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Are you the beneficiary under any other qualifying policy? For example this could be an endowment regular savings plan that is mainly a savings plan but includes an element of life assurance issued by a life insurance company, or a tax-exempt savings plan like the one you are applying for here. If so, you need to let us know by ticking the box.
Note that a qualifying life policy does not include term assurance - that is where you pay premiums that will only pay out in the event of your death, so you don't need to let us know about that. And if you invest in an ISA, like a Cash ISA, or a Stocks and Shares ISA or even a building society or bank deposit account, you don't need to let us know about these.
I hereby apply to Scottish Friendly Assurance Society Limited for a tax-free endowment assurance policy known as the Scottish Bond. I declare that, to the best of my knowledge and belief, the answers given to the questions on this application are true and complete and I agree that the information supplied will form the basis of the contract between myself and Scottish Friendly. I further declare that in arranging this policy with Scottish Friendly I will not be exceeding my tax-free limit in respect of friendly society policies of £25 per month (or £270 per year).
I declare that in arranging this policy with Scottish Friendly, I will not be contributing more than £3,600 in total each year to any qualifying life policy with Scottish Friendly or with any other life company or friendly society. I have received the relevant Key Information Document.
In the event of my death before the end of the life of the bond, I consent to Scottish Friendly contacting my doctor for medical information under the Access to Health Records Act 1990 and the Access to Health Records (Northern Ireland) Order 1991.
Important note - please read carefully
You must disclose to Scottish Friendly all material facts relevant to the insurance for which you are applying.
A material fact is one which is likely to influence the decision whether or not to accept the application, or on
what terms. If you are in any doubt whether a fact is material, you should disclose it. Non-disclosure of a material
fact may result in Scottish Friendly refusing to pay a claim on your death. You do not have to tell us about any
genetic test results you may have had. A copy of the terms and conditions of the policy and of this form are available
to you on request.
I consent to the Society using the information supplied on the Application to administer my policy and acknowledge that it will be held and my policy will be processed on the Society’s computer systems and may be used for underwriting or claims handling purposes.
To comply with money laundering regulations, we may verify your identity (or the identity of the payer, if different) by carrying out an electronic check with an independent agency. This will involve an electronic search of information, including access to databases and credit data. By submitting this form you consent to us undertaking this check of your identity.