Applicant A
Title
First Names
(Applicant A)
Surname
Date of Birth
Address


Postcode
Telephone
E-mail

 

Applicant B  
Title
First Names
(Applicant B)
Surname
Date of Birth
Address


Postcode
Telephone
E-mail

 

Type of contract required


Company/provider
Investment fund (if applicable)
Premium
Premium frequency
Commencement date
Is the plan to be written in trust?
YES
NO  
If 'YES', type of trust
Premium Waiver required? (if available)
YES
NO  
Commission to be used to enhance
policy benefits or reduce premium?
YES
NO  

Commission to be rebated as a cheque?
(to be declared as gross income
to HM Inspector of Taxes)
YES
NO  
Additional requirements/Notes

 

I/we confirm that I/we have received no investment advice whatsoever from A P Financial Planning Services or it's associated companies in connection with the above product which is to be provided on an 'execution-only' basis. I/we understand that if I/we elect to have commission rebated to us in the form of a cheque, that I/we shall be responsible for the repayment of part or all of such commission to A P Financial Planning Services in the event of the premature termination of the contract for any reason whatsoever.


I/we accept these terms


I/we reject these terms
Please allow 24hrs for a reply