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy	This form can be used to endorse highly personalised bonds and bring into the UK regulations as well as reduce tax implications. Operational Forms Portfolio Bond Endorsement Request Form UWSQ PR \| 02013
Varallisuuden Lähde	Varallisuuden Lähde asiakkaan varallisuustietojen toimittamisesta	Finland (FI)	Utmost Wealth Solutions	Finnish (FI)	FOS	Making a change to your policy, New Policy	Varallisuuden Lähde asiakkaan varallisuustietojen toimittamisesta Operational Forms Varallisuuden Lähde UWS PR 00433
Utmost International Trustee Solutions Client Agreement Form	For use with trusts incorporating a settlor’s investment direction (including terms of business, current fee scales and client money information sheet).	Hong Kong (HK), Middle East, Rest of the World, Singapore (SG)	Utmost International Trustee Solutions Limited	English (EN)	FOS	New Policy	For use with trusts incorporating a settlor’s investment direction (including terms of business, current fee scales and client money information sheet). Operational Forms Utmost International Trustee Solutions Client Agreement Form UTSQ PR \| 05921
Utmost International Trustee Solutions Limited Client Agreement Form	This form is required to obtain information about an applicant’s tax status under Automatic Exchange of Information (AEOI) regulations, Utmost International.	United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	New Policy	This form is required to obtain information about an applicant’s tax status under Automatic Exchange of Information (AEOI) regulations, Utmost International. Operational Forms Utmost International Trustee Solutions Limited Client Agreement Form UTSQ PR \| 03482
Utmost International Trustee Solutions Discretionary Investment Manager Application Form	This form can be used to appoint a Discretionary investment manager to a bond in trust with Utmost International Trustee Solutions Limited	United Kingdom (UK)	Utmost International Trustee Solutions Limited	English (EN)	FOS	New Policy	This form can be used to appoint a Discretionary investment manager to a bond in trust with Utmost International Trustee Solutions Limited Operational Forms Utmost International Trustee Solutions Discretionary Investment Manager Application Form UTSQ PR \| 03409
Mutual Stipulations and Nomination Form Irish jointly Owned Products	This form should be used for policies subject to the laws of Belgium, Cyprus, Spain or Sweden. Complete this form if you are the policyholder and request for the mutual stipulations wording to be applied to your policy and also wish to nominate the beneficiary(ies) listed in the appointment of beneficiary(ies) for your policy.	Belgium (BE), Cyprus (CY), Spain (ES), Sweden (SE)	Utmost PanEurope	English (EN)	FOS	Making a change to your policy	This form should be used for policies subject to the laws of Belgium, Cyprus, Spain or Sweden. Complete this form if you are the policyholder and request for the mutual stipulations wording to be applied to your policy and also wish to nominate the beneficiary(ies) listed in the appointment of beneficiary(ies) for your policy. Operational Forms Mutual Stipulations and Nomination Form Irish jointly Owned Products UPEQ PR \| 21042
UPE Declaration of Residence Outside of Ireland	Utmost PanEurope Policyholders resident outside of Ireland must make the declarations contained in this form in order to receive payments without the deduction of Irish tax if they hold a policy issued by an Irish insurer.	Europe Expat, Rest of the World, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	Making a change to your policy, Surrender or Claim	Utmost PanEurope Policyholders resident outside of Ireland must make the declarations contained in this form in order to receive payments without the deduction of Irish tax if they hold a policy issued by an Irish insurer. Operational Forms UPE Declaration of Residence Outside of Ireland UPEQ PR \| 20900
French Executive Portfolio Appointment of Fund Adviser Form	This form can be used if you wish to appoint a firm to act as a discretionary fund advisor on your French Executive Portfolio.	Europe Expat	Utmost PanEurope	English (EN)		Making a change to your policy	This form can be used if you wish to appoint a firm to act as a discretionary fund advisor on your French Executive Portfolio. Operational Forms French Executive Portfolio Appointment of Fund Adviser Form UPEQ PR \| 20844
French Executive Portfolio Withdrawal/Closure Form	This form can be used to request a withdrawal or closure of policy from the French Executive Portfolio.	Europe Expat	Utmost PanEurope	English (EN)	FOS	Surrender or Claim	This form can be used to request a withdrawal or closure of policy from the French Executive Portfolio. Operational Forms French Executive Portfolio Withdrawal/Closure Form UPEQ PR \| 20786
French Executive Portfolio – Clause bénéficiaire démembrée avec quasi-usufruit	Please use this form if your client would like to nominate a beneficiary using a clause bénéficiaire démembrée specific to French law	France (FR)	Utmost PanEurope	French (FR)	FOS	New Policy	Please use this form if your client would like to nominate a beneficiary using a clause bénéficiaire démembrée specific to French law Operational Forms French Executive Portfolio – Clause bénéficiaire démembrée avec quasi-usufruit UPEQ PR \| 20688
Payment Instruction Form	This form is for use with Utmost PanEurope dac. Omega and Integra policies.	Europe Expat	Utmost PanEurope	English (EN)		Making a change to your policy	This form is for use with Utmost PanEurope dac. Omega and Integra policies. Operational Forms Payment Instruction Form UPEQ PR \| 19967
Beneficiary Nomination Request for non UK residents	This is a Beneficiary Nomination Request form for non UK resident Policyholders for Utmost PanEurope dac	Europe Expat	Utmost PanEurope	English (EN)		Making a change to your policy	This is a Beneficiary Nomination Request form for non UK resident Policyholders for Utmost PanEurope dac Operational Forms Beneficiary Nomination Request for non UK residents UPEQ PR \| 14896
Begäran om byte av Förvaltare	Detta formulär kan användas för att begära att överföra vårdnad om tillgångar.This form can be used to request to transfer custodianship of assets.	Sweden (SE)	Utmost PanEurope	English (EN), Swedish (SV)	FOS	Making a change to your policy	Detta formulär kan användas för att begära att överföra vårdnad om tillgångar.This form can be used to request to transfer custodianship of assets. Operational Forms Begäran om byte av Förvaltare UPEQ PR \| 06987
Switch Form	This form enables you to switch your investments or change the funds in which your future regular investments are invested.	Europe Expat	Utmost PanEurope	English (EN)		Making a change to your policy	This form enables you to switch your investments or change the funds in which your future regular investments are invested. Operational Forms Switch Form UPEQ PR \| 03361
UPE Deed of Assignment	UPE Deed of Assignment		Utmost PanEurope	English (EN)	FOS	Making a change to your policy	UPE Deed of Assignment Operational Forms UPE Deed of Assignment UPE_WS \| 4466
Autocertificazione Al Fini Fiscali Contraente Persona Fisica	Il presente modulo è necessario per segnalare accuratamente la vostra polizza ai sensi dei pertinenti accordi sullo scambio di informazioni fiscali, tra cui il Foreign Account Tax Compliance Act (FATCA) e le norme Common Reporting Standard (CRS). Il presente modulo deve essere utilizzato dai singoli assicurati, dalle persone autorizzate a firmare per conto dell’assicurato, ad esempio il loro procuratore o il loro sostituto nominato dal tribunale, e dalle persone collegate al trust di cui Utmost International Trustee Solutions Limited è il trustee designato.	Italy (IT)	Utmost Wealth Solutions	Italian (IT)	FOS	Making a change to your policy	Il presente modulo è necessario per segnalare accuratamente la vostra polizza ai sensi dei pertinenti accordi sullo scambio di informazioni fiscali, tra cui il Foreign Account Tax Compliance Act (FATCA) e le norme Common Reporting Standard (CRS). Il presente modulo deve essere utilizzato dai singoli assicurati, dalle persone autorizzate a firmare per conto dell’assicurato, ad esempio il loro procuratore o il loro sostituto nominato dal tribunale, e dalle persone collegate al trust di cui Utmost International Trustee Solutions Limited è il trustee designato. Operational Forms Autocertificazione Al Fini Fiscali Contraente Persona Fisica UPE_WS \| 4381
Declaração Fiscal e Auto Certificação para Investidores Individuais	Este formulário deve ser preenchido para informar com precisão a sua apólice nos termos dos acordos de troca de informações fiscais relevantes, incluindo a Lei de Conformidade Fiscal de Contas Estrangeiras (FATCA) e os regulamentos da Norma Comum de Comunicação (CRS). Este formulário deve ser utilizado por segurados individuais, pessoas autorizadas a assinar em nome do segurado, por exemplo, o seu procurador ou representante nomeado pelo tribunal, e indivíduos ligados ao fundo fiduciário em que a Utmost International Trustee Solutions Limited é o administrador fiduciário nomeado.	Europe Expat, Portugal (PT), United Kingdom (UK)	Utmost Wealth Solutions	Portuguese (PT)	FOS	Making a change to your policy, New Policy, Surrender or Claim	Este formulário deve ser preenchido para informar com precisão a sua apólice nos termos dos acordos de troca de informações fiscais relevantes, incluindo a Lei de Conformidade Fiscal de Contas Estrangeiras (FATCA) e os regulamentos da Norma Comum de Comunicação (CRS). Este formulário deve ser utilizado por segurados individuais, pessoas autorizadas a assinar em nome do segurado, por exemplo, o seu procurador ou representante nomeado pelo tribunal, e indivíduos ligados ao fundo fiduciário em que a Utmost International Trustee Solutions Limited é o administrador fiduciário nomeado. Operational Forms Declaração Fiscal e Auto Certificação para Investidores Individuais UPE_WS \| 04029
Ilmoitus Verosääntöjen Noudattamisesta Oikeushenkilöille (Tax Declaration and Self-Certification for Entity Investors) Bilingual FI/EN	The Tax Declaration and Self-Certification form should be completed in order to accurately report your policy under the relevant Tax Information Exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for Entity investors such as, companies, corporate trusts or foundations.	Finland (FI)	Utmost PanEurope	English (EN), Finnish (FI)	FOS	Making a change to your policy, New Policy	The Tax Declaration and Self-Certification form should be completed in order to accurately report your policy under the relevant Tax Information Exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for Entity investors such as, companies, corporate trusts or foundations. Operational Forms Ilmoitus Verosääntöjen Noudattamisesta Oikeushenkilöille (Tax Declaration and Self-Certification for Entity Investors) Bilingual FI/EN UPE PR 12865
Autocertificazione Ai Fini Fiscali Contraente Persona Guirdica eo Societá Fiduciaria (IT)	Al fine di poter riportare accuratamente la vostra polizza ai sensi dei pertinenti accordi sullo scambio di informazioni fiscali, inclusi il Foreign Account Tax Compliance Act (FATCA) e il Common Reporting Standard (CRS). Il presente modulo deve essere utilizzato dagli investitori giuridici quali società, trust aziendali o fondazioni.	Italy (IT)	Utmost Wealth Solutions	Italian (IT)	FOS	Making a change to your policy, New Policy	Al fine di poter riportare accuratamente la vostra polizza ai sensi dei pertinenti accordi sullo scambio di informazioni fiscali, inclusi il Foreign Account Tax Compliance Act (FATCA) e il Common Reporting Standard (CRS). Il presente modulo deve essere utilizzato dagli investitori giuridici quali società, trust aziendali o fondazioni. Operational Forms Autocertificazione Ai Fini Fiscali Contraente Persona Guirdica eo Societá Fiduciaria (IT) UPE PR 12862
Déclaration Fiscale et Auto certification pour les Investisseurs Personnes Morales	Il vous a été demandé de remplir ce formulaire afin que la compagnie concernée puisse déclarer correctement votre contrat dans le cadre des accords d’échange d’informations fiscales, y compris FATCA et CRS.Ce formulaire doit être signé par la personne appropriée comme indiqué ci-dessous :› Pour une entreprise – Une personne qui a le pouvoir de signer, par exemple un dirigeant ou un administrateur d’une entreprise.	France (FR)	Utmost PanEurope	French (FR)	FOS	Making a change to your policy, New Policy, Surrender or Claim	Il vous a été demandé de remplir ce formulaire afin que la compagnie concernée puisse déclarer correctement votre contrat dans le cadre des accords d’échange d’informations fiscales, y compris FATCA et CRS.Ce formulaire doit être signé par la personne appropriée comme indiqué ci-dessous :› Pour une entreprise – Une personne qui a le pouvoir de signer, par exemple un dirigeant ou un administrateur d’une entreprise. Operational Forms Déclaration Fiscale et Auto certification pour les Investisseurs Personnes Morales UPE PR 12861
Declaração Fiscal e Auto Certificação para Entidades	Preencha este formulário para informar com precisão a sua apólice nos termos dos acordos de troca de informações fiscais relevantes, incluindo as regulamentações da Lei de Conformidade Fiscal de Contas Estrangeiras (FATCA) e da Norma Comum de Comunicação (CRS). Este formulário deve ser utilizado por investidores coletivos, tais como empresas, fundos fiduciários corporativos ou fundações.	Europe Expat, Portugal (PT), United Kingdom (UK)	Utmost Wealth Solutions	Portuguese (PT)	FOS	Making a change to your policy, New Policy	Preencha este formulário para informar com precisão a sua apólice nos termos dos acordos de troca de informações fiscais relevantes, incluindo as regulamentações da Lei de Conformidade Fiscal de Contas Estrangeiras (FATCA) e da Norma Comum de Comunicação (CRS). Este formulário deve ser utilizado por investidores coletivos, tais como empresas, fundos fiduciários corporativos ou fundações. Operational Forms Declaração Fiscal e Auto Certificação para Entidades UPE PR 12860
Never Received or Lost Policy Schedule Declaration (EN)	Utmost Pan Europe dac Never Received or Lost Policy Schedule Declaration	Chile (CL), Finland (FI), France (FR), Italy (IT), Mexico (MX), Portugal (PT), Spain (ES), United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	Surrender or Claim	Utmost Pan Europe dac Never Received or Lost Policy Schedule Declaration Operational Forms Never Received or Lost Policy Schedule Declaration (EN) UPE PR 12847
Formulaire de Changement de Coordonnées Personnelles	Ce formulaire est destiné aux clients d’Utmost PanEurope dac qui souhaitent nous informer de toute modification de leurs données personnelles, telles que le nom, le spécimen de signature, l’adresse, l’adresse e-mail ou le numéro de téléphone.	France (FR)	Utmost PanEurope	English (EN)	FOS	Making a change to your policy	Ce formulaire est destiné aux clients d’Utmost PanEurope dac qui souhaitent nous informer de toute modification de leurs données personnelles, telles que le nom, le spécimen de signature, l’adresse, l’adresse e-mail ou le numéro de téléphone. Operational Forms Formulaire de Changement de Coordonnées Personnelles UPE PR 12836
UPE Notification of Pledge Form	This Utmost PanEurope dac form is for completion by all policyholders, if they wish to pledge their policy to a pledgee/pledge creditor as security.	Chile (CL), Europe Expat, Italy (IT), Mexico (MX), Portugal (PT), Spain (ES), United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	Making a change to your policy, New Policy	This Utmost PanEurope dac form is for completion by all policyholders, if they wish to pledge their policy to a pledgee/pledge creditor as security. Operational Forms UPE Notification of Pledge Form UPE PR 12834
UPE Pay-By-Link Pound Sterling	If you are an Utmost PanEurope dac client and you pay regular premiums into your European Capital Account, European Pensions Account or European Savings Account in Pound Sterling, regardless of your current payment method, you can use the Pay-By-Link service.	Europe Expat, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	Making a change to your policy	If you are an Utmost PanEurope dac client and you pay regular premiums into your European Capital Account, European Pensions Account or European Savings Account in Pound Sterling, regardless of your current payment method, you can use the Pay-By-Link service. Operational Forms UPE Pay-By-Link Pound Sterling UPE PR 12774
UPE Pay-By-Link US Dollar	If you are an Utmost PanEurope dac client and you pay regular premiums into your European Capital Account, European Pensions Account or European Savings Account inUS Dollar, regardless of your current payment method, you can use the Pay-By-Link service.	Europe Expat, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	Making a change to your policy	If you are an Utmost PanEurope dac client and you pay regular premiums into your European Capital Account, European Pensions Account or European Savings Account inUS Dollar, regardless of your current payment method, you can use the Pay-By-Link service. Operational Forms UPE Pay-By-Link US Dollar UPE PR 12773
UPE Pay-By-Link Euro	If you are an Utmost PanEurope dac client and you pay regular premiums into your European Capital Account, European Pensions Account or European Savings Account inEuro, regardless of your current payment method, you can use the Pay-By-Link service.	Europe Expat, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	Making a change to your policy	If you are an Utmost PanEurope dac client and you pay regular premiums into your European Capital Account, European Pensions Account or European Savings Account inEuro, regardless of your current payment method, you can use the Pay-By-Link service. Operational Forms UPE Pay-By-Link Euro UPE PR 12772
Client Information and Change of Details Form	This form is intended for Utmost PanEurope dac customers (with a Scottish Mutual International or Phoenix Life branded policy) who wish to inform us of any changes to their personal details, such as name, specimen signature, address, email address or telephone number.		Utmost PanEurope	English (EN)	FOS	Making a change to your policy	This form is intended for Utmost PanEurope dac customers (with a Scottish Mutual International or Phoenix Life branded policy) who wish to inform us of any changes to their personal details, such as name, specimen signature, address, email address or telephone number. Operational Forms Client Information and Change of Details Form UPE PR 12745
Client Information and Change of Details Form	This form is intended for most Utmost PanEurope dac customers who wish to inform us of any changes to their personal details, such as name, specimen signature, address, email address or telephone number.	Chile (CL), Finland (FI), France (FR), Italy (IT), Mexico (MX), Portugal (PT), Spain (ES), United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	Making a change to your policy	This form is intended for most Utmost PanEurope dac customers who wish to inform us of any changes to their personal details, such as name, specimen signature, address, email address or telephone number. Operational Forms Client Information and Change of Details Form UPE PR 12682
Déclaration Fiscale et Auto-certification pour les Investisseurs Individuels	Il vous a été demandé de remplir ce formulaire afin que la compagnie concernée puisse déclarer correctement votre contrat dans le cadre des accords d’échange d’informations fiscales, y compris FATCA et CRS. Ce formulaire doit être complété par:• Le titulaire de la police (parfois appelé titulaire du régime ou titulaire du compte)• Les personnes autorisées à signer au nom de l’Assuré, par exemple leur mandataire ou leur adjoint désigné par le tribunal, lorsque nous détenons les documents appropriés qui peuvent justifier l’intervention d’une personne autorisée.	France (FR)	Utmost PanEurope	French (FR)	FOS	Making a change to your policy, New Policy, Surrender or Claim	Il vous a été demandé de remplir ce formulaire afin que la compagnie concernée puisse déclarer correctement votre contrat dans le cadre des accords d’échange d’informations fiscales, y compris FATCA et CRS. Ce formulaire doit être complété par:• Le titulaire de la police (parfois appelé titulaire du régime ou titulaire du compte)• Les personnes autorisées à signer au nom de l’Assuré, par exemple leur mandataire ou leur adjoint désigné par le tribunal, lorsque nous détenons les documents appropriés qui peuvent justifier l’intervention d’une personne autorisée. Operational Forms Déclaration Fiscale et Auto-certification pour les Investisseurs Individuels UPE PR 00232
Information Disclosure Agreement	Information Disclosure Agreement	ASIA	Utmost PCC Limited	English (EN)	FOS		Information Disclosure Agreement Operational Forms Information Disclosure Agreement UPCC CONT2859
Appointment of the Policyholder as Investment Manager	Appointment of the Policyholder as Investment Manager	ASIA	Utmost PCC Limited	English (EN)	FOS	Making a change to your policy	Appointment of the Policyholder as Investment Manager Operational Forms Appointment of the Policyholder as Investment Manager UPCC CONT1716
Appointment of an Investment Manager	Appointment of an Investment Manager form	Mexico (MX)	Utmost PCC Limited	English (EN)	FOS	Making a change to your policy	Appointment of an Investment Manager form Operational Forms Appointment of an Investment Manager UPCC CONT1533
Change of Communications Means and Use of Electronic Signatures form	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	France (FR)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Change of Communications Means and Use of Electronic Signatures form ULU PR 00102
DÉCLARATION DE PERTE DE DOCUMENTS	Formulaire de déclaration de perte de documents – Version française à utiliser avec Utmost Luxembourg S.A. France	France (FR)	Utmost Luxembourg S.A	French (FR)	FOS		Formulaire de déclaration de perte de documents – Version française à utiliser avec Utmost Luxembourg S.A. France Operational Forms DÉCLARATION DE PERTE DE DOCUMENTS ULU PR 00091
RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION	Use this form to request a change of Communication Means and address – South Africa	South Africa (ZA)	Utmost Luxembourg S.A	English (EN)	FOS	Making a change to your policy	Use this form to request a change of Communication Means and address – South Africa Operational Forms RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION ULU PCON1607
RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION	Use this form to request a change of Communication Means and address – Malta	Malta (MT)	Utmost Luxembourg S.A	English (EN)	FOS	Making a change to your policy	Use this form to request a change of Communication Means and address – Malta Operational Forms RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION ULU PCON1606
RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION	Use this form to request a change of Communication Means and address – Jersey	Jersey (JE)	Utmost Luxembourg S.A	English (EN)	FOS	Making a change to your policy	Use this form to request a change of Communication Means and address – Jersey Operational Forms RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION ULU PCON1605
RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION	Use this form to request a change of Communication Means and address – Israel	Israel (IL)	Utmost Luxembourg S.A	English (EN)	FOS	Making a change to your policy	Use this form to request a change of Communication Means and address – Israel Operational Forms RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION ULU PCON1604
RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION	Use this form to request a change of Communication Means and address – Cyprus	Cyprus (CY)	Utmost Luxembourg S.A	English (EN)	FOS	Making a change to your policy	Use this form to request a change of Communication Means and address – Cyprus Operational Forms RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION ULU PCON1602
Modification des caractéristiques principales d’une Unité de Compte constituée par un Fonds d’Assurance Spécialisé existant	Use this form to request a change to one or more key characteristics of a Specialised Assurance Fund; such as Change of Fund Manager and Custodian Bank	France (FR)	Utmost Luxembourg S.A	French (FR)	FOS		Use this form to request a change to one or more key characteristics of a Specialised Assurance Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Modification des caractéristiques principales d’une Unité de Compte constituée par un Fonds d’Assurance Spécialisé existant ULU PCON1566
Ändring av huvudsakliga egenskaper för en existerande Intern Dedikerad Fond / Change of the main characteristics of an existing Internal Dedicated Fund	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Sweden (SE)	Utmost Luxembourg S.A	English (EN), Swedish (SV)	FOS		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Ändring av huvudsakliga egenskaper för en existerande Intern Dedikerad Fond / Change of the main characteristics of an existing Internal Dedicated Fund ULU PCON1559
Switch Authorisation	Use this form to authorise the Insurer to perform switches of investments on your policy/contract – Sweden	Sweden (SE)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to authorise the Insurer to perform switches of investments on your policy/contract – Sweden Operational Forms Switch Authorisation ULU PCON1562
Olemassa olevan Sisäisen kohdistetun rahaston tärkeimpien ominaisuuksien muutos / Change of the main characteristics of an existing Internal Dedicated Fund	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Finland (FI)	Utmost Luxembourg S.A	English (EN), Finnish (FI)	FOS		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Olemassa olevan Sisäisen kohdistetun rahaston tärkeimpien ominaisuuksien muutos / Change of the main characteristics of an existing Internal Dedicated Fund ULU PCON1558
Wijziging van de voornaamste kenmerken van een bestaand Intern Toegewezen Fonds	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOS		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Wijziging van de voornaamste kenmerken van een bestaand Intern Toegewezen Fonds ULU PCON1557
Modification des caractéristiques principales d’un Fonds Interne Dédié existant	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Belgium (BE)	Utmost Luxembourg S.A	French (FR)	FOS		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Modification des caractéristiques principales d’un Fonds Interne Dédié existant ULU PCON1556
Request for Change of Investment Manager and Investment Strategy	Use this form to request a change of Investment Manager and Investment Strategy – Turkey	Turkey (TR)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of Investment Manager and Investment Strategy – Turkey Operational Forms Request for Change of Investment Manager and Investment Strategy ULU PCON1553
Wechsel des Vermittlers	Use this form to request a change of Intermediary – Germany	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Use this form to request a change of Intermediary – Germany Operational Forms Wechsel des Vermittlers ULU PCON1533
Change of Communication Means and Use of Electronic Signatures Form	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Change of Communication Means and Use of Electronic Signatures Form ULU PCON1531
Residenza e Comunicazioni	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOE FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Residenza e Comunicazioni ULU PCON1527
BOSTEDSADRESSE OG KOMMUNIKASJONSMIDDEL / RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Norway (NO)	Utmost Luxembourg S.A	English (EN), Norwegian (NO)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms BOSTEDSADRESSE OG KOMMUNIKASJONSMIDDEL / RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION ULU PCON1526
BOSTADSADRESS SAMT KOMMUNIKATIONSSÄTT / RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Sweden (SE)	Utmost Luxembourg S.A	English (EN), Swedish (SV)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms BOSTADSADRESS SAMT KOMMUNIKATIONSSÄTT / RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION ULU PCON1525
Formulaire de changement de moyen de communication et utilisation des signatures électroniques	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	France (FR)	Utmost Luxembourg S.A	French (FR)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Formulaire de changement de moyen de communication et utilisation des signatures électroniques ULU PCON1524
Formulário de Alteração dos Meios de Comunicação e Utilização de Assinaturas Electrónicas / Change of Communication Means and Use of Electronic Signatures Form	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Portugal (PT)	Utmost Luxembourg S.A	English (EN), Portuguese (PT)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Formulário de Alteração dos Meios de Comunicação e Utilização de Assinaturas Electrónicas / Change of Communication Means and Use of Electronic Signatures Form ULU PCON1523
ASUINOSOITE JA VIESTINTÄVÄLINEET / RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Finland (FI)	Utmost Luxembourg S.A	English (EN), Finnish (FI)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms ASUINOSOITE JA VIESTINTÄVÄLINEET / RESIDENTIAL ADDRESS AND MEANS OF COMMUNICATION ULU PCON1522
Formulaire de changement de moyen de communication et utilisation des signatures électroniques	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Belgium (BE)	Utmost Luxembourg S.A	French (FR)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Formulaire de changement de moyen de communication et utilisation des signatures électroniques ULU PCON1521
Wijziging van het communicatiemiddel voor correspondentie en het gebruik van elektronische handtekeningen	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Wijziging van het communicatiemiddel voor correspondentie en het gebruik van elektronische handtekeningen ULU PCON1520
WOHNSITZ UND KOMMUNIKATIONSMITTEL	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms WOHNSITZ UND KOMMUNIKATIONSMITTEL ULU PCON1519
Formulario de cambio de medio de comunicación y uso de firmas electrónicas / Change of Communication Means and Use of Electronic Signatures Form	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Spain (ES)	Utmost Luxembourg S.A	English (EN), Spanish (ES)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Formulario de cambio de medio de comunicación y uso de firmas electrónicas / Change of Communication Means and Use of Electronic Signatures Form ULU PCON1518
Change of Communication Means and Use of Electronic Signatures Form / Formulaire de changement de moyen de communication et utilisation des signatures électroniques	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Luxembourg (LU)	Utmost Luxembourg S.A	English (EN), French (FR)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Change of Communication Means and Use of Electronic Signatures Form / Formulaire de changement de moyen de communication et utilisation des signatures électroniques ULU PCON1514
Declaration as to Loss of Polivy Schedule	Form to be used to declare the loss of policy documents – Turkey	Turkey (TR)	Utmost Luxembourg S.A	English (EN)	FOS		Form to be used to declare the loss of policy documents – Turkey Operational Forms Declaration as to Loss of Polivy Schedule ULU PCON1485
Lisähenkivakuutettu – Vakuutuksenottajan Pyyntö / Additional Life Assured – Policyholder’s Request	Annex to add additional Life Assureds to the contract/policy	Finland (FI)	Utmost Luxembourg S.A	English (EN), Finnish (FI)	FOS		Annex to add additional Life Assureds to the contract/policy Operational Forms Lisähenkivakuutettu – Vakuutuksenottajan Pyyntö / Additional Life Assured – Policyholder’s Request ULU PCON1480
Edunsaajamääräyksen Muutoslomake / Change of Beneficiary Nomination	Use this form to request a change of Beneficiary – Finland	Finland (FI)	Utmost Luxembourg S.A	English (EN), Finnish (FI)	FOS		Use this form to request a change of Beneficiary – Finland Operational Forms Edunsaajamääräyksen Muutoslomake / Change of Beneficiary Nomination ULU PCON1479
Adreso korespondencijai pasirinkimas / Choice of Correspondence Address	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Lithuania (LT)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Adreso korespondencijai pasirinkimas / Choice of Correspondence Address ULU PCON1448
Request for Change of Investment Manager – Norwegian Market	Use this form to request a change of investment manager and Investment Strategy – Norway	Norway (NO)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of investment manager and Investment Strategy – Norway Operational Forms Request for Change of Investment Manager – Norwegian Market ULU PCON1389
Appointment of Broker	Use this form to request a change of Broker – Turkey	Turkey (TR)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of Broker – Turkey Operational Forms Appointment of Broker ULU PCON1375
Request for Change of Custodian Bank	Use this form to request a change of Custodian Bank – Turkey	Turkey (TR)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of Custodian Bank – Turkey Operational Forms Request for Change of Custodian Bank ULU PCON1346
Désignation d’Intermédiaire	Use this form to request an appointment or change of broker	Belgium (BE)	Utmost Luxembourg S.A	French (FR)	FOS		Use this form to request an appointment or change of broker Operational Forms Désignation d’Intermédiaire ULU PCON1323
Aanstelling van Tussenpersoon	Use this form to request an appointment or change of broker	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOS		Use this form to request an appointment or change of broker Operational Forms Aanstelling van Tussenpersoon ULU PCON1322
Richiesta di Modifica della Maggiorazione in caso di Decesso	Use this form to request a change of life cover – Italy (Branch)	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOE FOS		Use this form to request a change of life cover – Italy (Branch) Operational Forms Richiesta di Modifica della Maggiorazione in caso di Decesso ULU PCON1317
Atto di Variazione del Fondo Interno Dedicato	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOE FOS		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Atto di Variazione del Fondo Interno Dedicato ULU PCON1310
Übernahme einder bestehenden Police bei Ableben des Versicherungsnehmers	Use this form to request a transfer of your policy/contract to another policyholder – Germany	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Use this form to request a transfer of your policy/contract to another policyholder – Germany Operational Forms Übernahme einder bestehenden Police bei Ableben des Versicherungsnehmers ULU PCON1301
Änderung der Laufzeit für bestehende Policen	Use this form to request a change of term to your policy/contract – Germany	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Use this form to request a change of term to your policy/contract – Germany Operational Forms Änderung der Laufzeit für bestehende Policen ULU PCON1300
Wechsel des Versicherungsnehmers einer bestehenden Police	Use this form to request a change of policyholder on an existing policy/contract – Germany	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Use this form to request a change of policyholder on an existing policy/contract – Germany Operational Forms Wechsel des Versicherungsnehmers einer bestehenden Police ULU PCON1299
Wechsel der Anlagestrategie (Fondsauswahl + Vermögensverwaltung)	Use this form to request a change of Investment Strategy (Fund Picking) – Germany	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Use this form to request a change of Investment Strategy (Fund Picking) – Germany Operational Forms Wechsel der Anlagestrategie (Fondsauswahl + Vermögensverwaltung) ULU PCON1262
Choice of Correspondance Address	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Turkey (TR)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Choice of Correspondance Address ULU PCON1258
Elección de Dirección de Correspondencia / Choice of Correspondence Address	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Mexico (MX)	Utmost Luxembourg S.A	English (EN), Spanish (ES)	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Elección de Dirección de Correspondencia / Choice of Correspondence Address ULU PCON1259
Request for Change of Investment Manager to the Policyholder as Investment Manager	Use this form to request a change of Investment Manager to Policyholder as Investment Manager – Norway	Norway (NO)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of Investment Manager to Policyholder as Investment Manager – Norway Operational Forms Request for Change of Investment Manager to the Policyholder as Investment Manager ULU PCON1252
Bouppteckningsintyg	Use this form to initiate a death claim – Sweden	Sweden (SE)	Utmost Luxembourg S.A	Swedish (SV)	FOS		Use this form to initiate a death claim – Sweden Operational Forms Bouppteckningsintyg ULU PCON1253
Request for Change of Investment Manager to the Policyholder as Investment Manager	Use this form to request a change of Investment Manager to Policyholder as Investment Manager – Finland	Finland (FI)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of Investment Manager to Policyholder as Investment Manager – Finland Operational Forms Request for Change of Investment Manager to the Policyholder as Investment Manager ULU PCON1251
Request for Change of Investment Manager to the Policyholder as Investment Manager	Use this form to request a change of Investment Manager to Policyholder as Investment Manager – Sweden	Sweden (SE)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of Investment Manager to Policyholder as Investment Manager – Sweden Operational Forms Request for Change of Investment Manager to the Policyholder as Investment Manager ULU PCON1250
Richiesta Cambio Contraente Persona Giuridica	Use this form to request a change of Policyholder – Corporate Entity – Italy	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOE FOS		Use this form to request a change of Policyholder – Corporate Entity – Italy Operational Forms Richiesta Cambio Contraente Persona Giuridica ULU PCON1246
Richiesta Cambio Contraente Persona Fisica	Use this form to request a change of Policyholder – Physical Person – Italy	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOE FOS		Use this form to request a change of Policyholder – Physical Person – Italy Operational Forms Richiesta Cambio Contraente Persona Fisica ULU PCON1245
Dichiarazione di Smarrimento	Form to be used to declare the loss of policy documents – Italy	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOE FOS		Form to be used to declare the loss of policy documents – Italy Operational Forms Dichiarazione di Smarrimento ULU PCON1244
Richiesta Cambio Intermediario	Use this form to request a change of Intermediary – Italy	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOE FOS		Use this form to request a change of Intermediary – Italy Operational Forms Richiesta Cambio Intermediario ULU PCON1243
Request for Change of Investment Strategy	Use this form to request a change of Investment Strategy – United Kingdom	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of Investment Strategy – United Kingdom Operational Forms Request for Change of Investment Strategy ULU PCON1214
Richiesta Cambio Beneficiario	Use this form to request a change of Beneficiary – Italy	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOE FOS		Use this form to request a change of Beneficiary – Italy Operational Forms Richiesta Cambio Beneficiario ULU PCON1213
Requerimento Para Alteração Do Gestor De Investimento / Request for Change of Investment Manager	Use this form to request a change of Investment Manager – Portugal	Portugal (PT)	Utmost Luxembourg S.A	English (EN), Portuguese (PT)	FOS		Use this form to request a change of Investment Manager – Portugal Operational Forms Requerimento Para Alteração Do Gestor De Investimento / Request for Change of Investment Manager ULU PCON1193
Request for Change of Investment manager	Use this form to request a change of Investment Manager – United Kingdom	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of Investment Manager – United Kingdom Operational Forms Request for Change of Investment manager ULU PCON1072
Demande de Changement de Gestionnaire et Stratégie d’Investissement	Use this form to request a change of Investment Manager and Investment Strategy – France	France (FR)	Utmost Luxembourg S.A	French (FR)	FOS		Use this form to request a change of Investment Manager and Investment Strategy – France Operational Forms Demande de Changement de Gestionnaire et Stratégie d’Investissement ULU PCON1069
Formulaire Changement de Banque Dépositaire	Use this form to request a change of Custodian Bank	France (FR)	Utmost Luxembourg S.A	French (FR)	FOS		Use this form to request a change of Custodian Bank Operational Forms Formulaire Changement de Banque Dépositaire ULU PCON1060
Request for Change of Custodian Bank	Use this form to request a change of Custodian Bank	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of Custodian Bank Operational Forms Request for Change of Custodian Bank ULU PCON1057
Declaration as to Loss of Policy Schedule	Form to be used to declare the loss of policy documents – United Kingdom	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Form to be used to declare the loss of policy documents – United Kingdom Operational Forms Declaration as to Loss of Policy Schedule ULU PCON1042
Kuolintapaus / Death Claim	Use this form to initiate a death claim – Finland	Finland (FI)	Utmost Luxembourg S.A	English (EN), Finnish (FI)	FOS	Surrender or Claim	Use this form to initiate a death claim – Finland Operational Forms Kuolintapaus / Death Claim ULU PCON1006
Mandat de vérification d’instructions et de réception/ transmission d’ordres pour le Fonds d’Assurance Spécialisé	Power of Attorney for the verification of the instructions for the Specialised Assurance Fund – France	France (FR)	Utmost Luxembourg S.A	French (FR)	FOS	New Policy	Power of Attorney for the verification of the instructions for the Specialised Assurance Fund – France Operational Forms Mandat de vérification d’instructions et de réception/ transmission d’ordres pour le Fonds d’Assurance Spécialisé ULU CONT4875
Mandat de réception d’instructions pour un Fonds d’Assurance Spécialisé	Power of Attorney for the reception of the instructions for the Specialised Assurance Fund – France	France (FR)	Utmost Luxembourg S.A	French (FR)	FOS	New Policy	Power of Attorney for the reception of the instructions for the Specialised Assurance Fund – France Operational Forms Mandat de réception d’instructions pour un Fonds d’Assurance Spécialisé ULU CONT4874
Självcertifiering / Self-Certification (FATCA)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Sweden (SE)	Utmost Luxembourg S.A	English (EN), Swedish (SV)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Självcertifiering / Self-Certification (FATCA) ULU CONT4806
Automatisert Utveksling av Informasjon Egenerklæringsskjema / Automatic Exchange of Information Self-Certification	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Norway (NO)	Utmost Luxembourg S.A	English (EN), Norwegian (NO)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Automatisert Utveksling av Informasjon Egenerklæringsskjema / Automatic Exchange of Information Self-Certification ULU CONT4692
Regolamento del Fondo Interno Dedicato	Rules for Internal Dedicated Fund – Italy	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOS	New Policy	Rules for Internal Dedicated Fund – Italy Operational Forms Regolamento del Fondo Interno Dedicato ULU CONT4585
Power of Attorney / Procuration – Luxembourg Capitalisation Bond	Power of Attorney for the Investment Advisor – Luxembourg – Capitalisation Bond	Luxembourg (LU)	Utmost Luxembourg S.A	English (EN), French (FR)	FOS		Power of Attorney for the Investment Advisor – Luxembourg – Capitalisation Bond Operational Forms Power of Attorney / Procuration – Luxembourg Capitalisation Bond ULU CONT4549
Automatisert Utveksling av Informasjon – Egenerklæringsskjema for kontrollende personer	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Norway (NO)	Utmost Luxembourg S.A	English (EN), Norwegian (NO)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Automatisert Utveksling av Informasjon – Egenerklæringsskjema for kontrollende personer ULU CONT4268
Automaattinen Tietojenvaihto – Kontrollovia Henkilöitä Koskeva Todistuslomake	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Finland (FI)	Utmost Luxembourg S.A	Finnish (FI)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Automaattinen Tietojenvaihto – Kontrollovia Henkilöitä Koskeva Todistuslomake ULU CONT4267
Troca Automática de Informações – Formulário de Autocertificação para pessoas que exercem o controlo	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Portugal (PT)	Utmost Luxembourg S.A	Portuguese (PT)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Troca Automática de Informações – Formulário de Autocertificação para pessoas que exercem o controlo ULU CONT4265
Automatische Uitwisseling van Inlichtingen – Zelfcertificering voor uiteindelijk belanghebbenden	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Automatische Uitwisseling van Inlichtingen – Zelfcertificering voor uiteindelijk belanghebbenden ULU CONT4264
Automatischer Austausch von Informationen – Formular zur Selbstauskunft für beherrschende personen	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Automatischer Austausch von Informationen – Formular zur Selbstauskunft für beherrschende personen ULU CONT4263
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes détenant le contrôle	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Belgium (BE), Luxembourg (LU)	Utmost Luxembourg S.A	French (FR)	FOS	New Policy	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes détenant le contrôle ULU CONT4262
Intercambio Automático de Información – Formulario de Declaración para personas de control	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Mexico (MX), Peru (PE), Spain (ES)	Utmost Luxembourg S.A	Spanish (ES)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Intercambio Automático de Información – Formulario de Declaración para personas de control ULU CONT4261
Scambio Automatico di Informazioni – Modulo di Autocertificazione per persone che esercitano il controllo (FOS)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Scambio Automatico di Informazioni – Modulo di Autocertificazione per persone che esercitano il controllo (FOS) ULU CONT4260
Automatisert Utveksling av Informasjon Egenerklæringsskjema / Automatic Exchange of Information Self-Certification	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Norway (NO)	Utmost Luxembourg S.A	English (EN), Norwegian (NO)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Automatisert Utveksling av Informasjon Egenerklæringsskjema / Automatic Exchange of Information Self-Certification ULU CONT4256
Troca Automática de Informações – Formulário de Autocertificação para entidades	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Portugal (PT)	Utmost Luxembourg S.A	Portuguese (PT)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Troca Automática de Informações – Formulário de Autocertificação para entidades ULU CONT4253
Automatische Uitwisseling van Inlichtingen – Zelfcertificering voor entiteiten	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Automatische Uitwisseling van Inlichtingen – Zelfcertificering voor entiteiten ULU CONT4252
Automatischer Austausch von Informationen – Formular zur Selbstauskunft für rechtsträger	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Automatischer Austausch von Informationen – Formular zur Selbstauskunft für rechtsträger ULU CONT4251
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les entités	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Belgium (BE), Luxembourg (LU)	Utmost Luxembourg S.A	French (FR)	FOS	New Policy	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les entités ULU CONT4250
Intercambio Automático de Información – Formulario de Declaración para entidades	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Mexico (MX), Peru (PE), Spain (ES)	Utmost Luxembourg S.A	Spanish (ES)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Intercambio Automático de Información – Formulario de Declaración para entidades ULU CONT4249
Scambio Automatico di Informazioni – Modulo di Autocertificazione per persone giuridiche (FOS)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Scambio Automatico di Informazioni – Modulo di Autocertificazione per persone giuridiche (FOS) ULU CONT4248
Troca Automática de Informações – Formulário de Autocertificação para pessoas singulares	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Portugal (PT)	Utmost Luxembourg S.A	Portuguese (PT)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Troca Automática de Informações – Formulário de Autocertificação para pessoas singulares ULU CONT4244
Automatische Uitwisseling van Inlichtingen – Zelfcertificering voor natuurlijke personen	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Automatische Uitwisseling van Inlichtingen – Zelfcertificering voor natuurlijke personen ULU CONT4243
Automatischer Austausch von Informationen – Formular zur Selbstauskunft Für Natürliche Personen	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Automatischer Austausch von Informationen – Formular zur Selbstauskunft Für Natürliche Personen ULU CONT4242
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes physiques	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Belgium (BE), Luxembourg (LU)	Utmost Luxembourg S.A	French (FR)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes physiques ULU CONT4241
Intercambio Automático de Información – Formulario de Declaración para personas físicas	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Mexico (MX), Peru (PE), Spain (ES)	Utmost Luxembourg S.A	Spanish (ES)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Intercambio Automático de Información – Formulario de Declaración para personas físicas ULU CONT4240
Scambio Automatico di Informazioni – Modulo di Autocertificazione per persone fisiche (FOS)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Scambio Automatico di Informazioni – Modulo di Autocertificazione per persone fisiche (FOS) ULU CONT4239
Change of Client Role	Change of Client Role form	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS	Making a change to your policy	Change of Client Role form Operational Forms Change of Client Role ULU CONT3934
Avenant au contrat de capitalisation	“Prise de date” annex to the Liberté Capitalisation product – France	France (FR)	Utmost Luxembourg S.A	French (FR)	FOS	New Policy	“Prise de date” annex to the Liberté Capitalisation product – France Operational Forms Avenant au contrat de capitalisation ULU CONT3910
Avenant au contrat d’assurance-vie	“Prise de date” annex to the Liberté product – France	France (FR)	Utmost Luxembourg S.A	French (FR)	FOS	New Policy	“Prise de date” annex to the Liberté product – France Operational Forms Avenant au contrat d’assurance-vie ULU CONT3909
Choice of Law form	Choice of law for the French market (Englishh version)	France (FR)	Utmost Luxembourg S.A	English (EN)	FOS		Choice of law for the French market (Englishh version) Operational Forms Choice of Law form ULU CONT3572
Solicitação de Estatuto de Cliente Profissional / Request for Professional Client Status	Request for Professional Client Status	Portugal (PT)	Utmost Luxembourg S.A	English (EN), Portuguese (PT)	FOS		Request for Professional Client Status Operational Forms Solicitação de Estatuto de Cliente Profissional / Request for Professional Client Status ULU CONT3570
Capitalisation Bond – Liite: Sisäisten yhteisrahastojen luettelo / Appendix: list of available Internal Collective Funds	List of available Internal Collective Funds for the Private Client Portfolio product – Finland	Finland (FI)	Utmost Luxembourg S.A	English (EN), Finnish (FI)	FOS		List of available Internal Collective Funds for the Private Client Portfolio product – Finland Operational Forms Capitalisation Bond – Liite: Sisäisten yhteisrahastojen luettelo / Appendix: list of available Internal Collective Funds ULU CONT3555
Change of Client Information	Change of Client Information form	ASIA	Utmost Luxembourg S.A	English (EN)	FOS	Making a change to your policy	Change of Client Information form Operational Forms Change of Client Information ULU CONT3530
Change of Client Information	Use this form to request a change of Client information	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS	Making a change to your policy	Use this form to request a change of Client information Operational Forms Change of Client Information ULU CONT3473
Vaatimus Asiakasluokan alentamisesta – Demand for Client Category Downgrade	Use this form to request a downgrade of your investment category	Finland (FI)	Utmost Luxembourg S.A	English (EN), Finnish (FI)	FOS		Use this form to request a downgrade of your investment category Operational Forms Vaatimus Asiakasluokan alentamisesta – Demand for Client Category Downgrade ULU CONT3454
Pyyntö Asiakasluokan korottamisesta / Request for Client Category Upgrade	Use this form to request a upgrade of your investment category	Finland (FI)	Utmost Luxembourg S.A	English (EN), Finnish (FI)	FOS		Use this form to request a upgrade of your investment category Operational Forms Pyyntö Asiakasluokan korottamisesta / Request for Client Category Upgrade ULU CONT3455
Choice Of Law	Use this form to perform a choice of law	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to perform a choice of law Operational Forms Choice Of Law ULU CONT3261
Aanvraag van het Statuut van Professionele Cliënt / Request for Professional Client Status	Request for Professional Client Status	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL), English (EN)	FOS		Request for Professional Client Status Operational Forms Aanvraag van het Statuut van Professionele Cliënt / Request for Professional Client Status ULU CONT3210
Demande de Statut de Client Professionnel / Request for Professional Client Status	Request for Professional Client Status	Belgium (BE)	Utmost Luxembourg S.A	English (EN), French (FR)	FOS		Request for Professional Client Status Operational Forms Demande de Statut de Client Professionnel / Request for Professional Client Status ULU CONT3207
Power of Attorney / Procuration (Adviser)	Power of Attorney for the Investment Advisor – Luxembourg	Luxembourg (LU)	Utmost Luxembourg S.A	English (EN), French (FR)	FOS		Power of Attorney for the Investment Advisor – Luxembourg Operational Forms Power of Attorney / Procuration (Adviser) ULU CONT3198
Costi amministrativi addizionali	Annex showing the activity-based charging grid	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOE FOS		Annex showing the activity-based charging grid Operational Forms Costi amministrativi addizionali ULU CONT3183
Schedule of Additional Administrative Charges / Aperçu des frais administratifs additionnels	Annex showing the activity-based charging grid	Luxembourg (LU)	Utmost Luxembourg S.A	English (EN), French (FR)	FOS		Annex showing the activity-based charging grid Operational Forms Schedule of Additional Administrative Charges / Aperçu des frais administratifs additionnels ULU CONT3179
Tarifário de transações	Annex showing the activity-based charging grid	Portugal (PT)	Utmost Luxembourg S.A	Portuguese (PT)	FOS		Annex showing the activity-based charging grid Operational Forms Tarifário de transações ULU CONT3180
Schedule of Additional Administrative Charges	Annex showing the activity-based charging grid	Norway (NO)	Utmost Luxembourg S.A	English (EN)	FOS		Annex showing the activity-based charging grid Operational Forms Schedule of Additional Administrative Charges ULU CONT3177
Schedule of Additional Administrative Charges	Annex showing the activity-based charging grid	Sweden (SE)	Utmost Luxembourg S.A	English (EN)	FOS		Annex showing the activity-based charging grid Operational Forms Schedule of Additional Administrative Charges ULU CONT3178
Schedule of Additional Administrative Charges	Annex showing the activity-based charging grid	Turkey (TR)	Utmost Luxembourg S.A	English (EN)	FOS		Annex showing the activity-based charging grid Operational Forms Schedule of Additional Administrative Charges ULU CONT3170
Listado de costes administrativos adicionales	Annex showing the activity-based charging grid	Spain (ES)	Utmost Luxembourg S.A	Spanish (ES)	FOS		Annex showing the activity-based charging grid Operational Forms Listado de costes administrativos adicionales ULU CONT3171
Aperçu des frais administratifs additionnels	Annex showing the activity-based charging grid	Belgium (BE)	Utmost Luxembourg S.A	French (FR)	FOS		Annex showing the activity-based charging grid Operational Forms Aperçu des frais administratifs additionnels ULU CONT3168
Détails des Frais de transaction	Annex showing the activity-based charging grid	France (FR)	Utmost Luxembourg S.A	French (FR)	FOS		Annex showing the activity-based charging grid Operational Forms Détails des Frais de transaction ULU CONT3169
Einzelheiten zu Einmalgebühren für bestimmte Vorgänge	Annex showing the activity-based charging grid	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Annex showing the activity-based charging grid Operational Forms Einzelheiten zu Einmalgebühren für bestimmte Vorgänge ULU CONT3166
Overzicht van bijkomende administratieve vergoedingen	Annex showing the activity-based charging grid	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOS		Annex showing the activity-based charging grid Operational Forms Overzicht van bijkomende administratieve vergoedingen ULU CONT3167
Schedule of Additional Administrative Charges	Annex showing the activity-based charging grid	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Annex showing the activity-based charging grid Operational Forms Schedule of Additional Administrative Charges ULU CONT3165
Bijvoegsel bij de levensverzekeringsovereenkomst – Aanvaarding van de begunstiging	Annex to the application form for beneficiary acceptance	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOS		Annex to the application form for beneficiary acceptance Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Aanvaarding van de begunstiging ULU CONT2802
Avenant au contrat d’assurance-vie – Acceptation du bénéfice	Annex to the application form for beneficiary acceptance	Belgium (BE)	Utmost Luxembourg S.A	French (FR)	FOS		Annex to the application form for beneficiary acceptance Operational Forms Avenant au contrat d’assurance-vie – Acceptation du bénéfice ULU CONT2803
Bijvoegsel bij de levensverzekeringsovereenkomst – Ontbinding van de overdracht van verzekeringsrechten	Annex to the application form for signing the dissolution of the transfer of insurance rights	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOS		Annex to the application form for signing the dissolution of the transfer of insurance rights Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Ontbinding van de overdracht van verzekeringsrechten ULU CONT2798
Avenant au contrat d’assurance-vie – Dissolution de cession de droits	Annex to the application form for signing the dissolution of the transfer of insurance rights	Belgium (BE)	Utmost Luxembourg S.A	French (FR)	FOS		Annex to the application form for signing the dissolution of the transfer of insurance rights Operational Forms Avenant au contrat d’assurance-vie – Dissolution de cession de droits ULU CONT2799
Declaration de statut de « Non-U.S. Person » (Multi-Support)	Use this form to declare a status of “Non-U.S. Person”	France (FR)	Utmost Luxembourg S.A	French (FR)	FOS		Use this form to declare a status of “Non-U.S. Person” Operational Forms Declaration de statut de « Non-U.S. Person » (Multi-Support) ULU CONT2755
Request for Change of Life Cover	Use this form to request a change of life cover	Finland (FI)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request a change of life cover Operational Forms Request for Change of Life Cover ULU CONT2732
Request for Professional Client Status	Request for Professional Client Status	Sweden (SE)	Utmost Luxembourg S.A	English (EN)	FOS		Request for Professional Client Status Operational Forms Request for Professional Client Status ULU CONT2733
Addendum to Life Assurance Policy (PPB Addendum) – Discretionary Mandates	Addendum to the Personalised Portfolio Bond – Luxembourg	Luxembourg (LU), United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Addendum to the Personalised Portfolio Bond – Luxembourg Operational Forms Addendum to Life Assurance Policy (PPB Addendum) – Discretionary Mandates ULU CONT2688
Intercambio Automático de Información – Formulario de Declaración para Fideicomisos	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for Trusts.	Mexico (MX), Spain (ES)	Utmost Luxembourg S.A	Spanish (ES)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for Trusts. Operational Forms Intercambio Automático de Información – Formulario de Declaración para Fideicomisos ULU CONT2656
Avenant au contrat d’assurance-vie – Convention de Cession Post Mortem des droits découlant du Contrat	Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy	Belgium (BE)	Utmost Luxembourg S.A	French (FR)	FOS		Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy Operational Forms Avenant au contrat d’assurance-vie – Convention de Cession Post Mortem des droits découlant du Contrat ULU CONT2629
Automatic Exchange of Information – Self-Certification Form for Trust	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for Trusts.	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for Trusts. Operational Forms Automatic Exchange of Information – Self-Certification Form for Trust ULU CONT2655
Bijvoegsel bij de levensverzekeringsovereenkomst – Overeenkomst van Overdracht Post Mortem van de uit de Overeenkomst voortvloeiende rechten	Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOS		Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Overeenkomst van Overdracht Post Mortem van de uit de Overeenkomst voortvloeiende rechten ULU CONT2628
Benennung von Begünstigten für bestehende Policen	Use this form to nominate beneficiaries	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Use this form to nominate beneficiaries Operational Forms Benennung von Begünstigten für bestehende Policen ULU CONT2623
Benennung von unwiderruflichen Begünstigten für bestehende Policen	Use this form to nominate irrevocable beneficiaries	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Use this form to nominate irrevocable beneficiaries Operational Forms Benennung von unwiderruflichen Begünstigten für bestehende Policen ULU CONT2624
Automatic Exchange of Information – Self-Certification for Controlling Persons	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	ASIA, Belgium (BE), Cyprus (CY), Finland (FI), France (FR), Germany (DE), Gibraltar (GI), Israel (IL), Luxembourg (LU), Mexico (MX), Norway (NO), Portugal (PT), Spain (ES), Turkey (TR), United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Automatic Exchange of Information – Self-Certification for Controlling Persons ULU CONT2599
Choix de la Loi Applicable / Choice of Law – Capitalisation Contract	Use this form to perform a choice of law	France (FR)	Utmost Luxembourg S.A	English (EN), French (FR)	FOS		Use this form to perform a choice of law Operational Forms Choix de la Loi Applicable / Choice of Law – Capitalisation Contract ULU CONT2602
Automatic Exchange of Information – Self-Certification for Individuals	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	ASIA, Belgium (BE), Cyprus (CY), Finland (FI), France (FR), Germany (DE), Gibraltar (GI), Israel (IL), Jersey (JE), Luxembourg (LU), Mexico (MX), Norway (NO), Portugal (PT), Spain (ES), Turkey (TR), United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Automatic Exchange of Information – Self-Certification for Individuals ULU CONT2593
Automatic Exchange of Information – Self-Certification for Entities	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	ASIA, Belgium (BE), Cyprus (CY), Finland (FI), France (FR), Germany (DE), Gibraltar (GI), Luxembourg (LU), Malta (MT), Mexico (MX), Norway (NO), Peru (PE), Portugal (PT), Spain (ES), Turkey (TR), United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Automatic Exchange of Information – Self-Certification for Entities ULU CONT2596
Addendum to Life Assurance Policy (PPB Addendum)	Addendum to the Personalised Portfolio Bond – Portugal	Portugal (PT), United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Addendum to the Personalised Portfolio Bond – Portugal Operational Forms Addendum to Life Assurance Policy (PPB Addendum) ULU CONT2583
Choice of Law (Non-Residents)	Use this form to perform a choice of law	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to perform a choice of law Operational Forms Choice of Law (Non-Residents) ULU CONT2578
Request for Enhanced Death Benefit	Use this form to request an enhanced death benefit – United Kingdom	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request an enhanced death benefit – United Kingdom Operational Forms Request for Enhanced Death Benefit ULU CONT2381
Addendum to Life Assurance Policy – Investment Enhancement	Addendum for Investment Enhancement for the Private Client Portfolio product – United Kingdom	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Addendum for Investment Enhancement for the Private Client Portfolio product – United Kingdom Operational Forms Addendum to Life Assurance Policy – Investment Enhancement ULU CONT2371
Beneficiary Nomination	Use this form to nominate beneficiaries	Turkey (TR)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to nominate beneficiaries Operational Forms Beneficiary Nomination ULU CONT2378
Lovvalg / Choice of Law	Use this form to perform a choice of law	Norway (NO)	Utmost Luxembourg S.A	English (EN), Norwegian (NO)	FOS		Use this form to perform a choice of law Operational Forms Lovvalg / Choice of Law ULU CONT2360
Dichiarazione di Possesso della Qualifica di “Non-U.S. Person”	Use this form to declare a status of “Non-U.S. Person”	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOE FOS		Use this form to declare a status of “Non-U.S. Person” Operational Forms Dichiarazione di Possesso della Qualifica di “Non-U.S. Person” ULU CONT2364
Dichiarazione di Scelta di Legge / Choice of Law (FOS)	Use this form to perform a choice of law	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOS		Use this form to perform a choice of law Operational Forms Dichiarazione di Scelta di Legge / Choice of Law (FOS) ULU CONT2359
Loan Agreement	Loan agreement – United Kingdom	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Loan agreement – United Kingdom Operational Forms Loan Agreement ULU CONT2207
Wealth Preservation Trust – Flexible Trust Deed	Flexibe Trust Deed form linked to the Wealth Preservation Trust product – United Kingdom	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Flexibe Trust Deed form linked to the Wealth Preservation Trust product – United Kingdom Operational Forms Wealth Preservation Trust – Flexible Trust Deed ULU CONT2212
Loan Trust – Fixed Interest	Loan Trust agreement; Fixed Interest – United Kingdom	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Loan Trust agreement; Fixed Interest – United Kingdom Operational Forms Loan Trust – Fixed Interest ULU CONT2205
Loan Trust – Discretionary	Discretionary Loan Trust Agreement – United Kingdom	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Discretionary Loan Trust Agreement – United Kingdom Operational Forms Loan Trust – Discretionary ULU CONT2206
FATCA Egenklaering / Self Certification	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Norway (NO)	Utmost Luxembourg S.A	Norwegian (NO)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms FATCA Egenklaering / Self Certification ULU CONT2170-9
FATCA Autocertificazione (FOS)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms FATCA Autocertificazione (FOS) ULU CONT2170-7
FATCA Zelfcertificering	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms FATCA Zelfcertificering ULU CONT2170-8
FATCA Self-Certification	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	ASIA, Belgium (BE), France (FR), Germany (DE), Italy (IT), Luxembourg (LU), Mexico (MX), Portugal (PT), Spain (ES), Turkey (TR), United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms FATCA Self-Certification ULU CONT2170-5
FATCA Autocertificación	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Mexico (MX), Spain (ES)	Utmost Luxembourg S.A	Spanish (ES)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms FATCA Autocertificación ULU CONT2170-6
FATCA Selbstzertifizierung	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms FATCA Selbstzertifizierung ULU CONT2170-4
FATCA Auto-Certification	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Belgium (BE)	Utmost Luxembourg S.A	French (FR)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms FATCA Auto-Certification ULU CONT2170
FATCA Autocertificação	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Portugal (PT)	Utmost Luxembourg S.A	Portuguese (PT)	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms FATCA Autocertificação ULU CONT2170-10
Private Client Portfolio – Beneficiary Nomination Form	Annex to the application form for beneficiary nomination	Gibraltar (GI)	Utmost Luxembourg S.A	English (EN)	FOS		Annex to the application form for beneficiary nomination Operational Forms Private Client Portfolio – Beneficiary Nomination Form ULU CONT2073
Addendum to Life Assurance Policy – Investment Enhancement	Addendum for Investment Enhancement for the Private Client Portfolio product – Sweden	Sweden (SE), United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Addendum for Investment Enhancement for the Private Client Portfolio product – Sweden Operational Forms Addendum to Life Assurance Policy – Investment Enhancement ULU CONT2061
Declaration of “Non-U.S. Person” Status / Declaration de statut de « Non-U.S. Person »	Use this form to declare a status of “Non-U.S. Person”	Luxembourg (LU)	Utmost Luxembourg S.A	English (EN), French (FR)	FOS		Use this form to declare a status of “Non-U.S. Person” Operational Forms Declaration of “Non-U.S. Person” Status / Declaration de statut de « Non-U.S. Person » ULU CONT2042
Declaration of “Non-U.S. Person” Status / Declaration de statut de « Non-U.S. Person »	Use this form to declare a status of “Non-U.S. Person” for the Capitalisation Bond product – Luxembourg	Luxembourg (LU)	Utmost Luxembourg S.A	English (EN), French (FR)	FOS		Use this form to declare a status of “Non-U.S. Person” for the Capitalisation Bond product – Luxembourg Operational Forms Declaration of “Non-U.S. Person” Status / Declaration de statut de « Non-U.S. Person » ULU CONT2043
Vakuutus ”Ei Yhdysvaltalainen Henkilö” Asemasta / Declaration of “Non-U.S. Person” Status	Use this form to declare a status of “Non-U.S. Person” for the Liberté Capitalisation product – France	Finland (FI)	Utmost Luxembourg S.A	English (EN), Finnish (FI)	FOS		Use this form to declare a status of “Non-U.S. Person” for the Liberté Capitalisation product – France Operational Forms Vakuutus ”Ei Yhdysvaltalainen Henkilö” Asemasta / Declaration of “Non-U.S. Person” Status ULU CONT2039
Déclaration de Statut de « Non-U.S. Person »	Use this form to declare a status of “Non-U.S. Person”	France (FR)	Utmost Luxembourg S.A	French (FR)	FOS		Use this form to declare a status of “Non-U.S. Person” Operational Forms Déclaration de Statut de « Non-U.S. Person » ULU CONT2040
Addendum to Life Assurance Policy – Personalised Portfolio Bond	Addendum to the Personalised Portfolio Bond – Sweden	Sweden (SE), United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Addendum to the Personalised Portfolio Bond – Sweden Operational Forms Addendum to Life Assurance Policy – Personalised Portfolio Bond ULU CONT1851
Désignation des Bénéficiaires	Use this form to nominate beneficiaries	Belgium (BE)	Utmost Luxembourg S.A	French (FR)	FOS		Use this form to nominate beneficiaries Operational Forms Désignation des Bénéficiaires ULU CONT1802
Benoeming van Begunstigden	Use this form to nominate beneficiaries	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOS		Use this form to nominate beneficiaries Operational Forms Benoeming van Begunstigden ULU CONT1803
Elección de Ley Aplicable al Contrato / Choice of Law	Use this form to perform a choice of law	Spain (ES)	Utmost Luxembourg S.A	English (EN), Spanish (ES)	FOS		Use this form to perform a choice of law Operational Forms Elección de Ley Aplicable al Contrato / Choice of Law ULU CONT1796
Deklaration om Val av Tillämplig Lag / Choice of Law	Use this form to perform a choice of law	Sweden (SE)	Utmost Luxembourg S.A	English (EN), Swedish (SV)	FOS		Use this form to perform a choice of law Operational Forms Deklaration om Val av Tillämplig Lag / Choice of Law ULU CONT1793
Choix de la Loi Applicable / Choice of Law	Use this form to perform a choice of law	France (FR)	Utmost Luxembourg S.A	English (EN), French (FR)	FOS		Use this form to perform a choice of law Operational Forms Choix de la Loi Applicable / Choice of Law ULU CONT1794
Keuze van de Toepasbare Wet / Choice of Law	Use this form to perform a choice of law	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL), English (EN)	FOS		Use this form to perform a choice of law Operational Forms Keuze van de Toepasbare Wet / Choice of Law ULU CONT1791
Lainvalinta / Choice of Law	Use this form to perform a choice of law	Finland (FI)	Utmost Luxembourg S.A	English (EN), Finnish (FI)	FOS		Use this form to perform a choice of law Operational Forms Lainvalinta / Choice of Law ULU CONT1792
Choix de la Loi Applicable / Choice of Law	Use this form to perform a choice of law	Belgium (BE)	Utmost Luxembourg S.A	English (EN), French (FR)	FOS		Use this form to perform a choice of law Operational Forms Choix de la Loi Applicable / Choice of Law ULU CONT1790
Deklaration om Status som ”Icke-Amerikansk Person” / Declaration of “Non-U.S. Person” Status	Use this form to declare a status of “Non-U.S. Person”	Sweden (SE)	Utmost Luxembourg S.A	English (EN), Swedish (SV)	FOS		Use this form to declare a status of “Non-U.S. Person” Operational Forms Deklaration om Status som ”Icke-Amerikansk Person” / Declaration of “Non-U.S. Person” Status ULU CONT1637
Vakuutus ”Ei Yhdysvaltalainen Henkilö” Asemasta / Declaration of “Non-U.S. Person” Status	Use this form to declare a status of “Non-U.S. Person”	Finland (FI)	Utmost Luxembourg S.A	English (EN), Finnish (FI)	FOS		Use this form to declare a status of “Non-U.S. Person” Operational Forms Vakuutus ”Ei Yhdysvaltalainen Henkilö” Asemasta / Declaration of “Non-U.S. Person” Status ULU CONT1638
Verklaring omtrent „Non-U.S. Person”-status	Use this form to declare a status of “Non-U.S. Person”	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOS		Use this form to declare a status of “Non-U.S. Person” Operational Forms Verklaring omtrent „Non-U.S. Person”-status ULU CONT1634
Declaración como « Persona no Estadounidense »	Use this form to declare a status of “Non-U.S. Person”	Spain (ES)	Utmost Luxembourg S.A	English (EN), Spanish (ES)	FOS		Use this form to declare a status of “Non-U.S. Person” Operational Forms Declaración como « Persona no Estadounidense » ULU CONT1636
Déclaration de Statut de « Non-U.S. Person »	Use this form to declare a status of “Non-U.S. Person”	Belgium (BE)	Utmost Luxembourg S.A	French (FR)	FOS		Use this form to declare a status of “Non-U.S. Person” Operational Forms Déclaration de Statut de « Non-U.S. Person » ULU CONT1632
Erklärung bezüglich des Status „Nicht-US -Person“	Use this form to declare a status of “Non-U.S. Person”	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Use this form to declare a status of “Non-U.S. Person” Operational Forms Erklärung bezüglich des Status „Nicht-US -Person“ ULU CONT1633
Utnevnelse av Forsikringstakeren til Investeringsforvalter / Appointment of the Policyholder as Investment Manager	Use this form to appoint an Investment Manager/Advisor – Norway	Norway (NO)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to appoint an Investment Manager/Advisor – Norway Operational Forms Utnevnelse av Forsikringstakeren til Investeringsforvalter / Appointment of the Policyholder as Investment Manager ULU CONT1452
Appointment of the Policyholder(s) as Investment Manager – Swedish Market	Use this form to appoint an Investment Manager/Advisor – Sweden	Sweden (SE)	Utmost Luxembourg S.A	English (EN), Swedish (SV)	FOS		Use this form to appoint an Investment Manager/Advisor – Sweden Operational Forms Appointment of the Policyholder(s) as Investment Manager – Swedish Market ULU CONT1452-2
Change Request to Discretionary Mandate	Use this form to appoint an Investment Manager/Advisor	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to appoint an Investment Manager/Advisor Operational Forms Change Request to Discretionary Mandate ULU CONT1318
Private Client Portfolio – Discretionary Management Form – UK	Use this form to request the appointment of a discretionary Investment Manager	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Use this form to request the appointment of a discretionary Investment Manager Operational Forms Private Client Portfolio – Discretionary Management Form – UK ULU CONT1412
Request for Change of Life Cover	Change of Life Cover form	Sweden (SE)	Utmost Luxembourg S.A	English (EN)	FOS		Change of Life Cover form Operational Forms Request for Change of Life Cover ULU CONT1129
Confirmation des coordonnées du Client utilisées pour la signature électronique des documents	Confirmation of Client contact details used for the Electronic Signing of documents	France (FR)	Utmost Luxembourg S.A	French (FR)	FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Confirmation des coordonnées du Client utilisées pour la signature électronique des documents ULU CONNECT1057
Conferma dei dati di contatto del cliente utilizzati per la firma elettronica dei documenti	Confirmation of Client contact details used for the Electronic Signing of documents	Italy (IT)	Utmost Luxembourg S.A	Italian (IT)	FOE FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Conferma dei dati di contatto del cliente utilizzati per la firma elettronica dei documenti ULU CONNECT1058
Bekreftelse av kundens kontaktinformasjon brukt for elektronisk signering av dokumenter / Confirmation of Client contact details used for the Electronic Signing of documents	Confirmation of Client contact details used for the Electronic Signing of documents	Norway (NO)	Utmost Luxembourg S.A	English (EN), Norwegian (NO)	FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Bekreftelse av kundens kontaktinformasjon brukt for elektronisk signering av dokumenter / Confirmation of Client contact details used for the Electronic Signing of documents ULU CONNECT1055
Confirmation of Client contact details used for the Electronic Signing of documents / Confirmation des coordonnées du Client utilisées pour la signature électronique des documents	Confirmation of Client contact details used for the Electronic Signing of documents	Luxembourg (LU)	Utmost Luxembourg S.A	English (EN), French (FR)	FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Confirmation of Client contact details used for the Electronic Signing of documents / Confirmation des coordonnées du Client utilisées pour la signature électronique des documents ULU CONNECT1056
Bekräftelse av de kontaktuppgifter till kunden som används för elektronisk signering av dokument / Confirmation of Client contact details used for the Electronic Signing of documents	Confirmation of Client contact details used for the Electronic Signing of documents	Sweden (SE)	Utmost Luxembourg S.A	English (EN), Swedish (SV)	FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Bekräftelse av de kontaktuppgifter till kunden som används för elektronisk signering av dokument / Confirmation of Client contact details used for the Electronic Signing of documents ULU CONNECT1053
Asiakirjojen sähköisessä allekirjoittamisessa käytettävien asiakkaan yhteystietojen vahvistaminen / Confirmation of Client contact details used for the Electronic Signing of documents	Confirmation of Client contact details used for the Electronic Signing of documents	Finland (FI)	Utmost Luxembourg S.A	English (EN), Finnish (FI)	FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Asiakirjojen sähköisessä allekirjoittamisessa käytettävien asiakkaan yhteystietojen vahvistaminen / Confirmation of Client contact details used for the Electronic Signing of documents ULU CONNECT1054
Confirmación de los datos de contacto del cliente utilizados para la firma electrónica de documentos / Confirmation of Client contact details used for the Electronic Signing of documents	Confirmation of Client contact details used for the Electronic Signing of documents	Mexico (MX), Spain (ES)	Utmost Luxembourg S.A	English (EN), Spanish (ES)	FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Confirmación de los datos de contacto del cliente utilizados para la firma electrónica de documentos / Confirmation of Client contact details used for the Electronic Signing of documents ULU CONNECT1051
Confirmação dos dados de contato do Cliente utilizados para a Assinatura Eletrónica de Documentos / Confirmation of Client contact details used for the Electronic Signing of documents	Confirmation of Client contact details used for the Electronic Signing of documents	Portugal (PT)	Utmost Luxembourg S.A	English (EN), Portuguese (PT)	FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Confirmação dos dados de contato do Cliente utilizados para a Assinatura Eletrónica de Documentos / Confirmation of Client contact details used for the Electronic Signing of documents ULU CONNECT1052
Bevestiging van contactgegevens van de Cliënt die worden gebruikt voor de elektronische ondertekening van documenten	Confirmation of Client contact details used for the Electronic Signing of documents	Belgium (BE)	Utmost Luxembourg S.A	Dutch (NL)	FOE FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Bevestiging van contactgegevens van de Cliënt die worden gebruikt voor de elektronische ondertekening van documenten ULU CONNECT1049
Bestätigung der für die elektronische Unterzeichnung von Dokumenten verwendeten Kundenkontaktdaten	Confirmation of Client contact details used for the Electronic Signing of documents	Germany (DE)	Utmost Luxembourg S.A	German (DE)	FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Bestätigung der für die elektronische Unterzeichnung von Dokumenten verwendeten Kundenkontaktdaten ULU CONNECT1050
Confirmation of Client contact details used for the Electronic Signing of documents	Confirmation of Client contact details used for the Electronic Signing of documents	ASIA, Cyprus (CY), Gibraltar (GI), Greece (GR), Israel (IL), Jersey (JE), United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Confirmation of Client contact details used for the Electronic Signing of documents ULU CONNECT1046
Confirmation des coordonnées du Client utilisées pour la signature électronique des documents	Confirmation of Client contact details used for the Electronic Signing of documents	Belgium (BE)	Utmost Luxembourg S.A	French (FR)	FOE FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Confirmation des coordonnées du Client utilisées pour la signature électronique des documents ULU CONNECT1048
Declaration of Loss or Non-Receipt of Policy Form	This declaration form is for use in Hong Kong only and can be used if your policy documents were lost, destroyed or never received.	Hong Kong (HK)	Utmost International - IoM	English (EN)	FOS	Surrender or Claim	This declaration form is for use in Hong Kong only and can be used if your policy documents were lost, destroyed or never received. Operational Forms Declaration of Loss or Non-Receipt of Policy Form ULQ PR \| 6019
Request to Trustees for Loan Repayment and Acknowledgement of Receipt of Loan Payment	This document contains draft wording which the settlor can use to request the repayment of a loan from the trustees of a loan trust.It is for use with the settlor’s own legal advisers in relation to the Loan Trust, available with a Utmost International Bond.This document cannot be used to instruct Utmost International to make a surrender.	United Kingdom (UK)	Utmost International - IoM	English (EN)		New Policy	This document contains draft wording which the settlor can use to request the repayment of a loan from the trustees of a loan trust.It is for use with the settlor’s own legal advisers in relation to the Loan Trust, available with a Utmost International Bond.This document cannot be used to instruct Utmost International to make a surrender. Operational Forms Request to Trustees for Loan Repayment and Acknowledgement of Receipt of Loan Payment ULQ PR \| 25158
Policy Replacement Questionnaire and IFS-PR (Chinese)	Policy Replacement Questionnaire should be completed for all new application. You only need to complete the IFS-PR if you have answered ‘yes’ or ‘Not yet decided’ in the Policy Replacement Questionnaire.	Hong Kong (HK)	Utmost International - IoM	Chinese (Simplified) (ZH)		New Policy	Policy Replacement Questionnaire should be completed for all new application. You only need to complete the IFS-PR if you have answered ‘yes’ or ‘Not yet decided’ in the Policy Replacement Questionnaire. Operational Forms Policy Replacement Questionnaire and IFS-PR (Chinese) ULQ PR \| 21289
Policy Replacement Questionnaire and IFS-PR (English)	This Policy Replacement Questionnaire should be completed for all new applications. You only need to complete the IFS-PR if you have answered ‘yes’ or ‘Not yet decided’ in the Policy Replacement Questionnaire.	Hong Kong (HK)	Utmost International - IoM	English (EN)	FOS	New Policy	This Policy Replacement Questionnaire should be completed for all new applications. You only need to complete the IFS-PR if you have answered ‘yes’ or ‘Not yet decided’ in the Policy Replacement Questionnaire. Operational Forms Policy Replacement Questionnaire and IFS-PR (English) ULQ PR \| 21288
Declaración Fiscal y Autocertificación para Trusts/Fideicomisos	Rellene este formulario para que Utmost pueda informar con precisión sobre su póliza en virtud de los acuerdos de intercambio de información fiscal pertinentes, incluidas las normas de la Ley de Cumplimiento Tributario de Cuentas Extranjeras (FATCA) y el Estándar Común de Comunicación de Reporte (CRS). Este formulario debe utilizarse para trusts en los que todos los fideicomisarios sean personas físicas. Debe ser rellenado por un fideicomisario en nombre del trust.	Europe Expat, Spain (ES), United Kingdom (UK)	Utmost Wealth Solutions	Spanish (ES)	FOS	Making a change to your policy, New Policy	Rellene este formulario para que Utmost pueda informar con precisión sobre su póliza en virtud de los acuerdos de intercambio de información fiscal pertinentes, incluidas las normas de la Ley de Cumplimiento Tributario de Cuentas Extranjeras (FATCA) y el Estándar Común de Comunicación de Reporte (CRS). Este formulario debe utilizarse para trusts en los que todos los fideicomisarios sean personas físicas. Debe ser rellenado por un fideicomisario en nombre del trust. Operational Forms Declaración Fiscal y Autocertificación para Trusts/Fideicomisos ULQ PR \| 21019
Advisory Fee Authority – Unit-linked Plans	This form can be used if you wish to make arrangements to pay an advisory fee to an intermediary for advice provided in respect of your Utmost International Isle of Man account.	Singapore (SG)	Utmost International - IoM	English (EN)		Making a change to your policy	This form can be used if you wish to make arrangements to pay an advisory fee to an intermediary for advice provided in respect of your Utmost International Isle of Man account. Operational Forms Advisory Fee Authority – Unit-linked Plans ULQ PR \| 13326
Hong Kong switch form for use with Unit-linked accounts (English)	Switch Form for use with Unit-Linked Accounts. For Hong Kong use only.	Hong Kong (HK)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	Switch Form for use with Unit-Linked Accounts. For Hong Kong use only. Operational Forms Hong Kong switch form for use with Unit-linked accounts (English) ULQ PR \| 13555
Tax Declaration and Self-Certification for Trustee and Corporate Investors – Hong Kong (FATCA/CRS)	This form is to be used by Trustee and Corporate Trustee Investors, in the Hong Kong market only, to confirm their country of Tax Residence and related Tax Identification Numbers. Bilingual – Chinese/English	Hong Kong (HK)	Utmost International - IoM	Chinese (Traditional) (ZH), English (EN)	FOS	New Policy	This form is to be used by Trustee and Corporate Trustee Investors, in the Hong Kong market only, to confirm their country of Tax Residence and related Tax Identification Numbers. Bilingual – Chinese/English Operational Forms Tax Declaration and Self-Certification for Trustee and Corporate Investors – Hong Kong (FATCA/CRS) ULQ PR \| 13276
Tax Declaration and Self Certification for Individual Investors – Hong Kong (FATCA/CRS)	This form is to be used by Individual Investors, in the Hong Kong market only, to confirm their country of Tax Residence and related Tax Identification Numbers. Bilingual – Chinese/English	Hong Kong (HK)	Utmost International - IoM	Chinese (Traditional) (ZH), English (EN)	FOS	New Policy	This form is to be used by Individual Investors, in the Hong Kong market only, to confirm their country of Tax Residence and related Tax Identification Numbers. Bilingual – Chinese/English Operational Forms Tax Declaration and Self Certification for Individual Investors – Hong Kong (FATCA/CRS) ULQ PR \| 13273
Declaración Fiscal y Autocertificación para Personas Fisicas	Rellene este formulario para permitir que Utmost informe con precisión sobre su póliza en virtud de los acuerdos de intercambio de información fiscal pertinentes, incluidas las normas de la Ley de Cumplimiento Tributario de Cuentas Extranjeras (FATCA) y el Estándar Común de Comunicación de Información (CRS). Este formulario debe utilizarse para los titulares de pólizas individuales, las personas autorizadas para firmar en nombre del titular de la póliza, por ejemplo, su apoderado o representante designado por un tribunal, y las personas vinculadas al fideicomiso en el que Utmost International Trustee Solutions Limited es el fideicomisario designado.	Europe Expat, Spain (ES), United Kingdom (UK)	Utmost Wealth Solutions	Spanish (ES)	FOS	Making a change to your policy, New Policy	Rellene este formulario para permitir que Utmost informe con precisión sobre su póliza en virtud de los acuerdos de intercambio de información fiscal pertinentes, incluidas las normas de la Ley de Cumplimiento Tributario de Cuentas Extranjeras (FATCA) y el Estándar Común de Comunicación de Información (CRS). Este formulario debe utilizarse para los titulares de pólizas individuales, las personas autorizadas para firmar en nombre del titular de la póliza, por ejemplo, su apoderado o representante designado por un tribunal, y las personas vinculadas al fideicomiso en el que Utmost International Trustee Solutions Limited es el fideicomisario designado. Operational Forms Declaración Fiscal y Autocertificación para Personas Fisicas ULQ PR \| 13271
Enhanced Trail Commission Singapore version	This document describes the terms on which Utmost International Isle of Man Limited (Utmost International) agrees to pay enhanced trail commission (‘ETC’) to the Intermediary.	Singapore (SG)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	This document describes the terms on which Utmost International Isle of Man Limited (Utmost International) agrees to pay enhanced trail commission (‘ETC’) to the Intermediary. Operational Forms Enhanced Trail Commission Singapore version ULQ PR \| 13055
Skatteuppgifter och försäkran För enheter (Tax Info and Self-Certification for Entity Investors) (FATCA/CRS)	Vänligen använd det här formuläret för att bekräfta skattestatusen för förvaltare och företagssökande. Please use this form to confirm the tax status for Trustee and Corporate applicants.	Sweden (SE)	Utmost International - IoM	English (EN), Swedish (SV)		New Policy	Vänligen använd det här formuläret för att bekräfta skattestatusen för förvaltare och företagssökande. Please use this form to confirm the tax status for Trustee and Corporate applicants. Operational Forms Skatteuppgifter och försäkran För enheter (Tax Info and Self-Certification for Entity Investors) (FATCA/CRS) ULQ PR \| 12690
Skatteuppgifter och försäkran För individer (Tax Info and Self-Certification for Individual Investors) (FATCA/CRS)	Använd detta formulär för att bekräfta skattestatusen för enskilda sökande. Please use this form to confirm the tax status for individual applicants.	Sweden (SE)	Utmost International - IoM	English (EN), Swedish (SV)		New Policy	Använd detta formulär för att bekräfta skattestatusen för enskilda sökande. Please use this form to confirm the tax status for individual applicants. Operational Forms Skatteuppgifter och försäkran För individer (Tax Info and Self-Certification for Individual Investors) (FATCA/CRS) ULQ PR \| 12689
Deed of Assignment Singapore	Deed of assignment for one or more assignees. This deed should be used for Utmost International Isle of Man Singapore products only.	Singapore (SG)	Utmost International - IoM	English (EN)		Making a change to your policy	Deed of assignment for one or more assignees. This deed should be used for Utmost International Isle of Man Singapore products only. Operational Forms Deed of Assignment Singapore ULQ PR \| 11553
Affordability Declaration (Bilingual)	This document can be used by applicants over aged 60 – to declare the affordability of the relevant premium invested.	Hong Kong (HK)	Utmost International - IoM	Chinese (Simplified) (ZH), English (EN)		New Policy	This document can be used by applicants over aged 60 – to declare the affordability of the relevant premium invested. Operational Forms Affordability Declaration (Bilingual) ULQ PR \| 10967
Professional Investor Declaration Corporate Trust (ie trust corporation) Applicants	This is a Professional Investor Declaration for Investment in investment linked assurance scheme and non SFC authorised underlying asset choices for corporate trust (ie trust corporation) applicants.	Hong Kong (HK)	Utmost International - IoM	Chinese (Simplified) (ZH), English (EN)		New Policy	This is a Professional Investor Declaration for Investment in investment linked assurance scheme and non SFC authorised underlying asset choices for corporate trust (ie trust corporation) applicants. Operational Forms Professional Investor Declaration Corporate Trust (ie trust corporation) Applicants ULQ PR \| 10110
Professional Investor Declaration for Individual Applicants	This is a Professional Investor Declaration for Investment in investment linked assurance scheme and non SFC authorised underlying asset choices for individual applicants.	Hong Kong (HK)	Utmost International - IoM	Chinese (Simplified) (ZH), English (EN)		New Policy	This is a Professional Investor Declaration for Investment in investment linked assurance scheme and non SFC authorised underlying asset choices for individual applicants. Operational Forms Professional Investor Declaration for Individual Applicants ULQ PR \| 10108
Professional Investor Declaration Corporate Partnership Applicants (Bilingual)	This is a Professional Investor Declaration for Investment in investment linked assurance scheme and non SFC authorised underlying asset choices for corporate partnership applicants.	Hong Kong (HK)	Utmost International - IoM	Chinese (Simplified) (ZH), English (EN)		New Policy	This is a Professional Investor Declaration for Investment in investment linked assurance scheme and non SFC authorised underlying asset choices for corporate partnership applicants. Operational Forms Professional Investor Declaration Corporate Partnership Applicants (Bilingual) ULQ PR \| 10109
Telegraphic Transfer Details for Utmost International Isle of Man Limited	This document contains the telegraphic transfer details for transferring money to Utmost International Isle of Man Limited via Wealth Interactive.	Europe Expat, Middle East, Sweden (SE), United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	New Policy	This document contains the telegraphic transfer details for transferring money to Utmost International Isle of Man Limited via Wealth Interactive. Operational Forms Telegraphic Transfer Details for Utmost International Isle of Man Limited ULQ PR \| 09352
Investment Account Application Form – Individual Investors	This form can only be used for top-ups as this product is closed to new business. Use this application for individual investors.Please note that you will also need to fill out the Tax Declaration and Self Certification document.	Singapore (SG)	Utmost International - IoM	English (EN)	FOS	New Policy	This form can only be used for top-ups as this product is closed to new business. Use this application for individual investors.Please note that you will also need to fill out the Tax Declaration and Self Certification document. Operational Forms Investment Account Application Form – Individual Investors ULQ PR \| 09305
Wealth Interactive – Master User Registration Form for Existing Firms	Please use this form to appoint a master user to Wealth Interactive for adviser firms who already have terms of business with us.This form will allow us access to a nominated master user within your firm who can then grant access to other users (including other master users within your firm).	Hong Kong (HK), Middle East, Rest of the World, Singapore (SG), United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	New Policy	Please use this form to appoint a master user to Wealth Interactive for adviser firms who already have terms of business with us.This form will allow us access to a nominated master user within your firm who can then grant access to other users (including other master users within your firm). Operational Forms Wealth Interactive – Master User Registration Form for Existing Firms ULQ PR \| 08775
Appointment of a Lead Policyholder on the Flexible Investment Account	This form can be used to appoint a lead policyholder – for use with the Flexible Investment Account	Singapore (SG)	Utmost International - IoM	English (EN)		Making a change to your policy	This form can be used to appoint a lead policyholder – for use with the Flexible Investment Account Operational Forms Appointment of a Lead Policyholder on the Flexible Investment Account ULQ PR \| 08425
Beneficiary Nomination Request Form – for Accountholders Policyholders	This form can be used where the Accountholders wish to transfer the ownership of the Contract on the death of the Relevant Accountholder and this does not bring the Contract to an end;orFor use by both Individual and Corporate Accountholders. Where the Accountholders wish to transfer the ownership of the benefits on the death of the Relevant Life Assured and this brings the Contract to an end.	Hong Kong (HK), Middle East, United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	New Policy	This form can be used where the Accountholders wish to transfer the ownership of the Contract on the death of the Relevant Accountholder and this does not bring the Contract to an end;orFor use by both Individual and Corporate Accountholders. Where the Accountholders wish to transfer the ownership of the benefits on the death of the Relevant Life Assured and this brings the Contract to an end. Operational Forms Beneficiary Nomination Request Form – for Accountholders Policyholders ULQ PR \| 07959
Singapore Trust Beneficiary Form 6 – Notice of Revocation of Revocable Nomination	This form can only be used to give notice of the revocation, under section 49M(7)(a) or (b) of the Insurance Act (Cap. Executive Redemption Bond – PRIIPs), of revocable nomination made in respect of one relevant policy.	Singapore (SG)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	This form can only be used to give notice of the revocation, under section 49M(7)(a) or (b) of the Insurance Act (Cap. Executive Redemption Bond – PRIIPs), of revocable nomination made in respect of one relevant policy. Operational Forms Singapore Trust Beneficiary Form 6 – Notice of Revocation of Revocable Nomination ULQ PR \| 07058
Singapore Trust Beneficiary Form 5 – Revocation of Revocable Nomination	This form can only be used to revoke a revocable nomination made in respect of one relevant policy. For use in the Singapore market only.	Singapore (SG)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	This form can only be used to revoke a revocable nomination made in respect of one relevant policy. For use in the Singapore market only. Operational Forms Singapore Trust Beneficiary Form 5 – Revocation of Revocable Nomination ULQ PR \| 07057
Singapore Trust Beneficiary Form 4 – Revocable Nomination	This form can only be used to make a revocable nomination in respect of one relevant policy. For use in the Singapore market only.	Singapore (SG)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	This form can only be used to make a revocable nomination in respect of one relevant policy. For use in the Singapore market only. Operational Forms Singapore Trust Beneficiary Form 4 – Revocable Nomination ULQ PR \| 07056
Singapore Trust Beneficiary Nomination Form 1	The Trust Beneficiary Nomination for is for use in the Singapore market only and is to be used to make a trust nomination in respect of one relevant policy only.	Singapore (SG)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	The Trust Beneficiary Nomination for is for use in the Singapore market only and is to be used to make a trust nomination in respect of one relevant policy only. Operational Forms Singapore Trust Beneficiary Nomination Form 1 ULQ PR \| 07053
Singapore Trust Beneficiary Revocation of Nomination Form 2	This form can only be used to revoke a trust nomination made in respect of one relevant policy.	Singapore (SG)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	This form can only be used to revoke a trust nomination made in respect of one relevant policy. Operational Forms Singapore Trust Beneficiary Revocation of Nomination Form 2 ULQ PR \| 07054
Utmost International Isle of Man Letter of Wishes Form	This form can be used should the settlors like to include additional wishes be taken into account with regard to the Declaration of Trust.	Rest of the World, United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	New Policy	This form can be used should the settlors like to include additional wishes be taken into account with regard to the Declaration of Trust. Operational Forms Utmost International Isle of Man Letter of Wishes Form ULQ PR \| 05862
Request for Fixed Account Loan Withdrawal Form	This form can be used to request Utmost International Isle of Man or Utmost PanEurope to transfer monies to the fixed account and issue a loan withdrawal for the same amount.	Europe Expat, Middle East, Rest of the World	Utmost International - IoM	English (EN)	FOS	Surrender or Claim	This form can be used to request Utmost International Isle of Man or Utmost PanEurope to transfer monies to the fixed account and issue a loan withdrawal for the same amount. Operational Forms Request for Fixed Account Loan Withdrawal Form ULQ PR \| 04839
Declaration of Loss or Non-receipt of Policy Form	This declaration form can be used if your Utmost International Isle of Manpolicy documents were lost, destroyed or never received.	Middle East, Rest of the World, Singapore (SG)	Utmost International - IoM	English (EN)	FOS	New Policy	This declaration form can be used if your Utmost International Isle of Manpolicy documents were lost, destroyed or never received. Operational Forms Declaration of Loss or Non-receipt of Policy Form ULQ PR \| 01944
Delegated Switching Authority Form	This form can be used by clients to delegate the switching of funds to their funds adviser. The fund adviser will then be able to switch funds at any time without the need for client approval.	Middle East, Rest of the World	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	This form can be used by clients to delegate the switching of funds to their funds adviser. The fund adviser will then be able to switch funds at any time without the need for client approval. Operational Forms Delegated Switching Authority Form ULQ PR \| 00838
Automatic Exchange of Information – Self-Certification (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	English (EN)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Automatic Exchange of Information – Self-Certification (FOE) ULIT CONT4269
Automatic Exchange of Information – Self-Certification (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	English (EN)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Automatic Exchange of Information – Self-Certification (FOE) ULIT CONT4245
Automatic Exchange of Information – Self-Certification (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	English (EN)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Automatic Exchange of Information – Self-Certification (FOE) ULIT CONT4257
Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	Italian (IT)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE) ULIT CONT2597
Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	Italian (IT)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE) ULIT CONT2600
Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	Italian (IT)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE) ULIT CONT2594
FATCA Autocertificazione (FOE)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	Italian (IT)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms FATCA Autocertificazione (FOE) ULIT CONT2170-3
Dichiarazione di Scelta di Legge / Choice of Law (FOE)	Use this form to perform a choice of law	Italy (IT)	Utmost Luxembourg S.A. - Italian Branch	English (EN), Italian (IT)	FOE		Use this form to perform a choice of law Operational Forms Dichiarazione di Scelta di Legge / Choice of Law (FOE) ULIT CONT1795
Wijziging van de voornaamste kenmerken van een bestaand Intern Toegewezen Fonds	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	FOE		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Wijziging van de voornaamste kenmerken van een bestaand Intern Toegewezen Fonds ULBE PCON1561
Modification des caractéristiques principales d’un Fonds Interne Dédié existant	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	FOE		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Modification des caractéristiques principales d’un Fonds Interne Dédié existant ULBE PCON1560
Formulaire de changement de moyen de communication et utilisation des signatures électroniques	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	FOE		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Formulaire de changement de moyen de communication et utilisation des signatures électroniques ULBE PCON1530
Wijziging van het communicatiemiddel voor correspondentie en het gebruik van elektronische handtekeningen	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	FOE		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Wijziging van het communicatiemiddel voor correspondentie en het gebruik van elektronische handtekeningen ULBE PCON1529
Aanstelling van Tussenpersoon	Use this form to request an appointment or change of broker	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	FOE		Use this form to request an appointment or change of broker Operational Forms Aanstelling van Tussenpersoon ULBE PCON1430
Désignation d’Intermédiaire	Use this form to request an appointment or change of broker	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	FOE		Use this form to request an appointment or change of broker Operational Forms Désignation d’Intermédiaire ULBE PCON1429
Benoeming van Begunstigden	Use this form to nominate beneficiaries	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	FOE		Use this form to nominate beneficiaries Operational Forms Benoeming van Begunstigden ULBE CONT4383
Désignation des Bénéficiaires	Use this form to nominate beneficiaries	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	FOE		Use this form to nominate beneficiaries Operational Forms Désignation des Bénéficiaires ULBE CONT4382
Aanvraag van het Statuut van Professionele Cliënt / Request for Professional Client Status (Branch)	Request for Professional Client Status	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL), English (EN)	FOE		Request for Professional Client Status Operational Forms Aanvraag van het Statuut van Professionele Cliënt / Request for Professional Client Status (Branch) ULBE CONT3208
Demande de Statut de Client Professionnel / Request for Professional Client Status (Branch)	Request for Professional Client Status	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	English (EN), French (FR)	FOE		Request for Professional Client Status Operational Forms Demande de Statut de Client Professionnel / Request for Professional Client Status (Branch) ULBE CONT3209
Choix de la Loi Applicable / Choice of Law (Branch)	Use this form to perform a choice of law	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	English (EN), French (FR)	FOE		Use this form to perform a choice of law Operational Forms Choix de la Loi Applicable / Choice of Law (Branch) ULBE CONT3195
Keuze van de Toepasbare Wet / Choice of Law	Use this form to perform a choice of law	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL), English (EN)	FOE		Use this form to perform a choice of law Operational Forms Keuze van de Toepasbare Wet / Choice of Law ULBE CONT3196
Overzicht van bijkomende administratieve vergoedingen	Annex showing the activity-based charging grid	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	FOE		Annex showing the activity-based charging grid Operational Forms Overzicht van bijkomende administratieve vergoedingen ULBE CONT3181
Aperçu des frais administratifs additionnels	Annex showing the activity-based charging grid	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	FOE		Annex showing the activity-based charging grid Operational Forms Aperçu des frais administratifs additionnels ULBE CONT3182
FATCA Auto-certification	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms FATCA Auto-certification ULBE CONT2825
FATCA Self-Certification	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	English (EN)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms FATCA Self-Certification ULBE CONT2826
FATCA Zelfcertificering	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms FATCA Zelfcertificering ULBE CONT2824
Avenant au contrat d’assurance-vie – Acceptation du bénéfice (Branch)	Annex to the application form for beneficiary acceptance	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	FOE		Annex to the application form for beneficiary acceptance Operational Forms Avenant au contrat d’assurance-vie – Acceptation du bénéfice (Branch) ULBE CONT2805
Avenant au contrat d’assurance-vie – Dissolution de cession de droits (Branch)	Annex to the application form for signing the dissolution of the transfer of insurance rights	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	FOE		Annex to the application form for signing the dissolution of the transfer of insurance rights Operational Forms Avenant au contrat d’assurance-vie – Dissolution de cession de droits (Branch) ULBE CONT2801
Bijvoegsel bij de levensverzekeringsovereenkomst – Aanvaarding van de begunstiging (Branch)	Annex to the application form for beneficiary acceptance	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	FOE		Annex to the application form for beneficiary acceptance Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Aanvaarding van de begunstiging (Branch) ULBE CONT2804
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes détenant le contrôle (Branch)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes détenant le contrôle (Branch) ULBE CONT2796
Bijvoegsel bij de levensverzekeringsovereenkomst – Ontbinding van de overdracht van verzekeringsrechten (Branch)	Annex to the application form for signing the dissolution of the transfer of insurance rights	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	FOE		Annex to the application form for signing the dissolution of the transfer of insurance rights Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Ontbinding van de overdracht van verzekeringsrechten (Branch) ULBE CONT2800
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes physiques (Branch)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes physiques (Branch) ULBE CONT2794
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les entités (Branch)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les entités (Branch) ULBE CONT2795
Automatische Uitwisseling van Inlichtingen Zelfcertificering	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Automatische Uitwisseling van Inlichtingen Zelfcertificering ULBE CONT2792
Automatische Uitwisseling van Inlichtingen Zelfcertificering	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Automatische Uitwisseling van Inlichtingen Zelfcertificering ULBE CONT2793
Avenant au contrat d’assurance-vie – Convention de Cession Post Mortem des droits découlant du Contrat (Branch)	Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	FOE		Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy Operational Forms Avenant au contrat d’assurance-vie – Convention de Cession Post Mortem des droits découlant du Contrat (Branch) ULBE CONT2789
Automatische Uitwisseling van Inlichtingen Zelfcertificering	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Automatische Uitwisseling van Inlichtingen Zelfcertificering ULBE CONT2791
Bijvoegsel bij de levensverzekeringsovereenkomst – Overeenkomst van Overdracht Post Mortem van de uit de Overeenkomst voortvloeiende rechten (Branch)	Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	FOE		Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Overeenkomst van Overdracht Post Mortem van de uit de Overeenkomst voortvloeiende rechten (Branch) ULBE CONT2788
Novation Agreement	This agreement is used where the servicing rights for a number of Utmost International Isle of Man Limited policies, former Quilter UPE policies or Alpha International products, administered by Utmost Wealth Solutions are being transferred from one financial adviser firm to another following a novation.This form is to be completed by financial advisers only.	United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	This agreement is used where the servicing rights for a number of Utmost International Isle of Man Limited policies, former Quilter UPE policies or Alpha International products, administered by Utmost Wealth Solutions are being transferred from one financial adviser firm to another following a novation.This form is to be completed by financial advisers only. Operational Forms Novation Agreement UL PR 0243
Pay-By-Link Multi-Currency Bilingual English and Traditional Chinese	This document describes how to use our Pay-By-Link service.If you are an Utmost International Isle of Man Limited Hong Kong Branch client and pay regular premiums into your Executive Wealthbuilder Account, International Mortgage Account, Managed Account Plus, Managed Capital Account, Managed Pension Account, or Managed Savings Account, regardless of your current payment method, you can use the Pay-By-Link service.	Hong Kong (HK)	Utmost International - IoM	English (EN)		Making a change to your policy, New Policy	This document describes how to use our Pay-By-Link service.If you are an Utmost International Isle of Man Limited Hong Kong Branch client and pay regular premiums into your Executive Wealthbuilder Account, International Mortgage Account, Managed Account Plus, Managed Capital Account, Managed Pension Account, or Managed Savings Account, regardless of your current payment method, you can use the Pay-By-Link service. Operational Forms Pay-By-Link Multi-Currency Bilingual English and Traditional Chinese UL PR 00451
Details of Telegraphic Transfers	This document includes the banking details for Utmost International Isle of Man Limited Hong Kong Branch	Hong Kong (HK)	Utmost International - IoM	English (EN)	FOS	New Policy	This document includes the banking details for Utmost International Isle of Man Limited Hong Kong Branch Operational Forms Details of Telegraphic Transfers UL PR 00453
UIIOM Pay-By-Link Euro	This document describes how to use our Pay-By-Link service.If you are an Utmost International Isle of Man Limited client and you pay regular premiums into your Executive Wealthbuilder Account, Guaranteed Mortgage and Investment Plan, International Mortgage Account, International Portable Pension Plan, Managed Account Plus, Managed Capital Account, Managed Pension Account, Managed Savings Account or Pension Wealthbuilder Account inEuro, regardless of your current payment method, you can use the Pay-By-Link service.	Europe Expat, Middle East, Rest of the World, United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	This document describes how to use our Pay-By-Link service.If you are an Utmost International Isle of Man Limited client and you pay regular premiums into your Executive Wealthbuilder Account, Guaranteed Mortgage and Investment Plan, International Mortgage Account, International Portable Pension Plan, Managed Account Plus, Managed Capital Account, Managed Pension Account, Managed Savings Account or Pension Wealthbuilder Account inEuro, regardless of your current payment method, you can use the Pay-By-Link service. Operational Forms UIIOM Pay-By-Link Euro UL PR 00439
UIIOM Pay-By-Link Pound Sterling	This document describes how to use our Pay-By-Link service.If you are an Utmost International Isle of Man Limited client and you pay regular premiums into your Executive Wealthbuilder Account, Guaranteed Mortgage and Investment Plan, International Mortgage Account, International Portable Pension Plan, Managed Account Plus, Managed Capital Account, Managed Pension Account, Managed Savings Account or Pension Wealthbuilder Account inPound Sterling, regardless of your current payment method, you can use the Pay-By-Link service.	Europe Expat, Middle East, Rest of the World, United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	This document describes how to use our Pay-By-Link service.If you are an Utmost International Isle of Man Limited client and you pay regular premiums into your Executive Wealthbuilder Account, Guaranteed Mortgage and Investment Plan, International Mortgage Account, International Portable Pension Plan, Managed Account Plus, Managed Capital Account, Managed Pension Account, Managed Savings Account or Pension Wealthbuilder Account inPound Sterling, regardless of your current payment method, you can use the Pay-By-Link service. Operational Forms UIIOM Pay-By-Link Pound Sterling UL PR 00450
UIIOM Pay-By-Link Hong Kong Dollar	This document describes how to use our Pay-By-Link service.If you are an Utmost International Isle of Man Limited client and you pay regular premiums in Hong Kong Dollar, regardless of your current payment method, you can use the Pay-By-Link service to pay into your Executive Wealthbuilder Account, Guaranteed Mortgage and Investment Plan, International Mortgage Account, International Portable Pension Plan, Managed Account Plus, Managed Capital Account, Managed Pension Account, Managed Savings Account or Pension Wealthbuilder Account.	Hong Kong (HK)	Utmost International - IoM	English (EN)		Making a change to your policy	This document describes how to use our Pay-By-Link service.If you are an Utmost International Isle of Man Limited client and you pay regular premiums in Hong Kong Dollar, regardless of your current payment method, you can use the Pay-By-Link service to pay into your Executive Wealthbuilder Account, Guaranteed Mortgage and Investment Plan, International Mortgage Account, International Portable Pension Plan, Managed Account Plus, Managed Capital Account, Managed Pension Account, Managed Savings Account or Pension Wealthbuilder Account. Operational Forms UIIOM Pay-By-Link Hong Kong Dollar UL PR 00437
Pay-By-Link US Dollar	This document describes how to use our Pay-By-Link service.If you are an Utmost International Isle of Man Limited client and you pay regular premiums into your Executive Wealthbuilder Account, Guaranteed Mortgage and Investment Plan, International Mortgage Account, International Portable Pension Plan, Managed Account Plus, Managed Capital Account, Managed Pension Account, Managed Savings Account or Pension Wealthbuilder Account inUS Dollar, regardless of your current payment method, you can use the Pay-By-Link service.	Europe Expat, Middle East, Rest of the World, United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	This document describes how to use our Pay-By-Link service.If you are an Utmost International Isle of Man Limited client and you pay regular premiums into your Executive Wealthbuilder Account, Guaranteed Mortgage and Investment Plan, International Mortgage Account, International Portable Pension Plan, Managed Account Plus, Managed Capital Account, Managed Pension Account, Managed Savings Account or Pension Wealthbuilder Account inUS Dollar, regardless of your current payment method, you can use the Pay-By-Link service. Operational Forms Pay-By-Link US Dollar UL PR 00438
Assignment of Policies Form	Please use this form to assign ownership of segments to an individual, including splitting out segments to form a new bond.This is only for use with former Quilter International products.	Middle East, Rest of the World, United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	Please use this form to assign ownership of segments to an individual, including splitting out segments to form a new bond.This is only for use with former Quilter International products. Operational Forms Assignment of Policies Form UL PR 00417
Utmost International Isle of Man Client Information and Change of Details Form	This form is intended for Utmost International Isle of Man Limited customers who wish to inform us of any changes to their personal details, such as name, specimen signature, address, email address or telephone number.	Middle East, Rest of the World, Singapore (SG), Sweden (SE), United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	This form is intended for Utmost International Isle of Man Limited customers who wish to inform us of any changes to their personal details, such as name, specimen signature, address, email address or telephone number. Operational Forms Utmost International Isle of Man Client Information and Change of Details Form UL PR 00397
Notifying us of a Bereavement	This document describes how to notify us of a death and what our certification requirements are in relation to Death Certificate and Grant of Probate.This document is issued by Utmost International Isle of Man and is only relevant to UK resident individuals.	United Kingdom (UK)	Utmost International - IoM	English (EN)		Making a change to your policy	This document describes how to notify us of a death and what our certification requirements are in relation to Death Certificate and Grant of Probate.This document is issued by Utmost International Isle of Man and is only relevant to UK resident individuals. Operational Forms Notifying us of a Bereavement UL PR 00377
Know Your Client – Source of Funding and Verification of Identity	This form is issued by Utmost International Isle of Man and should be completed by all clients, trustees and corporate clients, where an application form does not already contain both a source of funding and verification of customer identity section.	Europe Expat, Middle East, Rest of the World, Singapore (SG), Sweden (SE), United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	New Policy	This form is issued by Utmost International Isle of Man and should be completed by all clients, trustees and corporate clients, where an application form does not already contain both a source of funding and verification of customer identity section. Operational Forms Know Your Client – Source of Funding and Verification of Identity UL PR 00391
Terms of Appointment of Investment Adviser	This document explains the terms of appointing an Investment Adviser.	United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	New Policy	This document explains the terms of appointing an Investment Adviser. Operational Forms Terms of Appointment of Investment Adviser UL PR 00350
Assignment of Policy for Surrender Form	This Assignment and Surrender Form can be used for assigning of policies for immediate surrender.	United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy, Surrender or Claim	This Assignment and Surrender Form can be used for assigning of policies for immediate surrender. Operational Forms Assignment of Policy for Surrender Form UL PR 00334
Change of Bank Details	This form can be used to request and change bank details from clients for Utmost International Isle of Man and Utmost PanEurope polices.	United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	New Policy	This form can be used to request and change bank details from clients for Utmost International Isle of Man and Utmost PanEurope polices. Operational Forms Change of Bank Details UL PR 00303
Protecting Your Identity	This leaflet provides advice on protecting yourself against identity theft and fraud and what to do if you become a victim of these crimes.For products formerly Scottish Mutual International.		Utmost PanEurope	English (EN)		New Policy	This leaflet provides advice on protecting yourself against identity theft and fraud and what to do if you become a victim of these crimes.For products formerly Scottish Mutual International. Operational Forms Protecting Your Identity UIC PR 00191
Guide to further requirements for Corporates Policies	This document details some extra supporting documents we may require for Corporates Policies.For products formerly branded Phoenix Life guide to further requirements for Corporates Policies.		Utmost PanEurope	English (EN)		New Policy	This document details some extra supporting documents we may require for Corporates Policies.For products formerly branded Phoenix Life guide to further requirements for Corporates Policies. Operational Forms Guide to further requirements for Corporates Policies UIC PR 00195
Switch Instruction form	This Switch Instruction Form outlines the bond switch details along with the bond owners, both personal and corporate investors.For products formerly Scottish Mutual International.		Utmost PanEurope	English (EN)		Making a change to your policy	This Switch Instruction Form outlines the bond switch details along with the bond owners, both personal and corporate investors.For products formerly Scottish Mutual International. Operational Forms Switch Instruction form UIC PR 00189
Retirement Benefits Plan – Withdrawal Form	This is a list of several options in relation to the accrued pension benefits.This form is used with a small number of older products.		Utmost PanEurope	English (EN)		Surrender or Claim	This is a list of several options in relation to the accrued pension benefits.This form is used with a small number of older products. Operational Forms Retirement Benefits Plan – Withdrawal Form UIC PR 00187
Retirement Request Form – Personal Pension Plans	This retirement request form includes a list of options available on retirement and discharge for non-pension payments.This form is used with a small number of older products.		Utmost PanEurope	English (EN)		Making a change to your policy	This retirement request form includes a list of options available on retirement and discharge for non-pension payments.This form is used with a small number of older products. Operational Forms Retirement Request Form – Personal Pension Plans UIC PR 00188
Executive Pension Request to Transfer to an Approved Retirement Fund	Request to transfer the fund or part of the fund accrued under the scheme or scheme(s) in respect of the Member’s retirement benefits to an approved retirement fund.	Europe Expat, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	Making a change to your policy	Request to transfer the fund or part of the fund accrued under the scheme or scheme(s) in respect of the Member’s retirement benefits to an approved retirement fund. Operational Forms Executive Pension Request to Transfer to an Approved Retirement Fund UIC PR 00185
Retirement Benefits Plan – Retirement Advice Form	This form is intended to allow the Trustees to indicate the required benefits for the retiring employee, provide details and authorise the payment of benefits.This form is used with a small number of older products.		Utmost PanEurope	English (EN)		Surrender or Claim	This form is intended to allow the Trustees to indicate the required benefits for the retiring employee, provide details and authorise the payment of benefits.This form is used with a small number of older products. Operational Forms Retirement Benefits Plan – Retirement Advice Form UIC PR 00186
Overseas Transfer Declaration	Declaration form to confirm that the transfer request conforms to the requirements of the Occupational Pension Schemes and Personal Retirement Savings Accounts and is for bona fide purpose.	Europe Expat, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	Making a change to your policy	Declaration form to confirm that the transfer request conforms to the requirements of the Occupational Pension Schemes and Personal Retirement Savings Accounts and is for bona fide purpose. Operational Forms Overseas Transfer Declaration UIC PR 00183
Permanent Health Insurance Claim Form	Permanent health insurance claim form to request the health details of the life assured and consent to Utmost PanEurope dac seeking and processing information in order to be able to process this claim.	Europe Expat, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	Surrender or Claim	Permanent health insurance claim form to request the health details of the life assured and consent to Utmost PanEurope dac seeking and processing information in order to be able to process this claim. Operational Forms Permanent Health Insurance Claim Form UIC PR 00184
Lapse Value Claim Form	Lapse Value Claim Form to claim the cash in value of the policy at the date of lapse together with late payment interest in full and final settlement of the policy.	Europe Expat, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	Surrender or Claim	Lapse Value Claim Form to claim the cash in value of the policy at the date of lapse together with late payment interest in full and final settlement of the policy. Operational Forms Lapse Value Claim Form UIC PR 00180
Full Encashment Request Form	This form is used to request full encashment. Please note the encashment value will be based on the date of receipt of all requirements and payable to the individual who according to Utmost PanEurope dac’s records is entitled to receive it.	Europe Expat, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	Surrender or Claim	This form is used to request full encashment. Please note the encashment value will be based on the date of receipt of all requirements and payable to the individual who according to Utmost PanEurope dac’s records is entitled to receive it. Operational Forms Full Encashment Request Form UIC PR 00179
Declaration of Health	This Medical Questionnaire needs to be completed to consent to Utmost PanEurope dac seeking and processing medical information at any time as this application will form the basis of the contract with Utmost PanEurope dac.	Europe Expat, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	New Policy	This Medical Questionnaire needs to be completed to consent to Utmost PanEurope dac seeking and processing medical information at any time as this application will form the basis of the contract with Utmost PanEurope dac. Operational Forms Declaration of Health UIC PR 00178
Benefit Crystallisation Events Declaration	This Declaration should be completed and given to the administrator of the pension arrangement prior to the payment of any benefits from that arrangement.	Europe Expat, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	New Policy	This Declaration should be completed and given to the administrator of the pension arrangement prior to the payment of any benefits from that arrangement. Operational Forms Benefit Crystallisation Events Declaration UIC PR 00173
Declaration of Continued Good Health	Declaration form to provide details regarding your health situation or any medical conditions while consenting to Utmost PanEurope dac seeking and processing medical information at any time in order to process your claims.	Europe Expat, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	New Policy	Declaration form to provide details regarding your health situation or any medical conditions while consenting to Utmost PanEurope dac seeking and processing medical information at any time in order to process your claims. Operational Forms Declaration of Continued Good Health UIC PR 00176
Switch Instruction Form	This Switch Instruction Form can be used to capture the bond switch details along with the bond owners for both personal and corporate investors.	Europe Expat, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	Making a change to your policy	This Switch Instruction Form can be used to capture the bond switch details along with the bond owners for both personal and corporate investors. Operational Forms Switch Instruction Form UIC PR 00170
Benefit Crystallisation Events Declaration	This Declaration should be completed and given to the administrator of the pension arrangement prior to the payment of any benefits from that arrangement.	Europe Expat, United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	New Policy	This Declaration should be completed and given to the administrator of the pension arrangement prior to the payment of any benefits from that arrangement. Operational Forms Benefit Crystallisation Events Declaration UIC PR 00172
Rückkaufsantrag	This surrender Request Form outlines the bond surrender details along with the bond owners, both personal and corporate investors. Also, any other surrender instructions, such as payment details. Fund Adviser Form used to request the appointment of a Fund Adviser to the contract. For products formerly Scottish Mutual International.		Utmost PanEurope	German (DE)	FOS	Surrender or Claim	This surrender Request Form outlines the bond surrender details along with the bond owners, both personal and corporate investors. Also, any other surrender instructions, such as payment details. Fund Adviser Form used to request the appointment of a Fund Adviser to the contract. For products formerly Scottish Mutual International. Operational Forms Rückkaufsantrag UIC PR 00168
Surrender Request Form	Surrender Request Form outlining the bond surrender details along with the bond owners, both personal and corporate investors. Also, any other surrender instructions, such as payment details.For products formerly Scottish Mutual International.		Utmost PanEurope	English (EN)	FOS	Surrender or Claim	Surrender Request Form outlining the bond surrender details along with the bond owners, both personal and corporate investors. Also, any other surrender instructions, such as payment details.For products formerly Scottish Mutual International. Operational Forms Surrender Request Form UIC PR 00169
Regular Withdrawal Request Form	The Regular Withdrawal Request Form outlines the bond withdrawal details along with the bond owners, both personal and corporate investors.For products formerly Scottish Mutual International.		Utmost PanEurope	English (EN)	FOS	Surrender or Claim	The Regular Withdrawal Request Form outlines the bond withdrawal details along with the bond owners, both personal and corporate investors.For products formerly Scottish Mutual International. Operational Forms Regular Withdrawal Request Form UIC PR 00164
Antragsformular für Regelmäßige Entnahmen	The Regular Withdrawal Request Form outlines the bond withdrawal details along with the bond owners, both personal and corporate investors.	Europe Expat	Utmost PanEurope	German (DE)	FOS	Surrender or Claim	The Regular Withdrawal Request Form outlines the bond withdrawal details along with the bond owners, both personal and corporate investors. Operational Forms Antragsformular für Regelmäßige Entnahmen UIC PR 00165
Erklärung Wohnsitzdefinition	This declaration must be signed by policyholders who are neither resident nor ordinarily resident in Ireland or by personal representatives signing on behalf of deceased persons.	Germany (DE)	Utmost PanEurope	German (DE)	FOS	Making a change to your policy, New Policy	This declaration must be signed by policyholders who are neither resident nor ordinarily resident in Ireland or by personal representatives signing on behalf of deceased persons. Operational Forms Erklärung Wohnsitzdefinition UIC PR 00163
Meldung Über den Verlust der Versicherungsurkunde	This form is used to declare the loss of Plan Schedule and any owners of the bond, both personal and corporate investors.	Germany (DE)	Utmost PanEurope	German (DE)	FOS	Making a change to your policy, Surrender or Claim	This form is used to declare the loss of Plan Schedule and any owners of the bond, both personal and corporate investors. Operational Forms Meldung Über den Verlust der Versicherungsurkunde UIC PR 00157
Declaration of Loss of Plan Schedule	For Products formerly Scottish Mutual International this form is used to declare the loss of Plan Schedule and any owners of the bond, both personal and corporate investors.	Germany (DE)	Utmost PanEurope	English (EN)	FOS	Making a change to your policy, Surrender or Claim	For Products formerly Scottish Mutual International this form is used to declare the loss of Plan Schedule and any owners of the bond, both personal and corporate investors. Operational Forms Declaration of Loss of Plan Schedule UIC PR 00158
Appointment of Fund Adviser Form	For Products formerly Scottish Mutual International Fund Adviser Form used to request the appointment of a Fund Adviser to the contract.		Utmost PanEurope	English (EN)		New Policy	For Products formerly Scottish Mutual International Fund Adviser Form used to request the appointment of a Fund Adviser to the contract. Operational Forms Appointment of Fund Adviser Form UIC PR 00155
Dealing Instructions Form	This form is used for dealing instructions carried out wherever possible, at the next available price immediately following receipt by Utmost PanEurope dac of these duly completed instructions.		Utmost PanEurope	English (EN)		Making a change to your policy	This form is used for dealing instructions carried out wherever possible, at the next available price immediately following receipt by Utmost PanEurope dac of these duly completed instructions. Operational Forms Dealing Instructions Form UIC PR 00156
Multi-Product Nomination of External Manager or Custodian	This form can be used to nominate or replace an External Manager or Custodian.This is not for use with former Quilter products.	United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy, New Policy	This form can be used to nominate or replace an External Manager or Custodian.This is not for use with former Quilter products. Operational Forms Multi-Product Nomination of External Manager or Custodian IOM PR 0110
Terms of Business and Application Form for Intermediaries	These Terms of Business regulate the relationship between Utmost International Isle of Man Limited and the Intermediary.	United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	New Policy	These Terms of Business regulate the relationship between Utmost International Isle of Man Limited and the Intermediary. Operational Forms Terms of Business and Application Form for Intermediaries IOM PR 0058
Nomination of Investment Adviser – Utmost International Isle of Man	Please use this form to nominate an investment adviser.This form is not for use with form Quilter International policies.	United Kingdom (UK)	Utmost International - IoM	English (EN)		Making a change to your policy	Please use this form to nominate an investment adviser.This form is not for use with form Quilter International policies. Operational Forms Nomination of Investment Adviser – Utmost International Isle of Man IOM PR 0057
Appointment of Financial Adviser – Utmost International Isle of Man	Please use this form to appointment a financial adviser.	United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	Please use this form to appointment a financial adviser. Operational Forms Appointment of Financial Adviser – Utmost International Isle of Man IOM PR 0032
Online dealing access authorisation form for clients	This form provides access for UK investment advisers to place deals online	United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS		This form provides access for UK investment advisers to place deals online Operational Forms Online dealing access authorisation form for clients IOM PR 0034
UWS Multi-Product Withdrawal and Surrender Form	This form should only be used for surrender or withdrawal requests from products designed forUtmost International Isle of Man Limited within the UK market or for any product where the policyholder is now UK resident.	United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	Surrender or Claim	This form should only be used for surrender or withdrawal requests from products designed forUtmost International Isle of Man Limited within the UK market or for any product where the policyholder is now UK resident. Operational Forms UWS Multi-Product Withdrawal and Surrender Form IOM PR 0027
Dealing Account Overdraft Clearance Instruction Form	Please use this form to inform Utmost on what actions you would like to take in order to clear your overdraft.	United Kingdom (UK)	Utmost International - IoM	English (EN)		Making a change to your policy	Please use this form to inform Utmost on what actions you would like to take in order to clear your overdraft. Operational Forms Dealing Account Overdraft Clearance Instruction Form IOM PR 0021
Assignment of Policies Form	This form should be used for assigning ownership of segments to an individual including slitting out segments to from a new bond.This is not for use with exQuilter policies.	United Kingdom (UK)	Utmost Wealth Solutions	English (EN)	FOS	Making a change to your policy	This form should be used for assigning ownership of segments to an individual including slitting out segments to from a new bond.This is not for use with exQuilter policies. Operational Forms Assignment of Policies Form IOM PR 0015
Investor Declaration – UK Products	For Utmost International Isle of Man Limited policies within the UK market. You must read and sign this Declaration if you wish to link your bond to unregulated collective investment schemes and certain close substitutes, together known as non-mainstream pooled investments, which are investments that are generally restricted to sophisticated investors and high net worth individuals.	United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	For Utmost International Isle of Man Limited policies within the UK market. You must read and sign this Declaration if you wish to link your bond to unregulated collective investment schemes and certain close substitutes, together known as non-mainstream pooled investments, which are investments that are generally restricted to sophisticated investors and high net worth individuals. Operational Forms Investor Declaration – UK Products IOM PR 0011
Investment Switch Request Form	This form should be used for policies that are invested within Guided Architecture only.	United Kingdom (UK)	Utmost International - IoM	English (EN)		Making a change to your policy	This form should be used for policies that are invested within Guided Architecture only. Operational Forms Investment Switch Request Form IOM PR 0012
Lost Policy Declaration	Please use this form to declare that your Utmost International Isle of Man Limited policy is lost.	United Kingdom (UK)	Utmost International - IoM	English (EN)	FOS	Making a change to your policy	Please use this form to declare that your Utmost International Isle of Man Limited policy is lost. Operational Forms Lost Policy Declaration AWI PR 0011
Online Dealing Access Authorisation Form for Investment Advisers	Online Dealing Access Authorisation Form for Investment Advisers for Utmost PanEurope dac.	United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	New Policy	Online Dealing Access Authorisation Form for Investment Advisers for Utmost PanEurope dac. Operational Forms Online Dealing Access Authorisation Form for Investment Advisers ALE PR 0067
Utmost PanEurope Online Dealing Access Authorisation Form	Online Dealing Access Authorisation Form for Policyholders for Utmost PanEurope dac.This is not suitable for Corporate or Trust cases.	United Kingdom (UK)	Utmost PanEurope	English (EN)	FOS	New Policy	Online Dealing Access Authorisation Form for Policyholders for Utmost PanEurope dac.This is not suitable for Corporate or Trust cases. Operational Forms Utmost PanEurope Online Dealing Access Authorisation Form ALE PR 0066

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