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Asset Type: Operational Forms

Process: Addition to your Policy

Documents

Title	Description	Insurer	Market	Language	Product	Regime	Excerpt
Unité de Compte du Contrat constituée par un Fonds Interne Dédié lié à plusieurs Contrats	Annex to add additional Internal Dedicated Funds to a multi-contract/policy on the Liberté product – France	France (FR)	Utmost Luxembourg S.A	French (FR)	Liberté	FOS	Annex to add additional Internal Dedicated Funds to a multi-contract/policy on the Liberté product – France Operational Forms Unité de Compte du Contrat constituée par un Fonds Interne Dédié lié à plusieurs Contrats ULU CONT3769
Unité de Compte du Contrat constituée par un Fonds Interne Dédié lié à plusieurs Contrats	Annex to add additional Internal Dedicated Funds to a multi-contract/policy on the Liberté Capitalisation product – France	France (FR)	Utmost Luxembourg S.A	French (FR)	Liberté Capitalisation	FOS	Annex to add additional Internal Dedicated Funds to a multi-contract/policy on the Liberté Capitalisation product – France Operational Forms Unité de Compte du Contrat constituée par un Fonds Interne Dédié lié à plusieurs Contrats ULU CONT3775
Formulaire de Choix Option « Opt-Out » (FR)	Operational Forms Formulaire de Choix Option « Opt-Out » (FR) ULBE PR 00008	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	French (FR)	Non Product Specific	FOE	Operational Forms Formulaire de Choix Option « Opt-Out » (FR) ULBE PR 00008
Keuzeformulier Voor de ‘Opt-Out’-Optie	Operational Forms Keuzeformulier Voor de ‘Opt-Out’-Optie ULBE PR 00007	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Dutch (NL)	Non Product Specific	FOE	Operational Forms Keuzeformulier Voor de ‘Opt-Out’-Optie ULBE PR 00007
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)	Non Product Specific	FOS	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
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)	Non Product Specific	FOS	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
Questionário Sobre a Origem do Património	Questionário Sobre a Origem do Património para fornecer detalhes sobre o património de um cliente	Portugal (PT)	Utmost Wealth Solutions	Portuguese (PT)	Apex (Portugal), Compass (Closed), Compass DFM (Closed), Private Wealth Portfolio - Portugal	FOS	Questionário Sobre a Origem do Património para fornecer detalhes sobre o património de um cliente Operational Forms Questionário Sobre a Origem do Património UWS PR 00473
Change Request to Fund Selection	Use this form to request a change to the Fund Selection – United Kingdom	United Kingdom (UK)	Utmost Luxembourg S.A	English (EN)	Private Client Portfolio	FOS	Use this form to request a change to the Fund Selection – United Kingdom Operational Forms Change Request to Fund Selection ULU CONT2933
Adding to Your Executive Wealthbuilder Account Form	Utmost International Isle of Man Limited top-up form. This document should be used by financial advisers, their staff or families (that have been offered the Executive Wealthbuilder Account special terms). This form can only be used for top-ups as this product is closed to new business.	Middle East	Utmost International - IoM	English (EN)	Legacy Product (Closed)	FOS	Utmost International Isle of Man Limited top-up form. This document should be used by financial advisers, their staff or families (that have been offered the Executive Wealthbuilder Account special terms). This form can only be used for top-ups as this product is closed to new business. Operational Forms Adding to Your Executive Wealthbuilder Account Form ULQ PR \| 08509
Unit Linked Individual Investor Premium Amendment form for use with Heritage products	Utmost International Isle of Man Limited form that can be used to increase or decrease regular premiums, to pay an additional single premium (top-up), to change frequency or to reinstate a policy. It can be used with Managed Savings Account, Managed Pension Account, Managed Capital Account and Executive Wealthbuilder Account.		Utmost International - IoM	English (EN)	Legacy Product (Closed), Managed Capital Account	FOS	Utmost International Isle of Man Limited form that can be used to increase or decrease regular premiums, to pay an additional single premium (top-up), to change frequency or to reinstate a policy. It can be used with Managed Savings Account, Managed Pension Account, Managed Capital Account and Executive Wealthbuilder Account. Operational Forms Unit Linked Individual Investor Premium Amendment form for use with Heritage products ULQ PR \| 03451

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