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Title	Description	Insurer	Market	Asset Type	Regime	Process	Excerpt
Demande de Rachat Partiel – MultiSupport	Use this form to request a withdrawal from your policy/contract – France	France (FR)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to request a withdrawal from your policy/contract – France Surrender/Claim/Withdrawal/Switch Demande de Rachat Partiel – MultiSupport ULU PCON1316
Rachat Partiel Programmé	Use this form to request a regular withdrawal from your policy/contract – Belgium (FOS) – French version	Belgium (BE)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to request a regular withdrawal from your policy/contract – Belgium (FOS) – French version Surrender/Claim/Withdrawal/Switch Rachat Partiel Programmé ULU PCON1078
Demande d’Arbitrage	Use this form to request a switch of investments on your policy/contract – Belgium (FOS) – Dutch version	Belgium (BE)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to request a switch of investments on your policy/contract – Belgium (FOS) – Dutch version Surrender/Claim/Withdrawal/Switch Demande d’Arbitrage ULU PCON1030
Demande de Rachat Partiel	Use this form to request a withdrawal from your policy/contract – Belgium (FOS) – French version	Belgium (BE)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to request a withdrawal from your policy/contract – Belgium (FOS) – French version Surrender/Claim/Withdrawal/Switch Demande de Rachat Partiel ULU PCON1033
Rachat Partiel Programmé (Branch)	Use this form to request a regular withdrawal from your policy/contract – Belgium (Branch) – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Surrender/Claim/Withdrawal/Switch	FOE		Use this form to request a regular withdrawal from your policy/contract – Belgium (Branch) – French version Surrender/Claim/Withdrawal/Switch Rachat Partiel Programmé (Branch) ULBE PCON1401
Demande d’Arbitrage	Use this form to request a switch of investments on your policy/contract – Belgium (Branch) – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Surrender/Claim/Withdrawal/Switch	FOE		Use this form to request a switch of investments on your policy/contract – Belgium (Branch) – French version Surrender/Claim/Withdrawal/Switch Demande d’Arbitrage ULBE PCON1432
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	Operational Forms	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
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	Operational Forms	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
Exoneration De La TVA Irlandaise	Les polices d’assurance-vie en unités de compte.	France (FR)	Utmost PanEurope	Tax and regulatory Literature/technical sales aids and literature		Making a change to your policy, New Policy	Les polices d’assurance-vie en unités de compte. Tax and regulatory Literature/technical sales aids and literature Exoneration De La TVA Irlandaise UPE PR 12754
L’ Avantage De la TVA Irlandaise	L’objectif de cette note technique est d’expliquer comment le traitement de la TVA en Irlande donne aux assureurs basés en Irlande, tels qu’Utmost PanEurope Dac (‘Utmost PanEurope’), un avantage en matière de TVA par rapport aux assureurs basés dans d’autres pays européens.	France (FR)	Utmost PanEurope	Tax and regulatory Literature/technical sales aids and literature		Making a change to your policy, New Policy	L’objectif de cette note technique est d’expliquer comment le traitement de la TVA en Irlande donne aux assureurs basés en Irlande, tels qu’Utmost PanEurope Dac (‘Utmost PanEurope’), un avantage en matière de TVA par rapport aux assureurs basés dans d’autres pays européens. Tax and regulatory Literature/technical sales aids and literature L’ Avantage De la TVA Irlandaise UPE PR 12753
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	Operational Forms	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 for the National Bank of Belgium (FR)	Please use this Information Disclosure Agreement for sharing client information with the National Bank of Belgium	Belgium (BE)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Please use this Information Disclosure Agreement for sharing client information with the National Bank of Belgium Client Letters/Indemnity/Data Protection Information Disclosure Agreement for the National Bank of Belgium (FR) ULU PR 00098
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	Operational Forms	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
Connect Sign in (French)	Connect Sign in (French)	France (FR)	Utmost Luxembourg S.A	Guides and Supporting Documents	FOS		Connect Sign in (French) Guides and Supporting Documents Connect Sign in (French) ULU PR 00019
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	Operational Forms	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
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	Operational Forms	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
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	Operational Forms	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
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	Operational Forms	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
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	Operational Forms	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
Formulaire de transmission d’ordre	Use this form for dealing purposes – France	France (FR)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS		Use this form for dealing purposes – France Investment literature/Strategies Formulaire de transmission d’ordre ULU PCON1460
Formulaire d’Arbitrage automatique	Use this form to request an automated switch of investments on your policy/contract – France	France (FR)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to request an automated switch of investments on your policy/contract – France Surrender/Claim/Withdrawal/Switch Formulaire d’Arbitrage automatique ULU PCON1399
Switch form / Formulaire d’arbitrage	Use this form to request a switch of investments on your policy/contract – Luxembourg	Luxembourg (LU)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to request a switch of investments on your policy/contract – Luxembourg Surrender/Claim/Withdrawal/Switch Switch form / Formulaire d’arbitrage ULU PCON1391
Partial surrender request / Demande de rachat partiel	Use this form to request a withdrawal from your policy/contract – Luxembourg	Luxembourg (LU)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to request a withdrawal from your policy/contract – Luxembourg Surrender/Claim/Withdrawal/Switch Partial surrender request / Demande de rachat partiel ULU PCON1387
Surrender request / Demande de rachat total	Use this form to request the surrender of your policy/contract – Luxembourg	Luxembourg (LU)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to request the surrender of your policy/contract – Luxembourg Surrender/Claim/Withdrawal/Switch Surrender request / Demande de rachat total ULU PCON1386
Demande de Rachat Total	Use this form to request the surrender of your policy/contract – France	France (FR)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to request the surrender of your policy/contract – France Surrender/Claim/Withdrawal/Switch Demande de Rachat Total ULU PCON1379
Désignation d’Intermédiaire	Use this form to request an appointment or change of broker	Belgium (BE)	Utmost Luxembourg S.A	Operational Forms	FOS		Use this form to request an appointment or change of broker Operational Forms Désignation d’Intermédiaire ULU PCON1323
Formulaire d’Arbitrage	Use this form to request a switch of investments on your policy/contract – France	France (FR)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS	New Policy	Use this form to request a switch of investments on your policy/contract – France Surrender/Claim/Withdrawal/Switch Formulaire d’Arbitrage ULU PCON1315
Rachat Partiel Programmé	Use this form to request a regular withdrawal from your policy/contract – France	France (FR)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to request a regular withdrawal from your policy/contract – France Surrender/Claim/Withdrawal/Switch Rachat Partiel Programmé ULU PCON1177
Déclaration de Perte de Documents	Form to be used to declare the loss of policy documents – Belgium (FOS) – French version	Belgium (BE)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Form to be used to declare the loss of policy documents – Belgium (FOS) – French version Client Letters/Indemnity/Data Protection Déclaration de Perte de Documents ULU PCON1089
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	Operational Forms	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
Dénouement par Décès	Use this form to initiate a death claim – Belgium (French version)	Belgium (BE)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to initiate a death claim – Belgium (French version) Surrender/Claim/Withdrawal/Switch Dénouement par Décès ULU PCON1065
Formulaire Changement de Banque Dépositaire	Use this form to request a change of Custodian Bank	France (FR)	Utmost Luxembourg S.A	Operational Forms	FOS		Use this form to request a change of Custodian Bank Operational Forms Formulaire Changement de Banque Dépositaire ULU PCON1060
Demande de Rachat Total	Use this form to request the surrender of your policy/contract – Belgium (FOS) – French version	Belgium (BE)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to request the surrender of your policy/contract – Belgium (FOS) – French version Surrender/Claim/Withdrawal/Switch Demande de Rachat Total ULU PCON1045
Demande de Rachat Partiel	Use this form to request a withdrawal from your policy/contract – France	France (FR)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to request a withdrawal from your policy/contract – France Surrender/Claim/Withdrawal/Switch Demande de Rachat Partiel ULU PCON1013
Dénouement par Décès	Use this form to initiate a death claim – France	France (FR)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	FOS		Use this form to initiate a death claim – France Surrender/Claim/Withdrawal/Switch Dénouement par Décès ULU PCON1005
Notre offer FAS avec notre partenaire CA Indosuez Wealth Europe	This document details our FAS offer with our partner CA Indosuez Wealth Europe	France (FR)	Utmost Luxembourg S.A	Investment literature/Strategies	FOE FOS		This document details our FAS offer with our partner CA Indosuez Wealth Europe Investment literature/Strategies Notre offer FAS avec notre partenaire CA Indosuez Wealth Europe ULU MARK2419
Notre offre FAS avec notre partenaire Edmond de Rothschild (Europe) Luxembourg	This document details our FAS offer with our partner Edmond de Rothschild (Europe) Luxembourg	France (FR)	Utmost Luxembourg S.A	Investment literature/Strategies	FOE FOS		This document details our FAS offer with our partner Edmond de Rothschild (Europe) Luxembourg Investment literature/Strategies Notre offre FAS avec notre partenaire Edmond de Rothschild (Europe) Luxembourg ULU MARK2417
Notre offre FAS avec notre partenaire Société Générale Luxembourg	This document details our FAS offer with our partner Société Générale Luxembourg	France (FR)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS		This document details our FAS offer with our partner Société Générale Luxembourg Investment literature/Strategies Notre offre FAS avec notre partenaire Société Générale Luxembourg ULU MARK2365
Notre offre FAS avec notre partenaire UBS France S.A.	This document details our FAS offer with our partner UBS France S.A.	France (FR)	Utmost Luxembourg S.A	Investment literature/Strategies	FOE FOS		This document details our FAS offer with our partner UBS France S.A. Investment literature/Strategies Notre offre FAS avec notre partenaire UBS France S.A. ULU MARK2361
Connect – Aperçu (Guide d’utilisation pour les clients)	This user guide helps to navigate through the Connect Platform and explain functionality – French version	Belgium (BE), France (FR)	Utmost Luxembourg S.A	Guides and Supporting Documents	FOE FOS		This user guide helps to navigate through the Connect Platform and explain functionality – French version Guides and Supporting Documents Connect – Aperçu (Guide d’utilisation pour les clients) ULU MARK2351
Conditions applicables à notre collaboration – Banque Havilland S.A.	This document details the conditions applicable to our collaboration with Banque Havilland S.A.	France (FR)	Utmost Luxembourg S.A	Investment literature/Strategies	FOE FOS		This document details the conditions applicable to our collaboration with Banque Havilland S.A. Investment literature/Strategies Conditions applicables à notre collaboration – Banque Havilland S.A. ULU MARK2346
Notre offre FAS avec notre partenaire Quintet Private Bank	This document details our FAS offer with our partner Quintet Private Bank	France (FR)	Utmost Luxembourg S.A	Investment literature/Strategies	FOE FOS		This document details our FAS offer with our partner Quintet Private Bank Investment literature/Strategies Notre offre FAS avec notre partenaire Quintet Private Bank ULU MARK2333
Notre offre FAS avec notre partenaire Banque Internationale à Luxembourg (BIL)	This document details our FAS offer with our partner Banque Internationale à Luxembourg (BIL)	France (FR)	Utmost Luxembourg S.A	Investment literature/Strategies	FOE FOS		This document details our FAS offer with our partner Banque Internationale à Luxembourg (BIL) Investment literature/Strategies Notre offre FAS avec notre partenaire Banque Internationale à Luxembourg (BIL) ULU MARK2326
Guide d’utilisation Connect Souscription Digitale – Belgique	This is a Connect User Guide for digital subscription – French version	Belgium (BE)	Utmost Luxembourg S.A	Guides and Supporting Documents	FOE FOS		This is a Connect User Guide for digital subscription – French version Guides and Supporting Documents Guide d’utilisation Connect Souscription Digitale – Belgique ULU MARK2302
Connect User Guide Digital Subscription	This is a Connect User Guide for digital subscription – French version	France (FR)	Utmost Luxembourg S.A	Guides and Supporting Documents	FOS		This is a Connect User Guide for digital subscription – French version Guides and Supporting Documents Connect User Guide Digital Subscription ULU MARK2276
Connect User Guide – Total Redemption (French)	Connect User Guide – Total Redemption (French)	Belgium (BE), France (FR)	Utmost Luxembourg S.A	Guides and Supporting Documents	FOE FOS		Connect User Guide – Total Redemption (French) Guides and Supporting Documents Connect User Guide – Total Redemption (French) ULU MARK2174
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	Operational Forms	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	Operational Forms	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
Power of Attorney / Procuration – Luxembourg Capitalisation Bond	Power of Attorney for the Investment Advisor – Luxembourg – Capitalisation Bond	Luxembourg (LU)	Utmost Luxembourg S.A	Operational Forms	FOS		Power of Attorney for the Investment Advisor – Luxembourg – Capitalisation Bond Operational Forms Power of Attorney / Procuration – Luxembourg Capitalisation Bond ULU CONT4549
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	Operational Forms	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
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	Operational Forms	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
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	Operational Forms	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
Avenant au contrat de capitalisation	“Prise de date” annex to the Liberté Capitalisation product – France	France (FR)	Utmost Luxembourg S.A	Operational Forms	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	Operational Forms	FOS	New Policy	“Prise de date” annex to the Liberté product – France Operational Forms Avenant au contrat d’assurance-vie ULU CONT3909
Appendix: Investment Rules for Internal Funds and External Funds / Annexe : Règles d’Investissement pour Fonds Internes et Fonds Externes	Table of Luxembourg Investment Rules – Capitalisation Bond – Luxembourg	Luxembourg (LU)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS		Table of Luxembourg Investment Rules – Capitalisation Bond – Luxembourg Investment literature/Strategies Appendix: Investment Rules for Internal Funds and External Funds / Annexe : Règles d’Investissement pour Fonds Internes et Fonds Externes ULU CONT3808
Règles d’investissement pour les Fonds Internes et Externes	Table of Luxembourg Investment Rules	Luxembourg (LU)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS		Table of Luxembourg Investment Rules Investment literature/Strategies Règles d’investissement pour les Fonds Internes et Externes ULU CONT3807
Règles d’investissement pour fonds internes – Belgique	Table of Luxembourg Investment Rules	Belgium (BE)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS		Table of Luxembourg Investment Rules Investment literature/Strategies Règles d’investissement pour fonds internes – Belgique ULU CONT3681
Règles d’investissement pour les Fonds Internes et Externes	Table of Luxembourg Investment Rules	France (FR)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS		Table of Luxembourg Investment Rules Investment literature/Strategies Règles d’investissement pour les Fonds Internes et Externes ULU CONT3678
Avis de confidentialité / Privacy Notice	Privacy Notice – English/French version	Luxembourg (LU)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Privacy Notice – English/French version Client Letters/Indemnity/Data Protection Avis de confidentialité / Privacy Notice ULU CONT3350-WEB
Déclaration concernant la Protection des Données à Caractère Personnel / Declaration with regard to Personal Data Protection	Privacy Notice – English/French version – Luxembourg	Luxembourg (LU)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Privacy Notice – English/French version – Luxembourg Client Letters/Indemnity/Data Protection Déclaration concernant la Protection des Données à Caractère Personnel / Declaration with regard to Personal Data Protection ULU CONT3350
Avis de confidentialité	Privacy Notice – French version	France (FR)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Privacy Notice – French version Client Letters/Indemnity/Data Protection Avis de confidentialité ULU CONT3347-WEB
Déclaration concernant la Protection des Données à Caractère Personel	Privacy Notice – French version – France	France (FR)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Privacy Notice – French version – France Client Letters/Indemnity/Data Protection Déclaration concernant la Protection des Données à Caractère Personel ULU CONT3347
Avis de confidentialité	Privacy Notice – French version	Belgium (BE)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Privacy Notice – French version Client Letters/Indemnity/Data Protection Avis de confidentialité ULU CONT3340-WEB
Déclaration concernant la Protection des Données à Caractère	Privacy Notice – French version – Belgium (FOS)	Belgium (BE)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Privacy Notice – French version – Belgium (FOS) Client Letters/Indemnity/Data Protection Déclaration concernant la Protection des Données à Caractère ULU CONT3340
Demande de Statut de Client Professionnel / Request for Professional Client Status	Request for Professional Client Status	Belgium (BE)	Utmost Luxembourg S.A	Operational Forms	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	Operational Forms	FOS		Power of Attorney for the Investment Advisor – Luxembourg Operational Forms Power of Attorney / Procuration (Adviser) ULU CONT3198
Request for Investment Category Upgrade / Demande de classement dans une catégorie d’investissement supérieure	Use this form to request a upgrade of your investment category	Luxembourg (LU)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS		Use this form to request a upgrade of your investment category Investment literature/Strategies Request for Investment Category Upgrade / Demande de classement dans une catégorie d’investissement supérieure ULU CONT3194
Schedule of Additional Administrative Charges / Aperçu des frais administratifs additionnels	Annex showing the activity-based charging grid	Luxembourg (LU)	Utmost Luxembourg S.A	Operational Forms	FOS		Annex showing the activity-based charging grid Operational Forms Schedule of Additional Administrative Charges / Aperçu des frais administratifs additionnels ULU CONT3179
Aperçu des frais administratifs additionnels	Annex showing the activity-based charging grid	Belgium (BE)	Utmost Luxembourg S.A	Operational Forms	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	Operational Forms	FOS		Annex showing the activity-based charging grid Operational Forms Détails des Frais de transaction ULU CONT3169
Profil d’Investissement (Déviation)	Use this form to request a deviation from your investment profile	France (FR)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS		Use this form to request a deviation from your investment profile Investment literature/Strategies Profil d’Investissement (Déviation) ULU CONT3073
Investment Profile (Deviation) / Profil d’Investissement (Déviation)	Use this form to request a deviation from your investment profile	Luxembourg (LU)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS		Use this form to request a deviation from your investment profile Investment literature/Strategies Investment Profile (Deviation) / Profil d’Investissement (Déviation) ULU CONT2993
INFORMATION DISCLOSURE AGREEMENT / ACCORD DE COMMUNICATION D’INFORMATION	Information Disclosure Agreement	Luxembourg (LU)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Information Disclosure Agreement Client Letters/Indemnity/Data Protection INFORMATION DISCLOSURE AGREEMENT / ACCORD DE COMMUNICATION D’INFORMATION ULU CONT2867
INFORMATION DISCLOSURE AGREEMENT / ACCORD DE COMMUNICATION D’INFORMATION	Information Disclosure Agreement	Luxembourg (LU)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Information Disclosure Agreement Client Letters/Indemnity/Data Protection INFORMATION DISCLOSURE AGREEMENT / ACCORD DE COMMUNICATION D’INFORMATION ULU CONT2868
ACCORD DE COMMUNICATION D’INFORMATION	Information Disclosure Agreement	France (FR)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Information Disclosure Agreement Client Letters/Indemnity/Data Protection ACCORD DE COMMUNICATION D’INFORMATION ULU CONT2864
ACCORD DE COMMUNICATION D’INFORMATION	Information Disclosure Agreement	Belgium (BE)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Information Disclosure Agreement Client Letters/Indemnity/Data Protection ACCORD DE COMMUNICATION D’INFORMATION ULU CONT2861
Avenant au contrat d’assurance-vie – Acceptation du bénéfice	Annex to the application form for beneficiary acceptance	Belgium (BE)	Utmost Luxembourg S.A	Operational Forms	FOS		Annex to the application form for beneficiary acceptance Operational Forms Avenant au contrat d’assurance-vie – Acceptation du bénéfice ULU CONT2803
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	Operational Forms	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	Operational Forms	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
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	Operational Forms	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
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	Operational Forms	FOS		Use this form to perform a choice of law Operational Forms Choix de la Loi Applicable / Choice of Law – Capitalisation Contract ULU CONT2602
Demande de classement dans une catégorie d’investissement supérieure	Use this form to request a upgrade of your investment category	Belgium (BE)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS		Use this form to request a upgrade of your investment category Investment literature/Strategies Demande de classement dans une catégorie d’investissement supérieure ULU CONT2526
Demande de classement dans une catégorie d’investissement inférieure	Use this form to request a downgrade of your investment category	Belgium (BE)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS		Use this form to request a downgrade of your investment category Investment literature/Strategies Demande de classement dans une catégorie d’investissement inférieure ULU CONT2515
Stratégie d’Investissement	Use this form to define your investment strategy (generic version)	Belgium (BE)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS		Use this form to define your investment strategy (generic version) Investment literature/Strategies Stratégie d’Investissement ULU CONT2276
Taxe sur les Opérations d’Assurance	Back-end tax annex – Belgium	Belgium (BE)	Utmost Luxembourg S.A	Tax and regulatory Literature/technical sales aids and literature	FOS		Back-end tax annex – Belgium Tax and regulatory Literature/technical sales aids and literature Taxe sur les Opérations d’Assurance ULU CONT2263
Déviation du Profil d’investissement	Use this form to request a deviation from your investment profile	Belgium (BE)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS		Use this form to request a deviation from your investment profile Investment literature/Strategies Déviation du Profil d’investissement ULU CONT2221
Rapport d’Examen Medical	Medical Examination Report – Belgium (FOS) – French version	Belgium (BE)	Utmost Luxembourg S.A	Underwriting guides/questionnaires/brochures	FOS		Medical Examination Report – Belgium (FOS) – French version Underwriting guides/questionnaires/brochures Rapport d’Examen Medical ULU CONT2189
Questionnaire Financier Confidentiel	Confidential Financial Questionnaire – Belgium (FOS) – French version	Belgium (BE)	Utmost Luxembourg S.A	Underwriting guides/questionnaires/brochures	FOS		Confidential Financial Questionnaire – Belgium (FOS) – French version Underwriting guides/questionnaires/brochures Questionnaire Financier Confidentiel ULU CONT2187
Questionnaire Complementaire Contrats d’Assurance Vie et Demandes Existantes	Additional Questionnaire on Preexisting Life Policies and Applications – Belgium (FOS) – French version	Belgium (BE)	Utmost Luxembourg S.A	Underwriting guides/questionnaires/brochures	FOS		Additional Questionnaire on Preexisting Life Policies and Applications – Belgium (FOS) – French version Underwriting guides/questionnaires/brochures Questionnaire Complementaire Contrats d’Assurance Vie et Demandes Existantes ULU CONT2185
Questionnaire Medical Complementaire	Additional Medical Questionnaire – Belgium (FOS) – French version	Belgium (BE)	Utmost Luxembourg S.A	Underwriting guides/questionnaires/brochures	FOS		Additional Medical Questionnaire – Belgium (FOS) – French version Underwriting guides/questionnaires/brochures Questionnaire Medical Complementaire ULU CONT2183
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	Operational Forms	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
Profil d’investissement et évaluation de l’adéquation	Use this form to complete an investment profile questionnaire and request a deviation from your investment profile	Belgium (BE)	Utmost Luxembourg S.A	Investment literature/Strategies	FOS	Addition to your Policy	Use this form to complete an investment profile questionnaire and request a deviation from your investment profile Investment literature/Strategies Profil d’investissement et évaluation de l’adéquation ULU CONT2114
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	Operational Forms	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	Operational Forms	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
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	Operational Forms	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
Custodian Bank located outside the EEA / Banque Depositaire hors de l’EEE	Declaration for the Use of a Custodian Bank located outside of the EEA – Luxembourg Capitalisation product	Luxembourg (LU)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Declaration for the Use of a Custodian Bank located outside of the EEA – Luxembourg Capitalisation product Client Letters/Indemnity/Data Protection Custodian Bank located outside the EEA / Banque Depositaire hors de l’EEE ULU CONT2037
Banque dépositaire hors de l’EEE	Declaration for the Use of a Custodian Bank located outside of the EEA – France – Liberté Capitalisation product	France (FR)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Declaration for the Use of a Custodian Bank located outside of the EEA – France – Liberté Capitalisation product Client Letters/Indemnity/Data Protection Banque dépositaire hors de l’EEE ULU CONT2035
Custodian Bank located outside the EEA / Banque Depositaire hors de l’EEE	Declaration for the Use of a Custodian Bank located outside of the EEA – Luxembourg	Luxembourg (LU)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Declaration for the Use of a Custodian Bank located outside of the EEA – Luxembourg Client Letters/Indemnity/Data Protection Custodian Bank located outside the EEA / Banque Depositaire hors de l’EEE ULU CONT2036
Tax Compliance Certification – Capitalisation Bond (PH) / Déclaration relative aux Obligations fiscales	Stand-alone Tax Compliance Certification form – Luxembourg Capitalisation Bond	Luxembourg (LU)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Stand-alone Tax Compliance Certification form – Luxembourg Capitalisation Bond Client Letters/Indemnity/Data Protection Tax Compliance Certification – Capitalisation Bond (PH) / Déclaration relative aux Obligations fiscales ULU CONT2026
Tax Compliance Certification (PH) / Déclaration relative aux Obligations fiscales	Stand-alone Tax Compliance Certification form – Luxembourg	Luxembourg (LU)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Stand-alone Tax Compliance Certification form – Luxembourg Client Letters/Indemnity/Data Protection Tax Compliance Certification (PH) / Déclaration relative aux Obligations fiscales ULU CONT2025
Déclaration relative aux Obligations Fiscales (PH)	Stand-alone Tax Compliance Certification form – France	France (FR)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Stand-alone Tax Compliance Certification form – France Client Letters/Indemnity/Data Protection Déclaration relative aux Obligations Fiscales (PH) ULU CONT1852
Désignation des Bénéficiaires	Use this form to nominate beneficiaries	Belgium (BE)	Utmost Luxembourg S.A	Operational Forms	FOS		Use this form to nominate beneficiaries Operational Forms Désignation des Bénéficiaires ULU CONT1802
Choix de la Loi Applicable / Choice of Law	Use this form to perform a choice of law	France (FR)	Utmost Luxembourg S.A	Operational Forms	FOS		Use this form to perform a choice of law Operational Forms Choix de la Loi Applicable / Choice of Law ULU CONT1794
Choix de la Loi Applicable / Choice of Law	Use this form to perform a choice of law	Belgium (BE)	Utmost Luxembourg S.A	Operational Forms	FOS		Use this form to perform a choice of law Operational Forms Choix de la Loi Applicable / Choice of Law ULU CONT1790
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	Operational Forms	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
Investissements Spécialisés	Stand-alone Notice on the risks of acceptance when investing in Specialised Investments – Belgium (FOS) – French version	Belgium (BE)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Stand-alone Notice on the risks of acceptance when investing in Specialised Investments – Belgium (FOS) – French version Client Letters/Indemnity/Data Protection Investissements Spécialisés ULU CONT1590
Notice d’information sur les risques que comporte un investissement sur une Unité de Compte dont les Actifs Sous- Jacents sont composés d’Investissements Spécialisés	Stand-alone Notice on the risks of acceptance when investing in Specialised Investments – France	France (FR)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Stand-alone Notice on the risks of acceptance when investing in Specialised Investments – France Client Letters/Indemnity/Data Protection Notice d’information sur les risques que comporte un investissement sur une Unité de Compte dont les Actifs Sous- Jacents sont composés d’Investissements Spécialisés ULU CONT1584
Déclaration pour l’utilisation d’une banque dépositaire hors de l’EEE	Declaration for the Use of a Custodian Bank located outside of the EEA – Belgium (FOS) – French version	France (FR)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Declaration for the Use of a Custodian Bank located outside of the EEA – Belgium (FOS) – French version Client Letters/Indemnity/Data Protection Déclaration pour l’utilisation d’une banque dépositaire hors de l’EEE ULU CONT1434-1
Déclaration pour l’utilisation d’une banque dépositaire hors de l’EEE	Declaration for the Use of a Custodian Bank located outside of the EEA – France – Liberté product	Belgium (BE)	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	FOS		Declaration for the Use of a Custodian Bank located outside of the EEA – France – Liberté product Client Letters/Indemnity/Data Protection Déclaration pour l’utilisation d’une banque dépositaire hors de l’EEE ULU CONT1434-2
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	Operational Forms	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
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	Operational Forms	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
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	Operational Forms	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
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	Operational Forms	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	Operational Forms	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
Désignation d’Intermédiaire	Use this form to request an appointment or change of broker	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	FOE		Use this form to request an appointment or change of broker Operational Forms Désignation d’Intermédiaire ULBE PCON1429
Demande de Rachat Total (Branch)	Use this form to request the surrender of your policy/contract – Belgium (Branch) – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Surrender/Claim/Withdrawal/Switch	FOE		Use this form to request the surrender of your policy/contract – Belgium (Branch) – French version Surrender/Claim/Withdrawal/Switch Demande de Rachat Total (Branch) ULBE PCON1345
Demande de Rachat Partiel (Branch)	Use this form to request a withdrawal from your policy/contract – Belgium (Branch) – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Surrender/Claim/Withdrawal/Switch	FOE		Use this form to request a withdrawal from your policy/contract – Belgium (Branch) – French version Surrender/Claim/Withdrawal/Switch Demande de Rachat Partiel (Branch) ULBE PCON1343
Déclaration de Perte de Documents (Branch)	Form to be used to declare the loss of policy documents – Belgium (Branch) – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	FOE		Form to be used to declare the loss of policy documents – Belgium (Branch) – French version Client Letters/Indemnity/Data Protection Déclaration de Perte de Documents (Branch) ULBE PCON1337
FOR INTERMEDIARIES – Document d’entrée enrelation / Version pour l’Intermédiaire – Société	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Fact Find	FOE	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. French version Fact Find FOR INTERMEDIARIES – Document d’entrée enrelation / Version pour l’Intermédiaire – Société ULBE CONT4475
Désignation des Bénéficiaires	Use this form to nominate beneficiaries	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	FOE		Use this form to nominate beneficiaries Operational Forms Désignation des Bénéficiaires ULBE CONT4382
FOR INTERMEDIARIES – Document d’entrée en relation – Version pour l’Intermédiaire / Personne physique	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to PHYSICAL PERSONS subscribing. To be used in combination with the new business application forms for this market. French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Fact Find	FOE	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to PHYSICAL PERSONS subscribing. To be used in combination with the new business application forms for this market. French version Fact Find FOR INTERMEDIARIES – Document d’entrée en relation – Version pour l’Intermédiaire / Personne physique ULBE CONT3968
Annexe: règles et limites d’investissement pour les Fonds Internes et Externes	Table of Luxembourg Investment Rules	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	FOE		Table of Luxembourg Investment Rules Investment literature/Strategies Annexe: règles et limites d’investissement pour les Fonds Internes et Externes ULBE CONT3682
Profil d’investissement et évaluation de l’adéquation	Use this form to complete an investment profile questionnaire and request a deviation from your investment profile	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	FOE	Addition to your Policy	Use this form to complete an investment profile questionnaire and request a deviation from your investment profile Investment literature/Strategies Profil d’investissement et évaluation de l’adéquation ULBE CONT3475
Taxe sur les Opérations d’Assurance	Back-end tax annex – Belgium	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Tax and regulatory Literature/technical sales aids and literature	FOE		Back-end tax annex – Belgium Tax and regulatory Literature/technical sales aids and literature Taxe sur les Opérations d’Assurance ULBE CONT3402
Déclaration concernant la Protection des Données à Caractère	Privacy Notice – Dutch version – Belgian Branch	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	FOS		Privacy Notice – Dutch version – Belgian Branch Client Letters/Indemnity/Data Protection Déclaration concernant la Protection des Données à Caractère ULBE CONT3338
Avis de confidentialité	Privacy Notice – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	FOE		Privacy Notice – French version Client Letters/Indemnity/Data Protection Avis de confidentialité ULBE CONT3338-WEB
ACCORD DE COMMUNICATION D’INFORMATION	Information Disclosure Agreement	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	FOE		Information Disclosure Agreement Client Letters/Indemnity/Data Protection ACCORD DE COMMUNICATION D’INFORMATION ULBE CONT3287
Déviation du Profil d’investissement	Use this form to request a deviation from your investment profile	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	FOE		Use this form to request a deviation from your investment profile Investment literature/Strategies Déviation du Profil d’investissement ULBE CONT3270
Demande de classement dans une catégorie d’investissement supérieure	Use this form to request a upgrade of your investment category	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	FOE		Use this form to request a upgrade of your investment category Investment literature/Strategies Demande de classement dans une catégorie d’investissement supérieure ULBE CONT3237
Demande de classement dans une catégorie d’investissement inférieure	Use this form to request a downgrade of your investment category	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	FOE		Use this form to request a downgrade of your investment category Investment literature/Strategies Demande de classement dans une catégorie d’investissement inférieure ULBE CONT3235
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	Operational Forms	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	Operational Forms	FOE		Use this form to perform a choice of law Operational Forms Choix de la Loi Applicable / Choice of Law (Branch) ULBE CONT3195
Aperçu des frais administratifs additionnels	Annex showing the activity-based charging grid	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	FOE		Annex showing the activity-based charging grid Operational Forms Aperçu des frais administratifs additionnels ULBE CONT3182
Banque Dépositaire hors de l’EEE (Branch)	Declaration for the Use of a Custodian Bank located outside of the EEA – Belgium (Branch) – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	FOE		Declaration for the Use of a Custodian Bank located outside of the EEA – Belgium (Branch) – French version Client Letters/Indemnity/Data Protection Banque Dépositaire hors de l’EEE (Branch) ULBE CONT2948
Déclaration relative aux Obligations Fiscales – Branch	Stand-alone Tax Compliance Certification form – Belgium (Branch) – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	FOE		Stand-alone Tax Compliance Certification form – Belgium (Branch) – French version Client Letters/Indemnity/Data Protection Déclaration relative aux Obligations Fiscales – Branch ULBE CONT2830
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	Operational Forms	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
Questionnaire financier confidentiel (Branch)	Confidential Financial Questionnaire – Belgium (Branch) – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Underwriting guides/questionnaires/brochures	FOE		Confidential Financial Questionnaire – Belgium (Branch) – French version Underwriting guides/questionnaires/brochures Questionnaire financier confidentiel (Branch) ULBE CONT2818
Questionnaire complémentaire Contrats d’assurance-vie et Demandes existantes (Branch)	Additional Questionnaire on Preexisting Life Policies and Applications – Belgium (Branch) – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Underwriting guides/questionnaires/brochures	FOE		Additional Questionnaire on Preexisting Life Policies and Applications – Belgium (Branch) – French version Underwriting guides/questionnaires/brochures Questionnaire complémentaire Contrats d’assurance-vie et Demandes existantes (Branch) ULBE CONT2816
Rapport d’Examen médical (Branch)	Medical Examination Report – Belgium (Branch) – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Underwriting guides/questionnaires/brochures	FOE		Medical Examination Report – Belgium (Branch) – French version Underwriting guides/questionnaires/brochures Rapport d’Examen médical (Branch) ULBE CONT2814
Questionnaire médical complémentaire (Branch)	Additional Medical Questionnaire – Belgium (Branch) – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Underwriting guides/questionnaires/brochures	FOE		Additional Medical Questionnaire – Belgium (Branch) – French version Underwriting guides/questionnaires/brochures Questionnaire médical complémentaire (Branch) ULBE CONT2812
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	Operational Forms	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	Operational Forms	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
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	Operational Forms	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
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	Operational Forms	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	Operational Forms	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
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	Operational Forms	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
Stratégie d’Investissement (Branch)	Generic investment strategy form for the Belgian market (Branch) – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	FOE		Generic investment strategy form for the Belgian market (Branch) – French version Investment literature/Strategies Stratégie d’Investissement (Branch) ULBE CONT2779
Select Client Policy – Conditions Générales	Stand-alone version of General Conditions for the Select Client Policy product – Belgium (Branch) – French version	Belgium (BE)	Utmost Luxembourg S.A. - Belgian Branch	Policy Conditions	FOE		Stand-alone version of General Conditions for the Select Client Policy product – Belgium (Branch) – French version Policy Conditions Select Client Policy – Conditions Générales ULBE CONT2694

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