CASH BUILDER - APPLICATION

Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct

Authority and the Prudential Regulation Authority

The easy, flexible way to save and watch your money grow

APPLICANT INFORMATION

Salutation:

Name:

Date of Birth:

Phone:

Address:

National Insurance Number:

Occupation:

Proposed by (If proposed by self - enter 'own life'):

Relationship to Proposed Assured:

REGULAR CONTRIBUTIONS

Payment:

Amount £:

Policy to be payable after (number of years):

Email address:

NB : If the premium is paid at greater frequencies than annually, the rates quoted increase by 4%

Are you already a member of this or any other friendly society?:

Please confirm:

Yes

If yes, please provide the name of the lodge/society and the amount of annual contribution/premium to those policies below:

Details:

OTHER INFORMATION

Are there any other facts or circumstances affecting this proposal which you think should be stated?

Yes

If “Yes”, please state all material facts below :

How did you hear about our Society/Products?

Tick:

Online

Press

Friend

Other (specify below)

Specify:

HOW WILL WE USE YOUR DATA

The information that you provide on this form will be held by the Grand United Order of Oddfellows and used to set up and administer the policy for which you are applying and for other business purposes. By taking out this policy we will rely upon this as our standard client agreement and for your own benefit and protection, you should read the terms within the Financial Products Key Information Document and Financial Products Table that are available to be reviewed on this page before signing. If you do not understand any point, please ask for further information. I confirm that I have not been given any advice by the Grand United Order of Oddfellows in relation to the purchase of this plan.

DECLARATION

Please confirm:

I agree that such statements that have been made shall be the basis of any Contract for affecting the required Assurance with the said Society and I agree to accept the Contract subject to the usual conditions prescribed by the Society. I wish to apply for the Grand United Order of Oddfellows Friendly Society Tax Exempt Savings Plan (TESP). I have read and understood the TESP Key Facts. I confirm that I am a UK resident (excluding the Isle of Man and Channel Islands) and I declare to the best of my knowledge and belief that the statements I have provided on this Application Form are true and correct and I agree to the TESP terms and conditions provided.I declare that I do not have any other Tax Exempt Plans ( excluding ISA’s) with this or any other Friendly Society which would exceed my maximum Tax Exempt Allowance for Tax Exempt Savings Plans of £25 per month or £270 per annum. Furthermore, I declare that, the total of my contributions to this and other taxable qualifying policies does not exceed £3600 per annum.

Failure to mention any material fact (this is a fact that an insurer would regard as likely to influence the assesment and acceptance of an application for a policy) may affect the amount payable upon death or maturity. If an applicant is in any doubt whether the fact is material or not, it should be disclosed anyway.

Processing of your personal data is necessary for the performance of our contract for services with you. Generally, this is the lawful basis on which we intend to rely for the processing of your data. Our policy is to gather and process only that personal data which is necessary for us to conduct our services appropriately with you.

Conditions and copies of the completed application forms are available on request.- but if required, please print your application BEFORE submission.

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