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Title	Description	Insurer	Language	Regime	Process	Excerpt
Scambio Automatico di Informazioni – Modulo di Autocertificazione per persone che esercitano il controllo (FOS) (AEoI)	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.	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) (AEoI) ULU CONT4260
Scambio Automatico di Informazioni – Modulo di Autocertificazione per persone giuridiche (FOS) (AEoI)	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.	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) (AEoI) ULU CONT4248
Scambio Automatico di Informazioni – Modulo di Autocertificazione per persone fisiche (FOS) (AEoI)	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.	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) (AEoI) ULU CONT4239
Automatic Exchange of Information – Self-Certification (FOE) (AEoI)	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.	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) (AEoI) ULIT CONT4245
Automatic Exchange of Information – Self-Certification (FOE) (AEoI)	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.	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) (AEoI) ULIT CONT4257
Automatic Exchange of Information – Self-Certification (FOE) (AEoI)	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.	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) (AEoI) ULIT CONT4269
Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE) (AEoI)	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.	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) (AEoI) ULIT CONT2594
Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE) (AEoI)	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.	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) (AEoI) ULIT CONT2597
Scambio Automatico di Informazioni – Modulo di Autocertificazione (FOE) (AEoI)	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.	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) (AEoI) ULIT CONT2600
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	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
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.	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.	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
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.	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
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.	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
Never Received or Lost Policy Schedule Declaration (EN)	Utmost Pan Europe dac Never Received or Lost Policy Schedule Declaration	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
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.	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
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.	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
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	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
Richiesta di Modifica della Maggiorazione in caso di Decesso	Use this form to request a change of life cover – Italy (Branch)	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	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
Richiesta Cambio Contraente Persona Giuridica	Use this form to request a change of Policyholder – Corporate Entity – Italy	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	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	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	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
Richiesta Cambio Beneficiario	Use this form to request a change of Beneficiary – Italy	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
Regolamento del Fondo Interno Dedicato	Rules for Internal Dedicated Fund – Italy	Utmost Luxembourg S.A	Italian (IT)	FOS	New Policy	Rules for Internal Dedicated Fund – Italy Operational Forms Regolamento del Fondo Interno Dedicato ULU CONT4585
Dichiarazione di Possesso della Qualifica di “Non-U.S. Person”	Use this form to declare a status of “Non-U.S. Person”	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	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
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.	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 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.	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
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	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
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.	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	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

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