www.wealthoptions.ie

PRSA Application Pack

YOUR PENSION PARTNER

Non-Standard

PersonalRetirement

Savings Account

2 separate solicitors must be appointed to arrange legal work One for seller and one for purchaser

Important points to note for legals: Propertymustberegisteredinthename“WealthOptionsLtdasTrusteesofClientNamePRSA” TheclientisfreetochooseanysolicitorfromtheWealthOptionsLtdpanelofsolicitors.Pleasecontactthe officeforfurtherdetails. APropertyManagementCompanymustbeappointed.

ThefollowingareimportantpointstonoteforliquidityastheremustbesufficientliquidityinthePRSAtomeetongoingrequirements: What is the property purchase price? Isthepropertyresidential/commercial? Will stamp duty apply to the purchase? WillthispropertypurchaseinanywaybreachtheRevenue’s“armslength”rules? Is there a management company in place to manage the property upkeep, repairs etc? What is the annual fee for the management company? Istherealettingagentinplacetomanagetenancy,lettings,tenantqueries,rentcollectionetc? Whatistheannualfeeforthelettingagent? Are there tenants inplace? If so,WealthOptionsLtdneed to sight the tenancy agreement to confirm current rental income RentmustbepaiddirectlytothePRSAbankaccount Arethereanyrenovationsorfurnishingcostsplanned? Nonprincipalprivateresidencetaxpayableannuallyonresidentialproperties LocalPropertyTaxpayableannuallyonresidentialproperties

Allpropertiesshouldbeindependentlyvaluedannually.ThevaluationfeeispayablebythePRSA.

FullycompletedandsignedApplicationBooklet ClientandTrustee

BankAccountOpeningMandateandAddendumsignedbytheClient

BankAuthorisationlettertotransferfunds

ContactdetailsofPensionAdministratorfromwhichtheClientistransferring

DetailedScheduleofAssetstobetransferredinspecie Ifcashonly–N/A

ChequeforInvestmentAmountorConfirmationofEFT Chequetobemadepayableto‘Client’sNamePRSA’

SignedandcompletedInvestmentInstruction/InvestmentDeclarationform

CertifiedCopyofProofofPPSN

CertifiedCopyof2UtilityBills/BankStatements Notmorethan6monthsold

CertifiedCopyofPhotoID Validandindatedrivinglicenceorpassport

CertificateofBenefitComparison RequiredwhenexistingpensionistobetransferedisfromanOccupationalPensionScheme,valuedover€10,000

ClienthasbeenprovidedwithaPreliminaryDisclosureCertificate,incorporatingsampleclientdetails

SignedPensionTransferInstructionForm

Documentation Checklist ...

PRSA Irish Property Purchase Checklist ...

Section A: PRSA Holder’s Details

Ms. Mr. Mrs. Other

Surname

FirstName

DateofBirth / /

Gender Male Female

Telephone

Address

Eircode Please notify us of future change in address

Email:

PPSNNo:

ChosenRetirementAge*

Status: Married Single Widow(er) Separated Divorced

CivilPartnership

AreyouaResidentofIreland? Yes No

Ifno,pleaseconfirmyourcountryofResidence:

CountryofBirth

CountryofCitizenship

AreyouaUSCitizen? Yes No

AreyouaUSTaxResident? Yes No

Areyou,orthebeneficialowner,aPEPorarelativeorclose

associateofaPEP?** Yes No

D D M M YY YY

Financial Broker Details

FinancialBrokerName

FinancialBrokerFirmAgencyNo

Section B: Occupation Details

Occupation

Employed1 Yes No Salary

Non-Standard PRSA Application Form ...

Please tick which one of the following best describes your occupation status:EmployeeManager,Professional,TechnicalAdministrative Sales

Clerical&Secretarial Plant&MachineryOperative

Trade,Craft&Related OtherEmployee

Personal&ProtectionServices

OR

Self EmployedSelfEmployed2 Yes No

Ifyes,pleasetickoneofthefollowingoptions: Agriculture Other

OR

UnemployedUnemployed Yes No

1 You are in receipt of remuneration chargeable to income tax under Schedule E from an office or employment held by you.2 You are in receipt of income chargeable to income tax under Schedule D which is immediately derived from carrying on a trade or a profession, either as an individual or as a partner personally acting in a partnership.

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* Age 60-75. If left blank, we will assume your chosen retirement age is 75. ** A PEP (Politically Exposed Person) is defined as a person who is, or has at any time in the preceding 12 months been, entrusted with a prominent public function.

€

Section C: Contribution Details

NameofPensionSchemePensionAuthorityReference

RevenueReferenceNumberNormalRetirementAge

Name(s)ofTrustees

NameofEmployer

IsthereaPensionAdjustmentOrderinplace?YesNo If yes, please provide evidence of same.

Isthetransferringscheme:DefinedBenefitDefinedContribution AnotherPRSA PersonalPensionPlan(RAC) OverseasScheme

IfthistransferisfromaPRSA,isthisavestedPRSA?i.e.haveyoutakenretirementbenefitsfromitpreviously?YesNo EmployeeEmployerAVCTotal

IauthorisetheAdministratoroftheaboveschemetotransfertoaWealthOptionsLtdPersonalRetirementSavingsAccounttheamountwhichintheopinionofthesaidTrusteesrepresentsthevalueofmybenefitsonwithdrawalunderthePlan.InconsiderationofthepaymentofsuchtransfervaluetoaWealthOptionsLtdPersonalRetirementSavingsAccount,IherebyreleasetheTrusteesofthePlanfromallliabilitytomeandmydependentsinrespectofallbenefitsundertheplanwitheffectfromthedateofsuchtransfer. PRSAHolder Date: // Signature

€ € € €

Signature Required

Single Contribution*Employee Employer AVC

PaymentType: EFT Cheque

Regular Contributions*Employee Employer AVC

PaymentType: ChequeOnly Frequency: MonthlyOnly

CommencementContributionDate://

*If contributions are being made by cheque, they should be made payable to ‘Client’s Name PRSA’. If being made by EFT, please contact the office for bank account details.

AVC PRSA Plan Details

IsthisschemeanAVCPRSA? Yes No

Ifyes,pleaseconfirmthefollowingdetails:

OPSTrusteeName: NormalRetirementAge:

Address:

TelephoneNo: Email:

Dateofjoiningcompany://

€

Section D: Transfer Details

Please Note: If the above details are not completed, the application cannot be processed.

D D M M Y YYY

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€ €

€ € €

D D M M Y YYY

D D M M Y YYY

Section F: Personal Retirement Savings Account Holder Declaration

Warning: If you propose to take out this PRSA in complete or partial replacement of any existing policy, please take special care to satisfy yourself that this policy meets your needs. In particular, please make sure that you are aware of the financial consequences of replacing your existing policy. If you are in doubt about this, please contact your current provider or financial broker.

Ideclarethatthe informationprovided inthisandotherrelatedforms (ifany)aretrueandcompletetothebestofmyknowledgeandbeliefwhetherinmyhandwritingornotandthatthisapplicationanddeclarationshallformthebasisofthecontractwithWealthOptionsLtd.

Data Protection NoticeWealthOptionsLtd(‘WealthOptions’)willkeeptheinformationyouprovide,forthepurposesof,andinconnectionwith,thisapplication,aboutyourselfandaboutthirdpartiesconfidential.WealthOptionswilluseittoadministerthisapplicationandanysubsequentappointment(agreement),andinordertocomplywithlegalobligationsimposedonit.WealthOptionsiscommittedtosafeguardingyourpersonaldatathroughitsobligationsundertheDataProtectionActs.FurtherdetailsofourdataprocessingpracticesandyourdataprotectionrightsareincludedinourDataProtectionPolicy.Thispolicyisavailableonourwebsiteand/orinhardcopyformatfromWealthOptionsLtd.,ElmHouse,MillenniumPark,Naas,Co.Kildare.

I agree that where I have selected fund(s) other than the Default Investment Strategy, by signing this declaration, and any supplementary application, I am providing written confirmation that I do not wish to avail of the Default Investment Strategy.

Whereapplicable,I,asanemployee,consenttomyemployerhavingaccesstodetailsofmyapplicationinordertofacilitatethe deductionofmypersonalcontributionsfrommysalary.IalsounderstandthatthecommencementdateofthecontractandthetimingofanysubsequentchangestocontributionswillbesubjecttomyEmployermakingthenecessarychangesinmypayroll.

IagreethatWealthOptionsLtdmayreceive information inrespectofanytransfervaluecontributionamountfromthe transferringTrustees/LifeOfficeand Iauthorise themtogiveWealthOptionsLtdthis information. Iaccept thetermsandconditionssetoutinthemarketingdocumentation.IauthorisetheRevenueandtheDepartmentofSocialandFamilyAffairstogiveWealthOptionsLtdmymostrecentaddressheldontheirrecordsatanytimeinthefuture.IconfirmthatIhavebeenprovidedwithaPreliminaryDisclosureCertificate.AllfeesassociatedwiththePRSAhavebeenexplainedtomeandIamsatisfiedwiththefees.Iamawarethatadditionalfeesmaybeappliedasaresultofmyunderlyinginvestment.IconfirmthatIhavereceivedAppendixBonPRSAs.IconfirmthatIunderstandthattheinvestmentrisksassociatedwithaNonStandardPRSAmaybehigherthanthoseunderaStandardPRSA.IamsatisfiedthatthisNonStandardPRSAisanappropriateproductforme.

PRSAHolder Date: // Signature

PleasesupplyallmarketingandcompliancedocumentationrelatingtotheseinvestmentstoWealthOptionsLtd.

*Wealth Options Ltd will ensure that there is sufficient liquidity in the PRSA for payment of fees before an investment is made.

Please tick oneofthefollowinginrelationtowhichinvestmentstrategyyouwouldliketoadopt(if you do not select one of these you

will be included in the default investment strategy):

1. Personal Investment StrategyIchoosetohavemyfundsplacedondepositpendingfurtherinstructionforinvestmentfrommyself-DetailsofsuchinvestmentscanbecompletedinthePRSAInvestmentInstructionFormonPage7ofthisapplicationbooklet(0verleaf).IfthisPRSAInvestmentInstructionFormonPage7isleftblankthenyourfundswillbekeptincashondeposituntilaninvestmentinstructionisreceived.

OR

2. Default Investment StrategyIfyouchoosethedefaultinvestmentstrategy,allcontributionsmustbemadeinaccordancewiththisstrategy)

Section E: Investment Strategy Details*

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Signature Required D D M M Y YYY

Notes

Pleaseusethisareatoprovideextrainformationinrelationtoanyofthequestionsintheapplicationform.Pleaseindicatewhichquestiontheextrainformationrelatesto.

Section G: Declaration of Financial Broker (Appendix C)

IherebydeclarethatinaccordancewithArticle3ofthePersonalRetirementSavingsAccount(Disclosure)Regulations2002,aPreliminaryDisclosureCertificatehasbeenprovidedto:

Insert PRSA Holders Name above.

andthatIhaveadvisedthepersonconcernedastothefinancialconsequencesoftransferringfromanoccupationalpensionschemeorreplacinganexistingPRSAcontractorretirementannuitycontractwiththisPRSAcontractbycancellationorreductionandofpossiblefinanciallossasaresultofsuchareplacement.

IdeclarethatIhaveexplainedtothisconsumerthattherearedifferencesbetweenaNon-StandardPRSAandStandardPRSA,andfocusedonthefactthatthechargesmaybehigherandtheinvestmentrisksaregreaterforthisnon-StandardPRSA.

Ideclarethatinmyopinionitisinthebestinterestoftheabovenamedconsumertopurchasethisnon-StandardPRSA.

Ideclarethatinmyopinionthenon-StandardPRSAIhaveoffered/recommendedtotheabovenamedconsumeristhePRSAproductmostsuitedtothisconsumerfromamongallthoseIamabletoprovide.

AreyouauthorisedbytheCentralBankofIrelandtogivefinancialadviceonPRSAs?Yes No

FinancialBroker Date // Signature

Declaration of PRSA Holder

IconfirmthatIhavereceivedinwritingtheinformationspecifiedintheabovedeclaration.

PRSAHolder Date// Signature

Warning: Please note that the provision of this service provided by Wealth Options Ltd does not require licensing, authorisation, or registration with the Central Bank and, as a result, it is not covered by the Central Bank’s requirements designed to protect consumers or by a statutory compensation scheme.

Signature Required

Signature Required

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D D M M Y YYY

D D M M Y YYY

PRSA Investment Instruction Form ...

Client Details

NameofPRSA

InvestmentInstruction

Fund / Investment Name Amount to be invested*€/%

€/%

€/%

€/%

Please supply all marketing and compliance documentation relating to the investments to Wealth Options Ltd - prospectus, loan/ investment agreement, brochures, fact sheet, memorandum. These documents should provide complete clarity on all investment charges, fees and commissions. Please note that no investments with fixed fees or performance fees can be facilitated.

Declaration

1. IwishforWealthOptionsLtdtoinvestintheabovementionedproduct.IunderstandthatthisinvestmentmaybemadebyaUnitTrustandwillbesubjecttotheprovisionsoftheTrustDeedasamended.IconsenttoWealthOptionsLtdapplyingforunitsintheUnitTrustonbehalfofmyPRSA.WealthOptionsLtd.aretrusteesoftheUnitTrustandyoumayalsobeinvestinginaproducteither producedorpromotedbyWealthOptionsLtd.ThereisnoconflictofinteresthereasWealthOptionsLtdastrusteesoftheUnitTrustwilloperateundertheinstructionofthebeneficialownerofthePRSA.

2. IherebyconsenttotheprovisionofinformationtotheRevenueCommissionersifrequestedinrelationtothisinvestment.3. IcertifythatIhavereceivedfinancialadvicepriortothemakingofthisinvestment.IunderstandthatWealthOptionsLtdwillnotbe

involvedinprovidinginvestmentadviceinrelationtoinvestmentsselectedunderthePRSAnamedabove.Iunderstandthatvaluescangodownaswellasup.Iunderstandthatifthereisgearing(lending)involvedinaninvestmenttheremaybeahigherdegreeofriskinvolvedinthatinvestment.AllfeesintheinvestmenthavebeenexplainedtomeandIamsatisfiedwiththefees.

4. IfIdecidetoexercisemycoolingoffoptiononaninsuredproduct,myfundwillberefundedlesstheadjustmentforanydownward movementintheunitpricefromthedateoftheinvestmenttopolicycancellationdate.

5. BysigningthisformIamindemnifyingWealthOptionsLtdagainstanyandallcostsandclaimsincurredorsufferedarisingdirectlyorindirectlyoutofthesigningbyWealthOptionsLtdoftheInvestmentapplicationand/ormakingtheinvestmentorotherwiseinconnectionwiththeinvestment.

Warning: Please note that the provision of this service provided by Wealth Options Ltd does not require licensing, authorisation, or registration with the Central Bank and, as a result, it is not covered by the Central Bank’s requirements designed to protect consumers or by a statutory compensation scheme.

SignatureofPRSADate//Holder

Signature Required

Data Protection Acts

WealthOptionsLtd(‘WealthOptions’)willkeeptheinformationyouprovide,forthepurposesof,andinconnectionwith,thisapplication, about yourself and about third parties confidential. Wealth Options will use it to administer this application and any subsequent appointment(agreement),andinordertocomplywithlegalobligationsimposedonit.WealthOptionsiscommittedtosafeguardingyour personal data through itsobligationsunder theDataProtectionActs. Furtherdetails ofourdataprocessingpractices andyourdata protectionrightsareincludedinourDataProtectionPolicy.Thispolicyisavailableonourwebsiteand/orinhardcopyformatfromWealthOptionsLtd.,ElmHouse,MillenniumPark,Naas,Co.Kildare.

FinancialBrokerName Date//

IconfirmthatIhavemettheabovenamedclient,explainedtheproducttothemandhavegiventhemsuitableadvice.

FinancialBrokerSignatureSignature Required

D D M M Y YYY

D D M M Y YYY

PRSA Investment Declaration ...

NameofPRSA: (the“Scheme”) NameofTrustee:WealthOptionsLtd.(the“Trustee”)

Detailsandnatureofproposedinvestment(s):

(the“Investment(s)”)

IherebydeclareforthebenefitoftheTrusteethatIamawareof,understandandhavetakensuchprofessionaladviceasIdeemappropriateinconnectionwiththeRevenueguidelinesandpracticesforPRSAs(the“Guidelines”)andtheirapplicationtotheInvestment(s),andIconfirmandacknowledgethattheInvestment(s)areorshallbeinconformitywithanddonotorshallnot,tothebestofmyknowledge,contradicttheguidelines.Iconfirmandacknowledgethattheinvestment(s)is/arebeingundertakenatmyrequestanddirectionandagreetorelease,indemnifyandholdharmlesstheTrusteefromanyandallliabilityinconnectionwithorarisingfromtheinvestment(s)beingdeemedtobreachtheguidelines.Asummaryof currentguidelinesisdetailedoverleafforconvenienceonly–yourprofessionaladviserwillneedtoadviseyouofanychanges affectingtheguidelinesandupdatesmayalsobeobtainedontheRevenue’swebsitewww.revenue.ie.

It is further AGREED as follows:Bysigning this form Iam indemnifyingWealthOptionsLtdagainstanyandall costsandclaims incurredorsufferedbythetrusteearisingdirectlyorindirectlyoutofthesigningbytheTrusteeoftheinvestmentapplicationand/ormakingtheinvestmentorotherwiseinconnectionwiththeInvestment.IunderstandthattheTrusteesreservetherighttorefuseaninvestment.

Signed:

Name:[BLOCKCAPITALS]

Date:

Witnessed by:

Signature Required

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PRSAHolderSignature

Signature Required

FinancialBrokerSignature

PRSA Investment Restrictions ...

AsthePRSAHolderdirectingtheinvestmentofyourPersonalRetirementSavingsAccount,youshouldbeawareofcertaininvestmentrestrictionswhichapplytoyourfund.

These restrictions arise from:

• TheRevenueCommissioners,asaconditionofapprovalofyourfund.ContraveningtheserestrictionscouldtriggeraforceddistributionoftheassetfromyourPRSA;theseinvestmentsarethereforeprohibitedforyourfund.

• Tax legislation (s779ATaxesConsolidationAct1997)whichmakecertain investment transactionsbyyour fundnottaxefficientforyou,bycausingaforcedwithdrawalfromthefundoftheassetsandfundsinvolved,togetherwithan associatedtaxchargeforyou.Assuchatransactionwouldnotbeinyourbestinterests,theseinvestmenttransactionsshouldalsobeconsideredtobeprohibitedforyourfund.

• PartXofthePensionsAct1990,asamended.ThislegislationrestrictsthechargesandfeesthatmaybechargedunderaPRSA.

Prohibited investments

Thefollowinginvestmentsandtransactionsarethereforeprohibited for your fund:• Buyingassetsfromorsellingassetstoyourself,oranyoneconnectedwith1you.• Aloanfromyourfundtoyourselfortoanyoneconnectedwithyou,includingtoyouremployer;• Shares,loans,debentures,etc.inthebusinessofanyoneconnectedtoyou;• Tangiblemovableassets,suchasworksofart,wine,gold,jewelery,cars,yachts,racehorse,technologydevices,etc.• Residentialorholidayproperties,tobeusedbyyouorbyanyoneconnectedwithyouforthispurpose;• Commencementof thepersonalusebyyou,orbyanyoneconnectedwithyou,ofa residentialorholidayproperty

previouslyheldbythefundasanarm’slengthinvestment;• Commencementoftheuseforbusinesspurposesbyyou,orbyanyoneconnectedwithyou,ofapropertypreviously

heldbythefundasanarm’slengthinvestment;• Shares,loannotes,debentures,etc.inacompanywhichisa‘closecompany’2,atatimewhenyou,oranyoneconnected

withyou,isalreadyaninvestorinthatcompany;• Sharesinaprivatecompanywhosevaluewouldexceed5%ofthefund’sassetsor10%oftheprivatecompany’sshare

capital;• Theacquisitionofapropertywhereanyoneofthefollowingwouldapply:

-Thevendorisnotatarm’slengthtoyouoranyoneconnectedwithyou;-Thepropertyistobeheldforonlyashortperiodandthensoldon;-Thepropertyistobeusedinabusinessyouareinvolvedin,oranyoneconnectedwithyouisinvolvedin;-Thepropertyistobedevelopedandthensoldon,withinashortperiod;-Anoverseasproperty³;-Thepurchaseofthepropertywouldleaveinsufficientliquidityinyourfundtoprovidebenefitsondeathandforannualdistributionsorfees;-AnyrenovationorworkscarriedoutonapropertyheldwithinthePRSAmustbecompletedonan“arms-length”basisi.e.byproviders,contractorsetcthathavenoconnectiontothePRSAholder.Invoicesshouldbepaidbythebuilder/contractorandincludedintheinvoicetothePRSAfortheworksandpaiddirectlyfromthepensionfund.AllinvoicesmustbeissuedtothePRSAnameandaddressedtothepropertyaddress.

• Aninvestment(includingjointinvestmentwithothers)inaninvestmentfundwheresomeoneconnectedwithyouisaninvestorandthereisanarrangementbywhichthevalueofthatotherperson’sholdinginthefundcanincreaseattheexpenseofthevalueofyourfund’sholdinginthefund.

Prohibited Charges• Assetoutins.104ofPartXofthePensionsAct1990• Nofixedcharges• Anychargesmustbeexpressedaspercentageofcontributionorpercentageoffundvalue

1. The term ‘connected with’ is very wide; see overleaf for a more detailed explanation2. The term ‘close company’ is explained in more detail overleaf3. Overseas properties are allowed in certain circumstances, subject to a number of restrictions

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‘Connected with’ ...Certain investmentsand transactions involvingpersons ‘connectedwith’youare,asoutlinedabove,prohibited.For thispurpose,thefollowingaredeemedtobe‘connectedwith’you• Yourspouseorcivilpartner;• Yourrelatives,i.e.yourbrother,sister,parents,grandparents,children,grandchildren,aunt,uncle,nieceornephew;• Thespouseorcivilpartnerofarelativeofyours,asabove.E.g.yourgrandchild’sspouseisconnectedwithyou.• Arelativeofyourspouseorcivilpartner,i.e.yourspouse’sbrother,sister,parents,grandparents,children,grandchildren,

aunt,uncle,nieceornephew;e.g.yourfatherinlawisconnectedwithyou.• Thespouseorcivilpartnerofarelativeofyourspouseorcivilpartner,asabove.E.g.yoursisterinlawisconnectedwith

you.• Acompanywhereyou(possiblyinconjunctionwithothersconnectedwithyou)havecontroloverthatcompany;and• Abusinesspartnerofyours,includingtheirspouseorcivilpartnerandrelatives.

Close company ...Investmentsbyyourfundinaclosecompany(orinacompanywhichwouldbeaclosecompanyifresidentintheState)areprohibitedifyouoranyoneconnectedwithyouarealreadyaninvestor,e.g.sharesorloans,inthatcompany.

Forthispurposea‘closecompany’isdefinedins10TaxesConsolidationAct1997andincludesacompany:•underthecontroloffiveorfewerinvestorsinthecompany;or•underthecontrolofitsdirectorswhoareallinvestorsinthecompany.MostIrishresidentcompaniesare‘close’companies.Acompanyownedbyasmallnumberofindividualsorafamilycompanywilllikelybeaclosecompany.Howevermostcompanieslistedonthestockexchangewilllikelynotbeclosecompanies.

ImportantWe believe this list of prohibited investments to be correct as at April 2018. However Revenue Practice and tax legislation can change over time and hence the list of prohibited investments can change from time to time.

Individuals who are connected with you ...

You

Your Spouse/ Civil Partner Your Relatives

Your Spouse/ Civil Partner’sRelatives

Spouse/ Civil Partnerof your Relative

Spouse/ Civil Partnerof Relative

A ‘relative’ is a brother, sister, grandparent,grandchild, aunt, uncle, niece or nephew.

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Property Investment Questionnaire ...AsthePRSAHolderdirectingtheinvestmentofyourPersonalRetirementSavingsAccount,youshouldbeawarethatcertain investmentrestrictionsapplytoyourfundinrelationtotheacquisitionofproperty.PleasecompletetheQuestionnairebelowinorderthatWealthOptionsLtdcandeterminewhetherthepropertyinquestioncanbeacquiredbyyourfundtoholdasan investment.

NameofPRSA

NameofPRSAHolder:

Property to be acquired

Residential Commercial Holiday Other

Addressofproperty:

Currentuseoftheproperty:

Isthepropertycurrentlylet? Yes No

Do you, or anyone connected with you, own a property in the locality either personally or through a pension? Yes No

Details of the vendor of the property

NameoftheVendor:

IstheVendoratarm’slengthtoyou? Yes No

IfNo,pleasegivemoredetails:

IstheVendorconnectedwithyou? Yes No(Please see graph on the left hand side of the form for an explanation of the persons who are ‘connected with’ you, for this purpose)

Proposed use of the property

Doyou,oranyoneconnectedwithyou,intendtousethepropertyasaresidenceorholidayhome? YesNo Do you, or anyone connected with you, intend to use the property in the course of a business in which you oranyoneconnectedwithyouisinvolved? YesNo

Willthepropertybeletorusedbyyouoranyoneconnectedtoyou,inthecourseofabusiness?YesNo

Isitproposedtosellon,ordevelopandthensellon,thepropertywithinashortperiodafteracquisition?YesNo

Finance

Acquisitioncost,includingcosts,oftheproperty: €€

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Signature Required

Declaration

Ihavereceived,readandunderstoodtheinvestmentrestrictions.IdeclarethattheanswersprovidedinthisQuestionnairearecorrectandcompletetothebestofmyknowledge.IunderstandandacceptthatiftheproposedpropertyinvestmentabovedoesnotcomplywithRevenueandtaxlegislationrequirements,WealthOptionsLtdcannotconsenttotheproposedacquisitionofthatproperty.

PRSAHolderSignature Date

Data ProtectionWealthOptionsLtd(‘WealthOptions’)willkeeptheinformationyouprovide,forthepurposesof,andinconnectionwith,thisapplication,aboutyourselfandaboutthirdpartiesconfidential.WealthOptionswilluseittoadministerthisapplicationandanysubsequentappointment(agreement),andinordertocomplywithlegalobligationsimposedonit.WealthOptionsiscommittedtosafeguardingyourpersonaldatathroughitsobligationsundertheDataProtectionActs.FurtherdetailsofourdataprocessingpracticesandyourdataprotectionrightsareincludedinourDataProtectionPolicy.Thispolicyisavailableonourwebsiteand/orinhardcopyformatfromWealthOptionsLtd.,ElmHouse,MillenniumPark,Naas,Co.Kildare.

¹Please see investment restrictions for an explanation of persons who are connected with you

Warning: Please note that the provision of this service provided by Wealth Options Ltd does not require licensing, authorisation, or registration with the Central Bank and, as a result, it is not covered by the Central Bank’s requirements designed to protect consumers or by a statutory compensation scheme.

12 | Page

Property Management Company Details

IsthereaPropertyManagementCompanyagreementcurrentlyinPlace?Yes No

Please provide details:

Name

Address

EmailAddress

PhoneNo.

Nominated Solicitor

Pleaseprovidedetailsofyournominatedsolicitor(mustbeapartoftheWealthOptionsLtdpanelofsolicitors).

Please provide details:

Name

Address

EmailAddress

PhoneNo.

Private Company Investment Questionnaire ...AsPRSAHolderdirectingtheinvestmentofyourPersonalRetirementSavingsAccount,youshouldbeawarethatcertain investmentrestrictionsapplytoyourfundinrelationtoaninvestmentinaprivatecompany.PleasecompletetheDeclarationbelowinorderthatWealthOptionsLtdcandeterminewhethertheproposedinvestmentinaprivatecompanycanbemadebyyourfund.

Signature Required

NameofPRSA: NameofPRSAHolder

Details of the private company in which the fund proposes to invest:

CompanyName:

CompanyRegistrationNo:

ContactName:

Areyouoranyoneconnectedwith¹youalreadyaninvestor(e.g.holdsshared,loannotes,debentures,etc.)inthiscompanyeitherpersonallyorthroughapension? Yes No

Detailsoftheproposedinvestmentintheprivatecompany: Shares Loans Debentures Other

IfOther,pleasegivedetails

Amountofproposedinvestment:€

Iftheproposedinvestmentinthecompanywillbebywayofsecurities,willtheybeissuedbythecompanyoracquiredfromanexistinginvestorinthecompany?: Issuedbycompany Acquiredfromanexistinginvestor

Ifthesecuritiesaretobeacquiredfromanexistinginvestor,areyouoranyoneconnectedwithyouthevendorofpartofallofthesecurities? Yes No

If theproposed investment isshares in thecompany,whatwillbe the issuedsharecapitalof thecompanyafteryourschemeacquiressharesinthecompany? €

Ihavereceived,readandunderstoodtheinvestmentrestrictions.IdeclarethattheanswersprovidedinthisQuestionnairearecorrectandcompletetothebestofmyknowledge.IunderstandandacceptthatiftheproposedinvestmentdoesnotcomplywithRevenueandtaxlegislationrequirements,WealthOptionsLtdcannotconsenttotheproposedinvestment.

PRSAHolderSignature Date

Declaration

Data Protection Notice WealthOptionsLtd(‘WealthOptions’)willkeeptheinformationyouprovide,forthepurposesof,andinconnectionwith,thisapplication,aboutyourselfandaboutthirdpartiesconfidential.WealthOptionswilluseittoadministerthisapplicationandanysubsequentappointment(agreement),andinordertocomplywithlegalobligationsimposedonit.WealthOptionsiscommittedtosafeguardingyourpersonaldatathroughitsobligationsundertheDataProtectionActs.FurtherdetailsofourdataprocessingpracticesandyourdataprotectionrightsareincludedinourDataProtectionPolicy.Thispolicyisavailableonourwebsiteand/orinhardcopyformatfromWealthOptionsLtd.,ElmHouse,Naas,Co.Kildare.

¹Please see investment restrictions for an explanation of persons who are connected with youWarning: Please note that the provision of this service provided by Wealth Options Ltd does not require licensing, authorisation, or registration with the Central Bank and, as a result, it is not covered by the Central Bank’s requirements designed to protect consumers or by a statutory compensation scheme.

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PolicyProvider/InsuranceCompanyname: _________________________________________

PolicyNumber: _________________________________________

PolicyHoldername: _________________________________________

DateofBirth: _________________________________________

Re: Pension Transfer Request

Date:_____________________,20____

ToWhomItMayConcern, PleaseacceptthisasmyinstructiontotransfermyexistingpensionwiththeabovenamedpensionprovidertomyWealthOptionsLimitedPRSA.

IherebyauthoriseyoutodirectlyprovideWealthOptionsLimitedwithanyinformationtheyrequireregardingthefinancialproductsheldbymeormycompany.

WealthOptionsLimitedislocatedat:

WealthOptionsLimitedElmHouseMillenniumParkNaasCo.Kildare

Tel:045882281Fax:045882286

Pleaseensurethatthechequeismadepayableto:___________________________________________________PRSA.

Itrustthatyoufindtheaboveinorder,howeverpleasedonothesitatetocontactthePRSADepartmentofWealthOptionsLimitedon045882281orprsa@wealthoptions.ieifyouhaveanyfurtherqueries.

Yoursfaithfully

ClientSignature

PrintName: __________________________________________

Date: __________________________________________

Signature Required

To:WealthOptionsLtd(“WealthOptions”)Unit1C/2AElmHouseMillenniumParkNaasCo.Kildare

From:__________________________________(the“PRSAHolder”)

__________________________________

__________________________________

__________________________________

Re:“________________________________________________________________________________________________”(the“PRSA”)

Date:_____________________,20____

DearSirs,

ThePRSAHolderasbeneficiaryofthePRSAherebyconsentstoWealthOptionsastrusteesolelyopeningandoperatingabankaccountoraccounts(togetherthe“Account”)withBankofIreland(the“Bank”)forthepurposesofthePRSAwhereWealthOptionsshallbethesolesignatoryorauthorisingpartyinrespectoftransfersandotherinstructionsinconnectionwiththeAccount,whethermadeelectronicallyorotherwise.SuchinstructionsshallcompriseallinstructionstobegiventotheBankinconnectionwiththeopeningandoperatingoftheAccountandmayinclude,butshallnotbelimitedto,mandatesandindemnityformsrequiredforelectronicbankingandallformsoftransferinstruction.

It is agreed and acknowledged betweenWealthOptions and the PRSAHolder to operate the following procedures in connectionwiththeAccount:(i)TheAccountshallbeestablishedasatrustaccountdesignatedforandidentifiedbythenameofthePRSA;(ii)TheAccountshallonlybeusedforandshallonlycontainfundsbelongingtoorheldforthepurposesofthePRSAandshallnotcontainfundsbelongingtoorheldforthepurposesofanyotherPRSA;(iii)WhilethemandateandotherinstructionsgiventothebankmaybesignedsolelybyandonbehalfofWealthOptions,WealthOptionsshallobtainthewrittenconsentofthePRSAHolderpriortomakingorissuinginstructionsforanytransferssavewhereanysuchtransferrelatesto:1. apaymenttotheRevenueCommissioners;2. onthedeathofthePRSAHolder,apaymentthatistobemadetoorasdirectedbythePRSAHolder‘spersonal

representativesaspartofhis/herestate;or3. thepaymentisinrespectofanyfeesorexpensesofWealthOptionsthathavenotbeenpaidwhendue.

It isagreedandacknowledgedthatnothinghereinshalloblige theBank toverify that theaboveprocedureshavebeen observed.

Yoursfaithfully,

ThePRSAHolder

Agreedandacknowledged:

_______________________________________ForandonbehalfofWealthOptionsLtd

Signature Required

Private & ConfidentialThePRSADeptWealthOptionsLtdUnit1CElmHouseMillenniumParkNaasCo.Kildare

Date:_____________________,20____

Re:________________________________________________________________________________________________PRSA

AccountNo:__________________________________

DearTeam,

We would be grateful if you could transfer €_______________ to the following account:

Bank:

Sort Code:

Account Number:

Account Name:

Swift Code:

IBAN:

Please quote reference:

Yours faithfully

ThePRSAHolder

_______________________________________ForandonbehalfofWealthOptionsLtd

Signature Required

www.wealthoptions.ie

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Please note that the provision of this service by Wealth Options Ltd does not require licensing, authorisation, or registration with the Central Bank and, as a result, it is not covered by the Central Bank’s requirements designed to protect consumers or by a statutory compensation scheme.

YOUR PENSION PARTNER

January 2019 - V1