INTERMEDIARY PROFILE

Address

Intermediary Principal Contact 1

Intermediary Principal Contact 2

Intermediary Administration Contact

Full name of each Director (or equivalent)

Full name of each Shareholder / Beneficial Owner representing at least 10% of voting equity (please ensure that each Ultimate Beneficial Owner is identified):

Please provide the names and addresses of two references

The acceptable categories of references, in order of descending acceptability, are as follows:

1. Two life insurance product providers with knowledge of the intermediary;
2. Two references from professional advisers such as a solicitor or accountant with knowledge of the intermediary.

We may request copies of documents / certificates which are not available on public registers.