ultimate retirement income 4life - assupol.co.za · ultimate retirement income 4life about you...
TRANSCRIPT
Ultimate Retirement Income 4Life
About you
Postal address
Postal code
Monthly salarybefore deductions
Description of job
Main occupation
Highest education
Street address
Postal code
About your work
Full first names
R
Dear Applicant. Please make sure that you understand this entire form, as well as the policy provisions provided with it. Complete all pages carefully, making sure that all blocks selected are marked clearly with an X, and then sign the form. We will consider your application according to our underwriting rules and practice. Please send us all the documents we need to [email protected] or fax it to 087 238 9449.
Application form
Tel (work) ( )
Tel (home) ( )
Cell
Fax ( )
TitleSurname Initials
Marital status English otherLanguage
Smoker yes no
married divorced widowedsingle
Gender male femaleID
How can we contact you? Income tax numberpost e-mail
1 application form
Province
Province
City or town
City or town
Employment sector
government parastatal private sector company self-employed informal sector
About us, the insurer of the policy
We, Assupol Life Ltd (registration no 2010/025083/06), are a registered insurer and authorized financial services provider.
Compliance department: fax 087 230 5667 e-mail [email protected]
tel fax web
Summit Place Office Park Building 6, 221 Garstfontein road, Menlyn, Pretoria, 0181
PO Box 35900 Menlo Park Pretoria 0102
0861 235 664 012 366 3500 assupol.co.za
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Documents you must give to us
This application form, completed and signedthe final quote for this policycopy of your South African bar-coded IDproof of your income tax reference number (for example IT34 or any official SARS communication stating your income tax reference number)bank statement or official letter stamped by your bank (not older than three months), confirming your bank detailsproof not older than three months of the address where you live, for example on your telephone or electricity account (voluntary money only)
Confirmation of certain details Investment premium Preferred start date
d ymd m y yy
Intermediary’s name Intermediary’s code
RFutureWealth quote number (office use)
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Name of
Type of account
Name of bank
current transmissionsavings
Your bank details - where guaranteed monthly income will be paid into
account holder
Branch
Account number
Branch code
About your spouse - if spouse income option is selected
Full first names
Cell
TitleSurname Initials
English otherLanguage
Smoker yes noGender male femaleID
Monthly salarybefore deductions
Description of job
Main occupation
Highest education
R
Employment sector
government parastatal private sector company self-employed informal sector
How his or her commission will be paid
Assupol representative or broker agent
Broker principal
First name and surname CodeInitials Telephone
As per contract with Assupol
%1
%2
%3
Status
How his or her commission is to be split, if applicable
The person who assists you with this application and your policy.
First name and surname CodeInitials % share
Your intermediary
X
Name of fund
Investment premium (Total investment premium from all sources)
Source of the investment premium
salary inheritance
donation
Transferring fund details 1
Fund registration number SARS approval number
Policy number Tel
Your investment premium
(Please complete Transferring fund details below)
Other
R
savings insurance policy
retirement fund
Investment premium R
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Your investment premium (continued)
R
Guarantee term
Yearly percentage increase yes no
yes no
Spouse income option
R
%
Guaranteed monthly income
Your benefits
Rewirement factor yes no
yes no %
Capital protection yes no %
Monthly premium
Your guaranteed monthly income is taxable as income at individual income tax rates published by the South African Revenue Service.
Do you want to specify a tax rate appropriate to your total annual income yes no
If you answered yes, please specify a tax rate %
Commission
Percentage of maximum commission(Commission is calculated in accordance with legislation)
Upfront commission(Commission paid on the investment amount and capital protection)
%
R
Beneficiaries
The persons you appoint to claim and receive policy benefits after your death. Only applicable when capital protection and a guarantee term is selected.
NameInitials Surname ID Relationshipto you
% of benefit
Name of fund
Transferring fund details 2
Fund registration number SARS approval number
Policy number Tel
Investment premium R
Name of fund
Transferring fund details 3
Fund registration number SARS approval number
Policy number Tel
Investment premium R
Name of fund
Transferring fund details 4
Fund registration number SARS approval number
Policy number Tel
Investment premium R
4 application form
Your financial needsYour financial needs analysisIt is important that you have the right financial products, and that you invest enough in them to meet your retirement needs. To achieve this, it is necessary to analyse your retirement needs, by means of the analysis below. Your intermediary must complete this analysis, and you must sign it after your intermediary has completed it. Make sure that you understand everything in this analysis, and that the information in it about your needs is complete and correct. Your intermediary's advice and recommendations to you will be based on this analysis.
What are your needs?
Have you retired or are planning to retire from your current employer?
Do you want your retirement income to increase every year?
Mark with X
yes no
yes no
Do you require your spouse to receive a percentage of your retirement income if you pass away before him or her? yes no
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yes no
yes no
Do you want a portion of your investment amount paid out to your beneficiaries when you pass away?
Do you want your retirement income to be paid for a guaranteed number of years, irrespective if you are still alive?
Let’s estimate your post retirement income need - based on your spending
What percentage of your gross salary at retirement do you want to replace with a guaranteed monthly income?Let’s start with 100% ... 100%
Remove your current retirement savings that should no longer be needed as a percentage of your gross salary at retirement
Remove your estimate of current expenses that should no longer be there after retirement (e.g. home loan instalments if you plan to have your home paid off by retirement, etc.) as a percentage of your gross salary at retirement
Add your estimate of current expenses that could be higher after retirement (e.g. medical scheme contributions, etc.) as a percentage of your gross salary at retirement
Remove the percentage of your gross salary at retirement that will be provided by other assets you own
Your estimated post-retirement income as a percentage of your gross salary at retirement
Your monthly salary before deduction (gross monthly salary) – as provided on page 1 of this application
Your estimated post retirement gross income need
(A)
(B)
(A) x (B)
- %
- %
+
- %
%
R
R
R
Signature of applicant
Signature of intermediary
Notes
%
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Record of advice
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This is a record of the advice your intermediary gave you. Your intermediary must complete this record of advice. And you must sign it after your intermediary has completed it. If you have questions about this record of advice, contact your intermediary.
Applicant’s name
Intermediary’s name
I read my intermediary’s disclosure letter
DateIntermediary’s cell no d ymd m y yy
yes no
Important aspects discussed with you Mark with X
The application form and policy provisions of the product you are applying for Appoint the right person, as your beneficiary, to receive benefits on your deathWhat could happen if your beneficiary is under age 18
Your access to funds
Whether the product can be cededBasic legal aspects of life annuities
Other - please specify
Summary of what was discussed with you Describe clearly
Date
Signature of applicant
Signature of intermediary
Date d ymd m y yyd ymd m y yy
Satisfying your financial needs Mark with X and fill in
Benefits you selected
Guaranteed monthly income R R Always included
Yearly increase percentage
Guarantee term
Rewirement factor
Spouse income option
Capital protection R
Benefit amount Premium Included in quote?
Yes
Yes
Yes
Yes
Yes
%
years
%
%
Declaration
6 application form
You, the applicant, declare ...
I understand and agree with everything in: (1) my declaration above, (2) this application form, (3) the policy provisions provided with this application form. I understand when benefits will not be paid or may be reduced or limited, and I am satisfied that I will be able to pay the premiums of the policy I apply for.
Signature of applicant
Signature
Date
Date
Date
Date
Name
Name
Job title
Information and documents Assupol must have to consider this application
All information and documents necessary and sufficient to consider this application have been provided to Assupol. This application form, and any documents in support of it, have been properly completed and signed. The documents were completed before they were signed. If information or a document has not been provided, or is not correct, benefits under the policy may be declined, and premiums paid could be forfeited.
I have made a properly informed decision about the insurance I apply for
An intermediary assisted me with this application. Before doing so, the intermediary gave me a disclosure letter which sets out his or her particulars, the services he or she provides, and whether he or she works under supervision. I gave information to the intermediary to analyse my needs for insurance. I did not require a comprehensive analysis, but only a limited one – namely the analysis on page 4.
I am satisfied that I know and understand everything I need to know and understand about the insurance I apply for. I have made sure of this, regardless of the information, advice and recommendations the intermediary gave me, and any information I received from Assupol.
South African citizenship
I am a South African citizen. If asked, I will give Assupol proof of my citizenship.
Information about me
Assupol may use information about me, also personal information meant in the Protection of Personal Information Act, that Assupol lawfully obtained in the past or may obtain in future, including the information provided to Assupol for this application, for the following purposes:
· to consider applications for policies of which I am the policyholder or a life insured; and · for all purposes of such policies, issued in the past or in future, particularly to consider claims for benefits and to trace persons who could receive benefits (tracing fees may be deducted from benefits).
Assupol may for these purposes, at any time, also after my death:
· obtain such information from other persons and entities, particularly from other insurers, and I authorize them to give such information to Assupol;· share such information with other insurers – directly or through a data base that insurers operate as a group, and in such form as Assupol or the operators of the data base may decide.
Assupol and companies in the Assupol group may use such information for my needs
Assupol and their agents may use such information to assist me with my insurance and financial needs, and from time to time offer other products and services to me.
Your intermediary declares ...I discussed this application form with the applicant. I checked that it had been completed and signed properly. It was completed before it was signed, and the applicant signed it in my presence. I complied fully with the parts on page 4 - financial needs analysis.
The sales manager declares ...
A responsible person declares ...
I have checked that this application form has been completed and signed properly. The intermediary code used for this application is the one recorded in the disclosure letter signed by the intermediary who assisted with this application.
I am responsible for doing a final overall check of this application form. I have checked that it has been completed and signed properly.
Signature
Signature
d ymd m y yy
d ymd m y yy
d ymd m y yy
d ymd m y yy
yes no
Office use
Office use
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Please read this entire document carefully, and make sure you understand it.
Policy provisions
About your policy
The contract with us
If your application is approved, you will receive a summary of your policy. The summary will confirm the benefits and premium of your policy, as well as other particulars. The policy itself will consist of your application form, the policy provisions in this document, and the policy summary.
Your policy is the contract with us, and the complete and only record of that contract. If anything in your application form or these policy provisions differs from your policy summary, the policy summary will apply.
Your application form + these policy provisions + your policy summary = your policy
When your policy starts and ends
Your policy benefits start on the first day of the month following the month in which we received the investment premium (single premium) for your policy. It ends on your death, or it may end later if you select a guarantee term or the spouse income option to apply - more details can be found under optional benefits.
Important: Once you have selected the Ultimate Retirement Income 4Life policy and the policy has started, it cannot be cancelled or changed.
The role-players in your policy
You are the premium-payer, namely the person who pays the investment premium of your policy. You are the life insured, namely the person on whose life your policy is taken out. Your spouse may also be a life-insured if the spouse income option is selected - see more details under optional benefits.
You are the policyholder, namely the person who holds and exercise the rights under your policy.
You may appoint persons, one or more, to receive the death benefit if you selected the capital protection benefit - see more details under optional benefits. They are called the beneficiaries.
If the spouse income option is selected, then if you die before your spouse, the monthly guaranteed income will be paid to your spouse - see more details under optional benefits.
If a guaranteed term is selected, then if you die before the end of the guarantee term, the monthly guaranteed income will be paid to beneficiaries - see more details under optional benefits.
Please ensure that you at all times nominate the right beneficiaries. You may change a beneficiary at any time. This may for example be necessary if you get married or divorced. You and your beneficiaries must be South African citizens. If your spouse is a life insured, he or she must be a South African citizen too.
Have you, for your policy, appointed a beneficiary who is under age 18?
If so, what will happen with your policy if you die? The beneficiary will become entitled to the rights and benefits under your policy. But, because the beneficiary is under 18 (a minor), the benefits will have to be paid to his or her legal guardian. The legal guardian of a minor is his or her parents or a person appointed by the High Court.
So, for example the following can happen:
You and a person you no longer are married to are the parents of your minor beneficiary. On your death the benefits of your policy will be · paid to that person. You are the only parent of your minor beneficiary. On your death, a guardian will have to be appointed by court, for the benefits of your · policy to be paid to that guardian. You are the only parent of your minor beneficiary. On your death, if a guardian is not appointed for the beneficiary, the benefits of your policy · will be paid to the Guardian Fund of the Master of the High Court. Money to support the beneficiary will then have to be claimed from the Guardian Fund. When the beneficiary turns 18 all the money can be withdrawn.
Is that what you want? If not, it is advisable that you get assistance from a financial adviser on how best to arrange your affairs in respect of yourpolicy.
You can cancel your policy during the cooling-off period
If your cancellation notice reaches us within 31 days after you received your policy summary (the summary mentioned above under Your contract with us), or within 31 days after it reasonably can be accepted that you should have received your policy summary, your policy ends. You can send your cancellation notice to our client services department. We will pay back the single premium we received, adjusted for changes in the market value of the investments under your policy since they were made, due to market changes. This is known as a cooling-off cancellation.
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Ultimate Retirement Income 4Life
The Ultimate Retirement Income 4Life
This policy provides you with a guaranteed income at the end of every month after the policy started while you are alive. Many optional benefits are available to address your needs – and some of these optional benefits ensure that the full guaranteed income or a part thereof also continues after your death – see more details under Optional benefits.
Optional benefits
You can choose any of the optional benefits:
a) Yearly increase percentage - ensures that the guaranteed level of monthly income increases every year to better keep up with inflation.
b) Guarantee term - ensures that a spouse and dependents will continue to receive an income if you die before the end of the guarantee term. A term of up to 20 years can be selected.
c) Rewirement factor - helps clients to adjust their spending to post-retirement income. Any Rewirement factor up to 10 can be chosen.
· The bigger the Rewirement factor chosen, the higher the guaranteed monthly income will start at. · But, the trade-off is that the guaranteed monthly income will remain level for an initial period of time, and a number of yearly
increases in the guaranteed monthly income will be skipped. · The number of increases that will be skipped is equal to the Rewirement factor chosen.
d) Spouse income option - ensures that a percentage of the guaranteed monthly income continues for your surviving spouse after your death. Any percentage up to 100% can be selected. The percentage may be limited based on the other benefits selected.
e) Capital protection - the full or a percentage of the investment premium can be protected so that on your death, beneficiaries receive the full or a percentage of the investment premium. Any percentage up to 100% can be selected. The percentage may be limited based on the other benefits selected.
· When capital protection is selected, a part of the Guaranteed Retirement Income 4Life provides you with a guaranteed monthly income for life.· The other part is used to fund the capital protection benefit. After tax has been deducted from the guaranteed monthly income, the premium for the capital protection benefit is also deducted. · The premium for the capital protection benefit follows the same pattern as the guaranteed monthly income. So, if the guaranteed monthly income increases by a percentage, then the capital protection premium also increases by the same percentage.
When Capital protection is selected, the Ultimate Retirement Income 4Life includes a life policy. The life policy premium increases yearly by the same percentage you selected the guaranteed monthly income to increase by.
What is payable on the policyholder’s death?
The Ultimate Retirement Income 4Life product ensures that an income or lump sum may be payable on the death of the policyholder. The guaranteed monthly income will end on the death of the policyholder unless one of the following benefits are selected:
a) The guarantee term ensures that your beneficiaries will continue to receive an income should the policyholder die before the end of the guarantee term. The guaranteed monthly income is to be paid at least until the guarantee date.
b) A spouse income option ensures that a percentage of the guaranteed income continues for a surviving spouse after the policyholder's death.
c) Capital protection - the full or a percentage of the investment premium can be protected so that on the death of the policyholder, beneficiaries receive a percentage of the investment premium.
When will the Ultimate Retirement Income 4Life come to an end?
This policy ends when you die, unless the -
· guarantee term was selected and you die within the guarantee term, then the policy ends at the end of the guarantee term; or· spouse income option was selected and you die before your spouse, then the policy ends on the death of your spouse.
Benefits are paid to you, or to your beneficiaries
While you, the policyholder, are alive, the benefits of your policy are paid to you. After your death, the capital protection benefit is paid to your beneficiaries. When you opt for the spouse income option, the selected percentage of the monthly income will be paid to your spouse if you die before your spouse.
If, for any reason, we cannot pay the benefits to beneficiaries, the benefits will have to be paid into a deceased estate. That can cause inconvenience and delay – therefore it is important to that you appoint beneficiaries, and always to make sure that the right persons are appointed as the beneficiaries. Remember, beneficiaries can be changed at any time.
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About your benefits
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For other assistance
Visit any of our offices, or contact our client services department:tel 0861 235 664 e-mail fax post [email protected] 0861 329 287 PO Box 35900, Menlo Park, Pretoria, 0102
Cash value, surrender value, loan value and cessions
The Ultimate Retirement Income 4Life does not have a cash value, no loans may be made against it and it may not be ceded or used as security for a loan. It does not have a surrender value.
Tax position
Assupol must deduct the statutory pay-as-you-earn (PAYE) rate of tax from the guaranteed monthly income you receive from the Ultimate Retirement Income 4Life. PAYE will be deducted from the guaranteed monthly income. In terms of the Income Tax Act, when the product is taken out voluntarily and not with retirement fund proceeds that must be used to buy a compulsory annuity, a portion of the guaranteed monthly income is deemed as income and attracts tax at your marginal tax rate.
For compulsory annuities, 100% of the guaranteed monthly income is deemed as income and attracts tax at your marginal tax rate.The income will be taxed as earnings by the South African Revenue Service (Sars). Assupol deducts the income tax payable based on the guaranteed monthly income paid to you. The rate at which you must pay tax depends on your total annual income and may differ from the amount deducted by Assupol. Any such differences will be allowed for by Sars in the year-end assessment.
When you have more than one regular income product from Assupol, each product will be handled individually and won't be added together before the statutory PAYE rate of tax will be deducted. When capital protection is selected, the benefit paid under the life cover policy is not taxable.
Legislative position
There are changes that may affect your policy, such as legislative changes or changes to the tax treatment of your policy. Assupol may recalculate the guaranteed monthly income if there are changes that affect your policy.
Your policy operates in terms of an actuarial basis
Life insurance policies operate in terms of actuarial rules, specifications and formulae, which are approved according to law, and are known as the actuarial basis of the policy. This requirement plays an essential role in the protection and fair treatment of policyholders. It ensures that policies are dealt with in a reasonable and objective manner – and that the benefits policies provide, and distinctions made between policies, are justified and financially sound. Therefore, in carrying out your policy its actuarial basis must always be considered.
South African law and currency apply
Payments on your policy are made in South Africa, and in South African currency. Your policy is always interpreted according to South African law, and any disputes must be settled in South Africa.
You must inform us of changes
You must inform us of changes to your personal, contact and banking details. Please also let us know when the personal and contact details of your beneficiary change.
To claim a policy benefit
Visit any of our offices countrywide. Also open on Saturdays from 08:00 to 13:00. You can find an Assupol office nearest to you on www.assupol.co.za or phone 0861 235 664.
About us, the insurer of the policy
We, Assupol Life Ltd (registration no 2010/025083/06), are a registered insurer and authorized financial services provider.1
tel 0861 235 664 PO Box 35900 Summit Place Office Park, Compliance department:fax 012 366 3500 Menlo Park Building 6, 221 Garstfontein road, fax 087 230 5667web assupol.co.za Pretoria, 0102 Menlyn, Pretoria, 0181 e-mail [email protected]
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Other things to know
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Complaints
Our commitment is to provide excellent service to you. Should it happen that you, after having contacted one of our offices or our client services department, still have a concern, please contact our complaints department:tel 087 098 0290 e-mail fax [email protected] 087 230 5669 post PO Box 35900, Menlo Park, Pretoria, 0102 If, after you have contacted our complaints department, your concern has not been resolved to your satisfaction, you could approach the:1
Pension Funds Adjudicator about an aspect of your policy:–e-mail fax 012 346 1738 post PO Box 580, Menlyn, Pretoria, [email protected]
Fais Ombud about the conduct of the intermediary who assisted you:–e-mail fax 021 348 3447 post PO Box 74571, Lynnwood Ridge, Pretoria, [email protected]
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