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Market: Belgium (BE)

Documents

Title	Description	Insurer	Asset Type	Language	Product	Regime	Process	Excerpt
Afkoop na Overlijden	Use this form to initiate a death claim – Belgium (Dutch version)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	Dutch (NL)	Non Product Specific	FOS		Use this form to initiate a death claim – Belgium (Dutch version) Surrender/Claim/Withdrawal/Switch Afkoop na Overlijden ULU PCON1008
Source of Wealth Questionnaire	This questionnaire seeks to obtain information and documentation from the adviser to establish the source of wealth of high-risk clients of Utmost International Isle of Man Limited and Utmost PanEurope dac	Utmost Wealth Solutions	Operational Forms	English (EN)	Non Product Specific	FOS	Addition to your Policy, New Policy	This questionnaire seeks to obtain information and documentation from the adviser to establish the source of wealth of high-risk clients of Utmost International Isle of Man Limited and Utmost PanEurope dac Operational Forms Source of Wealth Questionnaire UWSQ PR \| 20888
Tax Declaration and Self-Certification for Trusts	For Use with Utmost Worldwide, Utmost PanEurope and Utmost International Isle of Man products. You have been asked to complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for trusts where all the trustees are all individuals. It should be completed by one trustee on behalf of the trust.	Utmost Wealth Solutions	Tax and regulatory Literature/technical sales aids and literature	English (EN)	Non Product Specific	FOS	Making a change to your policy, New Policy	For Use with Utmost Worldwide, Utmost PanEurope and Utmost International Isle of Man products. You have been asked to complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for trusts where all the trustees are all individuals. It should be completed by one trustee on behalf of the trust. Tax and regulatory Literature/technical sales aids and literature Tax Declaration and Self-Certification for Trusts UTSQ PR \| 20885
Mutual Stipulations and Nomination Form Irish jointly Owned Products	This form should be used for policies subject to the laws of Belgium, Cyprus, Spain or Sweden. Complete this form if you are the policyholder and request for the mutual stipulations wording to be applied to your policy and also wish to nominate the beneficiary(ies) listed in the appointment of beneficiary(ies) for your policy.	Utmost PanEurope	Operational Forms	English (EN)	Non Product Specific	FOS	Making a change to your policy	This form should be used for policies subject to the laws of Belgium, Cyprus, Spain or Sweden. Complete this form if you are the policyholder and request for the mutual stipulations wording to be applied to your policy and also wish to nominate the beneficiary(ies) listed in the appointment of beneficiary(ies) for your policy. Operational Forms Mutual Stipulations and Nomination Form Irish jointly Owned Products UPEQ PR \| 21042
Balanced Universal Portfolio – Institutionele fiche	This document provides you with key information about this investment option, provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Life Protect Plan 2, Life Protect Policy	FOS		This document provides you with key information about this investment option, provided by the investment manager. Investment literature/Strategies Balanced Universal Portfolio – Institutionele fiche ULU_Portfolio_Universal_Balanced_Report_NL PR
Dynamic Selection Portfolio – Beheersinformatie	This document provides you with key information about this investment option, provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Life Protect Plan 2, Life Protect Policy	FOS		This document provides you with key information about this investment option, provided by the investment manager. Investment literature/Strategies Dynamic Selection Portfolio – Beheersinformatie ULU_Portfolio_Selection_Dynamic_Report_NL PR
Balanced Universal Portfolio – Fiche institutionnelle	This document provides you with key information about this investment option, provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Life Protect Plan 2, Life Protect Policy	FOS		This document provides you with key information about this investment option, provided by the investment manager. Investment literature/Strategies Balanced Universal Portfolio – Fiche institutionnelle ULU_Portfolio_Universal_Balanced_Report_FR PR
Balanced Selection Portfolio – Beheersinformatie	This document provides you with key information about this investment option, provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Life Protect Plan 2, Life Protect Policy	FOS		This document provides you with key information about this investment option, provided by the investment manager. Investment literature/Strategies Balanced Selection Portfolio – Beheersinformatie ULU_Portfolio_Selection_Balanced_Report_NL PR
Dynamic Selection Portfolio – Informations sur la gestion	This document provides you with key information about this investment option, provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Life Protect Plan 2, Life Protect Policy	FOS		This document provides you with key information about this investment option, provided by the investment manager. Investment literature/Strategies Dynamic Selection Portfolio – Informations sur la gestion ULU_Portfolio_Selection_Dynamic_Report_FR PR
Dynamic Heritage Portfolio – Beheersinformatie	This document provides you with key information about this investment option, provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Life Protect Plan 2	FOS		This document provides you with key information about this investment option, provided by the investment manager. Investment literature/Strategies Dynamic Heritage Portfolio – Beheersinformatie ULU_Portfolio_Heritage_Dynamic_Report_NL PR
Balanced Selection Portfolio – Informations sur la gestion	This document provides you with key information about this investment option, provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Life Protect Plan 2, Life Protect Policy	FOS		This document provides you with key information about this investment option, provided by the investment manager. Investment literature/Strategies Balanced Selection Portfolio – Informations sur la gestion ULU_Portfolio_Selection_Balanced_Report_FR PR
Conservative Heritage Portfolio – Beheersinformatie	This document provides you with key information about this investment option, provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Life Protect Plan 2	FOS		This document provides you with key information about this investment option, provided by the investment manager. Investment literature/Strategies Conservative Heritage Portfolio – Beheersinformatie ULU_Portfolio_Heritage_Conservative_Report_NL PR
Dynamic Heritage Portfolio – Informations sur la gestion	This document provides you with key information about this investment option, provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Life Protect Plan 2	FOS		This document provides you with key information about this investment option, provided by the investment manager. Investment literature/Strategies Dynamic Heritage Portfolio – Informations sur la gestion ULU_Portfolio_Heritage_Dynamic_Report_FR PR
Balanced Heritage Portfolio – Beheersinformatie	This document provides you with key information about this investment option, provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Life Protect Plan 2	FOS		This document provides you with key information about this investment option, provided by the investment manager. Investment literature/Strategies Balanced Heritage Portfolio – Beheersinformatie ULU_Portfolio_Heritage_Balanced_Report_NL PR
Conservative Heritage Portfolio – Informations sur la gestion	This document provides you with key information about this investment option, provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Life Protect Plan 2	FOS		This document provides you with key information about this investment option, provided by the investment manager. Investment literature/Strategies Conservative Heritage Portfolio – Informations sur la gestion ULU_Portfolio_Heritage_Conservative_Report_FR PR
Balanced Generation Portfolio – Institutionele fiche	This document provides you with key information about the Balanced Generation Portfolio provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Life Protect Plan 2	FOS		This document provides you with key information about the Balanced Generation Portfolio provided by the investment manager. Investment literature/Strategies Balanced Generation Portfolio – Institutionele fiche ULU_Portfolio_Generation_Balanced_Report_NL PR
Balanced Heritage Portfolio – Informations sur la gestion	This document provides you with key information about this investment option, provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Life Protect Plan 2, Life Protect Policy	FOS		This document provides you with key information about this investment option, provided by the investment manager. Investment literature/Strategies Balanced Heritage Portfolio – Informations sur la gestion ULU_Portfolio_Heritage_Balanced_Report_FR PR
Balanced Generation Portfolio – Fiche institutionnelle	This document provides you with key information about the Balanced Generation Portfolio provided by the investment manager.	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Life Protect Plan 2	FOS		This document provides you with key information about the Balanced Generation Portfolio provided by the investment manager. Investment literature/Strategies Balanced Generation Portfolio – Fiche institutionnelle ULU_Portfolio_Generation_Balanced_Report_FR PR
Essentiële-informatiedocument (“Eid”)	This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A	Key Information Document	Dutch (NL)	Select Client Plan	FOS		This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Essentiële-informatiedocument (“Eid”) ULU_KID_LU_BE_EUR_SCP-HO_NL PR
Essentiële-informatiedocument (“Eid”)	Private Client Plan – This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A	Key Information Document	Dutch (NL)	Private Client Plan	FOS		Private Client Plan – This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Essentiële-informatiedocument (“Eid”) ULU_KID_LU_BE_EUR_PCP-HO_NL PR
Document d’informations clés (“DIC”)	This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A	Key Information Document	French (FR)	Select Client Plan	FOS		This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Document d’informations clés (“DIC”) ULU_KID_LU_BE_EUR_SCP-HO_FR PR
Essentiële-informatiedocument (“Eid”)	This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A	Key Information Document	Dutch (NL)	Life Protect Plan 2	FOS		This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Essentiële-informatiedocument (“Eid”) ULU_KID_LU_BE_EUR_LPP-HO_NL PR
Document d’informations clés (“DIC”)	Private Client Plan – This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A	Key Information Document	French (FR)	Private Client Plan	FOS		Private Client Plan – This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Document d’informations clés (“DIC”) ULU_KID_LU_BE_EUR_PCP-HO_FR PR
Essentiële-informatiedocument (“Eid”)	This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A	Key Information Document	Dutch (NL)	Corporate Select Plan	FOS		This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Essentiële-informatiedocument (“Eid”) ULU_KID_LU_BE_EUR_CSP-HO_NL PR
Document d’informations clés (“DIC”)	This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A	Key Information Document	French (FR)	Life Protect Plan 2	FOS		This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Document d’informations clés (“DIC”) ULU_KID_LU_BE_EUR_LPP-HO_FR PR
Connect Gebruikershandleiding – Gedeeltelijke afkoop	This Connect User Guide shows how to request a regular withdrawal – in Dutch	Utmost Luxembourg S.A	Product Guides/Brochures/Snapshots and Training Materials	Dutch (NL)	Non Product Specific	FOE FOS		This Connect User Guide shows how to request a regular withdrawal – in Dutch Product Guides/Brochures/Snapshots and Training Materials Connect Gebruikershandleiding – Gedeeltelijke afkoop ULU PROD2154
Document d’informations clés (“DIC”)	This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A	Key Information Document	French (FR)	Corporate Select Plan	FOS		This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Document d’informations clés (“DIC”) ULU_KID_LU_BE_EUR_CSP-HO_FR PR
Capital Gains Tax 10 reasons to consider subscribing a Life Assurance contract (Dutch) and Belgium Branch	Capital Gains Tax 10 reasons to consider subscribing a Life Assurance contract (Dutch) and Belgium Branch.	Utmost Luxembourg S.A	Tax and regulatory Literature/technical sales aids and literature	Dutch (NL)	Corporate Select Plan, Select Client Plan, Select Client Policy	FOE FOS		Capital Gains Tax 10 reasons to consider subscribing a Life Assurance contract (Dutch) and Belgium Branch. Tax and regulatory Literature/technical sales aids and literature Capital Gains Tax 10 reasons to consider subscribing a Life Assurance contract (Dutch) and Belgium Branch ULU PR 00134
Capital Gains Tax 10 reasons to consider subscribing a Life Assurance contract (French) and for Belgium Branch	Capital Gains Tax 10 reasons to consider subscribing a Life Assurance contract (French) and for Belgium Branch	Utmost Luxembourg S.A	Tax and regulatory Literature/technical sales aids and literature	French (FR)	Corporate Select Plan, Select Client Plan, Select Client Policy	FOE FOS		Capital Gains Tax 10 reasons to consider subscribing a Life Assurance contract (French) and for Belgium Branch Tax and regulatory Literature/technical sales aids and literature Capital Gains Tax 10 reasons to consider subscribing a Life Assurance contract (French) and for Belgium Branch ULU PR 00132
Capital Gains Tax 10 reasons to consider subscribing a Life Assurance contract (English)	Capital Gains Tax 10 reasons to consider subscribing a Life Assurance contract (English).	Utmost Luxembourg S.A	Tax and regulatory Literature/technical sales aids and literature	English (EN)	Corporate Select Plan, Select Client Plan, Select Client Policy	FOE FOS		Capital Gains Tax 10 reasons to consider subscribing a Life Assurance contract (English). Tax and regulatory Literature/technical sales aids and literature Capital Gains Tax 10 reasons to consider subscribing a Life Assurance contract (English) ULU PR 00133
Information Disclosure Agreement for the National Bank of Belgium (NL)	Please use this Information Disclosure Agreement for sharing client information with the National Bank of Belgium	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	Dutch (NL)	Non Product Specific	FOS		Please use this Information Disclosure Agreement for sharing client information with the National Bank of Belgium Client Letters/Indemnity/Data Protection Information Disclosure Agreement for the National Bank of Belgium (NL) ULU PR 00099
Information Disclosure Agreement for the National Bank of Belgium (FR)	Please use this Information Disclosure Agreement for sharing client information with the National Bank of Belgium	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	French (FR)	Non Product Specific	FOS		Please use this Information Disclosure Agreement for sharing client information with the National Bank of Belgium Client Letters/Indemnity/Data Protection Information Disclosure Agreement for the National Bank of Belgium (FR) ULU PR 00098
Modification des caractéristiques principales d’un Fonds Interne Dédié existant	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOS		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Modification des caractéristiques principales d’un Fonds Interne Dédié existant ULU PCON1556
Wijziging van de voornaamste kenmerken van een bestaand Intern Toegewezen Fonds	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOS		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Wijziging van de voornaamste kenmerken van een bestaand Intern Toegewezen Fonds ULU PCON1557
Formulaire de changement de moyen de communication et utilisation des signatures électroniques	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Formulaire de changement de moyen de communication et utilisation des signatures électroniques ULU PCON1521
Wijziging van het communicatiemiddel voor correspondentie en het gebruik van elektronische handtekeningen	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOS		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Wijziging van het communicatiemiddel voor correspondentie en het gebruik van elektronische handtekeningen ULU PCON1520
Désignation d’Intermédiaire	Use this form to request an appointment or change of broker	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOS		Use this form to request an appointment or change of broker Operational Forms Désignation d’Intermédiaire ULU PCON1323
Aanstelling van Tussenpersoon	Use this form to request an appointment or change of broker	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOS		Use this form to request an appointment or change of broker Operational Forms Aanstelling van Tussenpersoon ULU PCON1322
Verklaring van Verlies van Polisdocument	Form to be used to declare the loss of policy documents – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	Dutch (NL)	Non Product Specific	FOS		Form to be used to declare the loss of policy documents – Belgium (FOS) – Dutch version Client Letters/Indemnity/Data Protection Verklaring van Verlies van Polisdocument ULU PCON1088
Déclaration de Perte de Documents	Form to be used to declare the loss of policy documents – Belgium (FOS) – French version	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	French (FR)	Non Product Specific	FOS		Form to be used to declare the loss of policy documents – Belgium (FOS) – French version Client Letters/Indemnity/Data Protection Déclaration de Perte de Documents ULU PCON1089
Aanvraag tot Regelmatige Terugtrekking	Use this form to request a regular withdrawal from your policy/contract – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	Dutch (NL)	Non Product Specific	FOS		Use this form to request a regular withdrawal from your policy/contract – Belgium (FOS) – Dutch version Surrender/Claim/Withdrawal/Switch Aanvraag tot Regelmatige Terugtrekking ULU PCON1077
Rachat Partiel Programmé	Use this form to request a regular withdrawal from your policy/contract – Belgium (FOS) – French version	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	French (FR)	Non Product Specific	FOS		Use this form to request a regular withdrawal from your policy/contract – Belgium (FOS) – French version Surrender/Claim/Withdrawal/Switch Rachat Partiel Programmé ULU PCON1078
Dénouement par Décès	Use this form to initiate a death claim – Belgium (French version)	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	French (FR)	Non Product Specific	FOS		Use this form to initiate a death claim – Belgium (French version) Surrender/Claim/Withdrawal/Switch Dénouement par Décès ULU PCON1065
Formulier voor de storting van een bijkomende Premie	Use this form for an addition to your policy/contract – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Top Up/Additional Investment	Dutch (NL)	Select Client Plan	FOS	Addition to your Policy	Use this form for an addition to your policy/contract – Belgium (FOS) – Dutch version Top Up/Additional Investment Formulier voor de storting van een bijkomende Premie ULU PCON1048
Formulaire de versement de Prime complémentaire	Use this form for an addition to your policy/contract – Belgium (FOS) – French version	Utmost Luxembourg S.A	Top Up/Additional Investment	French (FR)	Select Client Plan	FOS	Addition to your Policy	Use this form for an addition to your policy/contract – Belgium (FOS) – French version Top Up/Additional Investment Formulaire de versement de Prime complémentaire ULU PCON1047
Demande de Rachat Total	Use this form to request the surrender of your policy/contract – Belgium (FOS) – French version	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	French (FR)	Non Product Specific	FOS		Use this form to request the surrender of your policy/contract – Belgium (FOS) – French version Surrender/Claim/Withdrawal/Switch Demande de Rachat Total ULU PCON1045
Demande de Rachat Partiel	Use this form to request a withdrawal from your policy/contract – Belgium (FOS) – French version	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	French (FR)	Non Product Specific	FOS		Use this form to request a withdrawal from your policy/contract – Belgium (FOS) – French version Surrender/Claim/Withdrawal/Switch Demande de Rachat Partiel ULU PCON1033
Arbitrageverzoek	Use this form to request a switch of investments on your policy/contract – Belgium (FOS) – French version	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	Dutch (NL)	Non Product Specific	FOS		Use this form to request a switch of investments on your policy/contract – Belgium (FOS) – French version Surrender/Claim/Withdrawal/Switch Arbitrageverzoek ULU PCON1035
Demande d’Arbitrage	Use this form to request a switch of investments on your policy/contract – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	French (FR)	Non Product Specific	FOS		Use this form to request a switch of investments on your policy/contract – Belgium (FOS) – Dutch version Surrender/Claim/Withdrawal/Switch Demande d’Arbitrage ULU PCON1030
Verzoek tot Afkoop	Use this form to request the surrender of your policy/contract – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	Dutch (NL)	Non Product Specific	FOS		Use this form to request the surrender of your policy/contract – Belgium (FOS) – Dutch version Surrender/Claim/Withdrawal/Switch Verzoek tot Afkoop ULU PCON1026
Aanvraag tot Gedeeltelijke Afkoop	Use this form to request a withdrawal from your policy/contract – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	Dutch (NL)	Non Product Specific	FOS		Use this form to request a withdrawal from your policy/contract – Belgium (FOS) – Dutch version Surrender/Claim/Withdrawal/Switch Aanvraag tot Gedeeltelijke Afkoop ULU PCON1017
Connect – Aperçu (Guide d’utilisation pour les clients)	This user guide helps to navigate through the Connect Platform and explain functionality – French version	Utmost Luxembourg S.A	Guides and Supporting Documents	French (FR)	Non Product Specific	FOE FOS		This user guide helps to navigate through the Connect Platform and explain functionality – French version Guides and Supporting Documents Connect – Aperçu (Guide d’utilisation pour les clients) ULU MARK2351
Connect Overview – Customer Guide (Dutch)	Connect Overview – Customer Guide (Dutch)	Utmost Luxembourg S.A	Guides and Supporting Documents	Dutch (NL)	Non Product Specific	FOE FOS		Connect Overview – Customer Guide (Dutch) Guides and Supporting Documents Connect Overview – Customer Guide (Dutch) ULU MARK2352
User Guide Connect Digitale Onderschrijving – België	This is a Connect User Guide for digital subscription – Dutch version	Utmost Luxembourg S.A	Guides and Supporting Documents	Dutch (NL)	Non Product Specific	FOE FOS		This is a Connect User Guide for digital subscription – Dutch version Guides and Supporting Documents User Guide Connect Digitale Onderschrijving – België ULU MARK2303
Guide d’utilisation Connect Souscription Digitale – Belgique	This is a Connect User Guide for digital subscription – French version	Utmost Luxembourg S.A	Guides and Supporting Documents	French (FR)	Non Product Specific	FOE FOS		This is a Connect User Guide for digital subscription – French version Guides and Supporting Documents Guide d’utilisation Connect Souscription Digitale – Belgique ULU MARK2302
Connect Gebruikershandleiding – Volledige Afkoop	Connect User Manual – Full Redemption (Dutch)	Utmost Luxembourg S.A	Guides and Supporting Documents	Dutch (NL)	Non Product Specific	FOE FOS		Connect User Manual – Full Redemption (Dutch) Guides and Supporting Documents Connect Gebruikershandleiding – Volledige Afkoop ULU MARK2171
Connect User Guide – Total Redemption (French)	Connect User Guide – Total Redemption (French)	Utmost Luxembourg S.A	Guides and Supporting Documents	French (FR)	Non Product Specific	FOE FOS		Connect User Guide – Total Redemption (French) Guides and Supporting Documents Connect User Guide – Total Redemption (French) ULU MARK2174
Automatische Uitwisseling van Inlichtingen – Zelfcertificering voor uiteindelijk belanghebbenden (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Automatische Uitwisseling van Inlichtingen – Zelfcertificering voor uiteindelijk belanghebbenden (AEoI) ULU CONT4264
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes détenant le contrôle (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOS	New Policy	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes détenant le contrôle (AEoI) ULU CONT4262
Automatische Uitwisseling van Inlichtingen – Zelfcertificering voor entiteiten (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Automatische Uitwisseling van Inlichtingen – Zelfcertificering voor entiteiten (AEoI) ULU CONT4252
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les entités (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOS	New Policy	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les entités (AEoI) ULU CONT4250
Automatische Uitwisseling van Inlichtingen – Zelfcertificering voor natuurlijke personen (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Automatische Uitwisseling van Inlichtingen – Zelfcertificering voor natuurlijke personen (AEoI) ULU CONT4243
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes physiques (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes physiques (AEoI) ULU CONT4241
Verklaring van de maten van een burgerlijke maatschap als Verzekeringnemer	Declaration of the partners of a civil partnership as policyholder	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Select Client Plan	FOS	New Policy	Declaration of the partners of a civil partnership as policyholder Operational Forms Verklaring van de maten van een burgerlijke maatschap als Verzekeringnemer ULU CONT4192
Corporate Select Plan – België – Bijlage: lijst van beschikbare Externe Fondsen	This form shows the list of available internal collective funds for the Corporate Select Plan product	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Corporate Select Plan	FOS	New Business Pack	This form shows the list of available internal collective funds for the Corporate Select Plan product Investment literature/Strategies Corporate Select Plan – België – Bijlage: lijst van beschikbare Externe Fondsen ULU CONT4190
Déclaration des associés d’une société civile en tant que Preneur d’Assurance	Declaration of the partners of a civil partnership as policyholder	Utmost Luxembourg S.A	Operational Forms	French (FR)	Select Client Plan	FOS	New Policy	Declaration of the partners of a civil partnership as policyholder Operational Forms Déclaration des associés d’une société civile en tant que Preneur d’Assurance ULU CONT4191
Corporate Select Plan – Algemene Voorwaarden	Stand-alone version of General Conditions for the Corporate Select Plan product – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Policy Conditions	Dutch (NL)	Corporate Select Plan	FOS	New Business Pack	Stand-alone version of General Conditions for the Corporate Select Plan product – Belgium (FOS) – Dutch version Policy Conditions Corporate Select Plan – Algemene Voorwaarden ULU CONT4180
Corporate Select Plan – Belgique – Annexe : liste des Fonds Externes disponibles	This form shows the list of available external funds for the Corporate Select Plan product	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Corporate Select Plan	FOS	New Business Pack	This form shows the list of available external funds for the Corporate Select Plan product Investment literature/Strategies Corporate Select Plan – Belgique – Annexe : liste des Fonds Externes disponibles ULU CONT4189
Corporate Select Plan	New business application form for the Corporate Select Plan product – Belgium; Capitalisation contract	Utmost Luxembourg S.A	Application Form	Dutch (NL)	Corporate Select Plan	FOS	New Business Pack	New business application form for the Corporate Select Plan product – Belgium; Capitalisation contract Application Form Corporate Select Plan ULU CONT4175
Corporate Select Plan – Conditions Générales	Stand-alone version of General Conditions for the Corporate Select Plan product – Belgium (FOS) – French version	Utmost Luxembourg S.A	Policy Conditions	French (FR)	Corporate Select Plan	FOS	New Business Pack	Stand-alone version of General Conditions for the Corporate Select Plan product – Belgium (FOS) – French version Policy Conditions Corporate Select Plan – Conditions Générales ULU CONT4179
FOR INTERMEDIARIES – Identifiedocument – Versie voor de Tussenpersoon (Vennootschap)	Fact Find for INTERMEDIARIES for the Belgian market (FOS); dedicated to CORPORATE ENTITIES subscribing. To be used in combination with the new business application forms for this market. Dutch version	Utmost Luxembourg S.A	Fact Find	Dutch (NL)	Corporate Select Plan	FOS	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (FOS); dedicated to CORPORATE ENTITIES subscribing. To be used in combination with the new business application forms for this market. Dutch version Fact Find FOR INTERMEDIARIES – Identifiedocument – Versie voor de Tussenpersoon (Vennootschap) ULU CONT4161
Corporate Select Plan	New business application form for the Corporate Select Plan product – Belgium; Capitalisation contract	Utmost Luxembourg S.A	Application Form	French (FR)	Corporate Select Plan	FOS	New Business Pack	New business application form for the Corporate Select Plan product – Belgium; Capitalisation contract Application Form Corporate Select Plan ULU CONT4174
FOR INTERMEDIARIES – Document d’entrée en relation / Version pour l’Intermédiaire – Société	Fact Find for INTERMEDIARIES for the Belgian market (FOS); dedicated to CORPORATE ENTITIES subscribing. To be used in combination with the new business application forms for this market. French version	Utmost Luxembourg S.A	Fact Find	French (FR)	Corporate Select Plan	FOS	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (FOS); dedicated to CORPORATE ENTITIES subscribing. To be used in combination with the new business application forms for this market. French version Fact Find FOR INTERMEDIARIES – Document d’entrée en relation / Version pour l’Intermédiaire – Société ULU CONT4160
FOR INTERMEDIARIES – Document d’entrée en relation – version pour l’Intermédiaire / Société simple/Fondation	Fact Find for INTERMEDIARIES for the Belgian market (FOS); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. French version	Utmost Luxembourg S.A	Fact Find	French (FR)	Select Client Plan	FOS	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (FOS); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. French version Fact Find FOR INTERMEDIARIES – Document d’entrée en relation – version pour l’Intermédiaire / Société simple/Fondation ULU CONT3964
FOR INTERMEDIARIES – Identificatiedocument – Versie voor de Tussenpersoon / Maatschap/Stichting	Fact Find for INTERMEDIARIES for the Belgian market (FOS); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. Dutch version	Utmost Luxembourg S.A	Fact Find	Dutch (NL)	Select Client Plan	FOS	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (FOS); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. Dutch version Fact Find FOR INTERMEDIARIES – Identificatiedocument – Versie voor de Tussenpersoon / Maatschap/Stichting ULU CONT3965
FOR INTERMEDIARIES – Document d’entrée en relation – Version pour l’Intermédiaire Personne physique	Fact Find for INTERMEDIARIES for the Belgian market (FOS); dedicated to PHYSICAL PERSONS subscribing. To be used in combination with the new business application forms for this market. French version	Utmost Luxembourg S.A	Fact Find	French (FR)	Select Client Plan	FOS	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (FOS); dedicated to PHYSICAL PERSONS subscribing. To be used in combination with the new business application forms for this market. French version Fact Find FOR INTERMEDIARIES – Document d’entrée en relation – Version pour l’Intermédiaire Personne physique ULU CONT3960
FOR INTERMEDIARIES – Identificatiedocument – Versie voor de Tussenpersoon Naturlijke persoon	Fact Find for INTERMEDIARIES for the Belgian market (FOS); dedicated to PHYSICAL PERSONS subscribing. To be used in combination with the new business application forms for this market. Dutch version	Utmost Luxembourg S.A	Fact Find	Dutch (NL)	Select Client Plan	FOS	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (FOS); dedicated to PHYSICAL PERSONS subscribing. To be used in combination with the new business application forms for this market. Dutch version Fact Find FOR INTERMEDIARIES – Identificatiedocument – Versie voor de Tussenpersoon Naturlijke persoon ULU CONT3961
Select Client Plan – Caractéristiques principales du (family shared) Fonds interne dédié	Annex to add additional Family Shared Internal Dedicated Funds to the contract/policy	Utmost Luxembourg S.A	Operational Forms	French (FR)	Select Client Plan	FOS	New Policy	Annex to add additional Family Shared Internal Dedicated Funds to the contract/policy Operational Forms Select Client Plan – Caractéristiques principales du (family shared) Fonds interne dédié ULU CONT3788
Select Client Plan – Voornaamste kenmerken van het (family shared) Intern Toegewezen Fonds	Annex to add additional Family Shared Internal Dedicated Funds to the contract/policy	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Select Client Plan	FOS	New Policy	Annex to add additional Family Shared Internal Dedicated Funds to the contract/policy Operational Forms Select Client Plan – Voornaamste kenmerken van het (family shared) Intern Toegewezen Fonds ULU CONT3789
Règles d’investissement pour fonds internes – Belgique	Table of Luxembourg Investment Rules	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Non Product Specific	FOS		Table of Luxembourg Investment Rules Investment literature/Strategies Règles d’investissement pour fonds internes – Belgique ULU CONT3681
Bijlage: beleggingsregels en -limieten voor Interne en Externe Fondsen	Table of Luxembourg Investment Rules	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Non Product Specific	FOS		Table of Luxembourg Investment Rules Investment literature/Strategies Bijlage: beleggingsregels en -limieten voor Interne en Externe Fondsen ULU CONT3683
Select Client Plan (Multi-Support) – Fonds Interne Dédié additionnel	Annex to add additional Internal Dedicated Funds to the contract/policy	Utmost Luxembourg S.A	Operational Forms	French (FR)	Select Client Plan	FOS	New Policy	Annex to add additional Internal Dedicated Funds to the contract/policy Operational Forms Select Client Plan (Multi-Support) – Fonds Interne Dédié additionnel ULU CONT3633
Select Client Plan – België – Bijlage: lijst van beschikbare Interne Collectieve Fondsen	Internal Collective Funds list – Belgium	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Select Client Plan	FOS		Internal Collective Funds list – Belgium Investment literature/Strategies Select Client Plan – België – Bijlage: lijst van beschikbare Interne Collectieve Fondsen ULU CONT3620-2
Select Client Plan (Multi-Support) – Bijkomend Intern Toegewezen Fonds	Annex to add additional Internal Dedicated Funds to the contract/policy	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Select Client Plan	FOS	New Policy	Annex to add additional Internal Dedicated Funds to the contract/policy Operational Forms Select Client Plan (Multi-Support) – Bijkomend Intern Toegewezen Fonds ULU CONT3632
Select Client Plan – Bijlage: lijst van beschikbare Externe Fondsen	This form shows the list of available external funds for the Select Client Plan product	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Select Client Plan	FOS	New Business Pack	This form shows the list of available external funds for the Select Client Plan product Investment literature/Strategies Select Client Plan – Bijlage: lijst van beschikbare Externe Fondsen ULU CONT3620
Select Client Plan – Annexe : liste des Fonds Externes disponibles	This form shows the list of available external funds for the Select Client Plan product	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Select Client Plan	FOS	New Business Pack	This form shows the list of available external funds for the Select Client Plan product Investment literature/Strategies Select Client Plan – Annexe : liste des Fonds Externes disponibles ULU CONT3603-1
Select Client Plan – Belgique – Annexe : liste des Fonds Internes Collectifs disponibles	Internal Collective Funds list – Belgium	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Select Client Plan	FOS		Internal Collective Funds list – Belgium Investment literature/Strategies Select Client Plan – Belgique – Annexe : liste des Fonds Internes Collectifs disponibles ULU CONT3603-2
Demande de Statut de Client Professionnel / Request for Professional Client Status	Request for Professional Client Status	Utmost Luxembourg S.A	Operational Forms	English (EN), French (FR)	Non Product Specific	FOS		Request for Professional Client Status Operational Forms Demande de Statut de Client Professionnel / Request for Professional Client Status ULU CONT3207
Aanvraag van het Statuut van Professionele Cliënt / Request for Professional Client Status	Request for Professional Client Status	Utmost Luxembourg S.A	Operational Forms	Dutch (NL), English (EN)	Non Product Specific	FOS		Request for Professional Client Status Operational Forms Aanvraag van het Statuut van Professionele Cliënt / Request for Professional Client Status ULU CONT3210
Overzicht van bijkomende administratieve vergoedingen	Annex showing the activity-based charging grid	Utmost Luxembourg S.A	Commission Documents/Fees & Charges Literature and Illustrations	Dutch (NL)	Non Product Specific	FOS		Annex showing the activity-based charging grid Commission Documents/Fees & Charges Literature and Illustrations Overzicht van bijkomende administratieve vergoedingen ULU CONT3167
Aperçu des frais administratifs additionnels	Annex showing the activity-based charging grid	Utmost Luxembourg S.A	Commission Documents/Fees & Charges Literature and Illustrations	French (FR)	Non Product Specific	FOS		Annex showing the activity-based charging grid Commission Documents/Fees & Charges Literature and Illustrations Aperçu des frais administratifs additionnels ULU CONT3168
OVEREENKOMST INZAKE OPENBAARMAKING VAN INFORMATIE	Information Disclosure Agreement	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	Dutch (NL)	Non Product Specific	FOS		Information Disclosure Agreement Client Letters/Indemnity/Data Protection OVEREENKOMST INZAKE OPENBAARMAKING VAN INFORMATIE ULU CONT2860
ACCORD DE COMMUNICATION D’INFORMATION	Information Disclosure Agreement	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	French (FR)	Non Product Specific	FOS		Information Disclosure Agreement Client Letters/Indemnity/Data Protection ACCORD DE COMMUNICATION D’INFORMATION ULU CONT2861
Bijvoegsel bij de levensverzekeringsovereenkomst – Aanvaarding van de begunstiging	Annex to the application form for beneficiary acceptance	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOS		Annex to the application form for beneficiary acceptance Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Aanvaarding van de begunstiging ULU CONT2802
Avenant au contrat d’assurance-vie – Acceptation du bénéfice	Annex to the application form for beneficiary acceptance	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOS		Annex to the application form for beneficiary acceptance Operational Forms Avenant au contrat d’assurance-vie – Acceptation du bénéfice ULU CONT2803
Bijvoegsel bij de levensverzekeringsovereenkomst – Ontbinding van de overdracht van verzekeringsrechten	Annex to the application form for signing the dissolution of the transfer of insurance rights	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOS		Annex to the application form for signing the dissolution of the transfer of insurance rights Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Ontbinding van de overdracht van verzekeringsrechten ULU CONT2798
Avenant au contrat d’assurance-vie – Dissolution de cession de droits	Annex to the application form for signing the dissolution of the transfer of insurance rights	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOS		Annex to the application form for signing the dissolution of the transfer of insurance rights Operational Forms Avenant au contrat d’assurance-vie – Dissolution de cession de droits ULU CONT2799
Avenant au contrat d’assurance-vie – Convention de Cession Post Mortem des droits découlant du Contrat	Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOS		Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy Operational Forms Avenant au contrat d’assurance-vie – Convention de Cession Post Mortem des droits découlant du Contrat ULU CONT2629
Bijvoegsel bij de levensverzekeringsovereenkomst – Overeenkomst van Overdracht Post Mortem van de uit de Overeenkomst voortvloeiende rechten	Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOS		Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Overeenkomst van Overdracht Post Mortem van de uit de Overeenkomst voortvloeiende rechten ULU CONT2628
Automatic Exchange of Information – Self-Certification for Controlling Persons (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Utmost Luxembourg S.A	Operational Forms	English (EN)	Non Product Specific	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Automatic Exchange of Information – Self-Certification for Controlling Persons (AEoI) ULU CONT2599
Automatic Exchange of Information – Self-Certification for Individuals (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Utmost Luxembourg S.A	Operational Forms	English (EN)	Non Product Specific	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Automatic Exchange of Information – Self-Certification for Individuals (AEoI) ULU CONT2593
Automatic Exchange of Information – Self-Certification for Entities (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Utmost Luxembourg S.A	Operational Forms	English (EN)	Non Product Specific	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Automatic Exchange of Information – Self-Certification for Entities (AEoI) ULU CONT2596
Verzoek om een hogere investeringscategorie	Use this form to request a upgrade of your investment category	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Non Product Specific	FOS		Use this form to request a upgrade of your investment category Investment literature/Strategies Verzoek om een hogere investeringscategorie ULU CONT2529
Demande de classement dans une catégorie d’investissement supérieure	Use this form to request a upgrade of your investment category	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Non Product Specific	FOS		Use this form to request a upgrade of your investment category Investment literature/Strategies Demande de classement dans une catégorie d’investissement supérieure ULU CONT2526
Verzoek om een lagere investeringscategorie	Use this form to request a downgrade of your investment category	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Non Product Specific	FOS		Use this form to request a downgrade of your investment category Investment literature/Strategies Verzoek om een lagere investeringscategorie ULU CONT2518
Demande de classement dans une catégorie d’investissement inférieure	Use this form to request a downgrade of your investment category	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Non Product Specific	FOS		Use this form to request a downgrade of your investment category Investment literature/Strategies Demande de classement dans une catégorie d’investissement inférieure ULU CONT2515
Tax on Insurance Transactions	Annex on the advance payment of the premium tax	Utmost Luxembourg S.A	Operational Forms	English (EN)	Non Product Specific	FOS		Annex on the advance payment of the premium tax Operational Forms Tax on Insurance Transactions ULU CONT2466
Beleggingsstrategie	Use this form to define your investment strategy (generic version)	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Non Product Specific	FOS		Use this form to define your investment strategy (generic version) Investment literature/Strategies Beleggingsstrategie ULU CONT2275
Stratégie d’Investissement	Use this form to define your investment strategy (generic version)	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Non Product Specific	FOS		Use this form to define your investment strategy (generic version) Investment literature/Strategies Stratégie d’Investissement ULU CONT2276
Taks op de Verzekeringsverrichtingen	Bijlage inzake de voorafbetaling van de premietaks	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOS		Bijlage inzake de voorafbetaling van de premietaks Operational Forms Taks op de Verzekeringsverrichtingen ULU CONT2262
Taxe sur les Opérations d’Assurance	Annexe relative au paiement anticipé de la taxe sur les primes	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOS		Annexe relative au paiement anticipé de la taxe sur les primes Operational Forms Taxe sur les Opérations d’Assurance ULU CONT2263
Afwijking van het Beleggingsprofiel	Use this form to request a deviation from your investment profile	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Non Product Specific	FOS		Use this form to request a deviation from your investment profile Investment literature/Strategies Afwijking van het Beleggingsprofiel ULU CONT2220
Déviation du Profil d’investissement	Use this form to request a deviation from your investment profile	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Non Product Specific	FOS		Use this form to request a deviation from your investment profile Investment literature/Strategies Déviation du Profil d’investissement ULU CONT2221
Verslag Medisch Onderzoek	Medical Examination Report – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Underwriting guides/questionnaires/brochures	Dutch (NL)	Non Product Specific	FOS		Medical Examination Report – Belgium (FOS) – Dutch version Underwriting guides/questionnaires/brochures Verslag Medisch Onderzoek ULU CONT2190
Vertrouwelijke Financiële Vragenlijst	Confidential Financial Questionnaire – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Underwriting guides/questionnaires/brochures	Dutch (NL)	Non Product Specific	FOS		Confidential Financial Questionnaire – Belgium (FOS) – Dutch version Underwriting guides/questionnaires/brochures Vertrouwelijke Financiële Vragenlijst ULU CONT2188
Rapport d’Examen Medical	Medical Examination Report – Belgium (FOS) – French version	Utmost Luxembourg S.A	Underwriting guides/questionnaires/brochures	French (FR)	Non Product Specific	FOS		Medical Examination Report – Belgium (FOS) – French version Underwriting guides/questionnaires/brochures Rapport d’Examen Medical ULU CONT2189
Bijkomende Vragenlijst over Bestaande Levensverzekeringsovereenkomsten en Aanvragen	Additional Questionnaire on Preexisting Life Policies and Applications – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Underwriting guides/questionnaires/brochures	Dutch (NL)	Non Product Specific	FOS		Additional Questionnaire on Preexisting Life Policies and Applications – Belgium (FOS) – Dutch version Underwriting guides/questionnaires/brochures Bijkomende Vragenlijst over Bestaande Levensverzekeringsovereenkomsten en Aanvragen ULU CONT2186
Questionnaire Financier Confidentiel	Confidential Financial Questionnaire – Belgium (FOS) – French version	Utmost Luxembourg S.A	Underwriting guides/questionnaires/brochures	French (FR)	Non Product Specific	FOS		Confidential Financial Questionnaire – Belgium (FOS) – French version Underwriting guides/questionnaires/brochures Questionnaire Financier Confidentiel ULU CONT2187
Bijkomende Medische Vragenlijst	Additional Medical Questionnaire – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Underwriting guides/questionnaires/brochures	Dutch (NL)	Non Product Specific	FOS		Additional Medical Questionnaire – Belgium (FOS) – Dutch version Underwriting guides/questionnaires/brochures Bijkomende Medische Vragenlijst ULU CONT2184
Questionnaire Complementaire Contrats d’Assurance Vie et Demandes Existantes	Additional Questionnaire on Preexisting Life Policies and Applications – Belgium (FOS) – French version	Utmost Luxembourg S.A	Underwriting guides/questionnaires/brochures	French (FR)	Non Product Specific	FOS		Additional Questionnaire on Preexisting Life Policies and Applications – Belgium (FOS) – French version Underwriting guides/questionnaires/brochures Questionnaire Complementaire Contrats d’Assurance Vie et Demandes Existantes ULU CONT2185
Questionnaire Medical Complementaire	Additional Medical Questionnaire – Belgium (FOS) – French version	Utmost Luxembourg S.A	Underwriting guides/questionnaires/brochures	French (FR)	Non Product Specific	FOS		Additional Medical Questionnaire – Belgium (FOS) – French version Underwriting guides/questionnaires/brochures Questionnaire Medical Complementaire ULU CONT2183
FATCA Zelfcertificering	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms FATCA Zelfcertificering ULU CONT2170-8
FATCA Self-Certification	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Utmost Luxembourg S.A	Operational Forms	English (EN)	Non Product Specific	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms FATCA Self-Certification ULU CONT2170-5
FATCA Auto-Certification	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOS		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms FATCA Auto-Certification ULU CONT2170
Profil d’investissement et évaluation de l’adéquation	Use this form to complete an investment profile questionnaire and request a deviation from your investment profile	Utmost Luxembourg S.A	Investment literature/Strategies	French (FR)	Non Product Specific	FOS	Addition to your Policy	Use this form to complete an investment profile questionnaire and request a deviation from your investment profile Investment literature/Strategies Profil d’investissement et évaluation de l’adéquation ULU CONT2114
Beleggingsprofiel en geschiktheidsevaluatie	Use this form to complete an investment profile questionnaire and request a deviation from your investment profile	Utmost Luxembourg S.A	Investment literature/Strategies	Dutch (NL)	Non Product Specific	FOS	Addition to your Policy	Use this form to complete an investment profile questionnaire and request a deviation from your investment profile Investment literature/Strategies Beleggingsprofiel en geschiktheidsevaluatie ULU CONT2113
Select Client Plan (Multi-Support) – Algemene Voorwaarden	Stand-alone version of General Conditions for the Select Client Plan product – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Policy Conditions	Dutch (NL)	Select Client Plan	FOS		Stand-alone version of General Conditions for the Select Client Plan product – Belgium (FOS) – Dutch version Policy Conditions Select Client Plan (Multi-Support) – Algemene Voorwaarden ULU CONT1868
Select Client Plan – Conditions Générales	Stand-alone version of General Conditions for the Select Client Plan product – Belgium (FOS) – French version	Utmost Luxembourg S.A	Policy Conditions	French (FR)	Select Client Plan	FOS		Stand-alone version of General Conditions for the Select Client Plan product – Belgium (FOS) – French version Policy Conditions Select Client Plan – Conditions Générales ULU CONT1867
Benoeming van Begunstigden	Use this form to nominate beneficiaries	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOS		Use this form to nominate beneficiaries Operational Forms Benoeming van Begunstigden ULU CONT1803
Désignation des Bénéficiaires	Use this form to nominate beneficiaries	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOS		Use this form to nominate beneficiaries Operational Forms Désignation des Bénéficiaires ULU CONT1802
Choix de la Loi Applicable / Choice of Law	Use this form to perform a choice of law	Utmost Luxembourg S.A	Operational Forms	English (EN), French (FR)	Non Product Specific	FOS		Use this form to perform a choice of law Operational Forms Choix de la Loi Applicable / Choice of Law ULU CONT1790
Keuze van de Toepasbare Wet / Choice of Law	Use this form to perform a choice of law	Utmost Luxembourg S.A	Operational Forms	Dutch (NL), English (EN)	Non Product Specific	FOS		Use this form to perform a choice of law Operational Forms Keuze van de Toepasbare Wet / Choice of Law ULU CONT1791
Select Client Plan	New business application form for the Select Client Plan product – Belgium	Utmost Luxembourg S.A	Application Form	Dutch (NL)	Select Client Plan	FOS	New Business Pack	New business application form for the Select Client Plan product – Belgium Application Form Select Client Plan ULU CONT1729
Select Client Plan	New business application form for the Select Client Plan product – Belgium	Utmost Luxembourg S.A	Application Form	French (FR)	Select Client Plan	FOS	New Business Pack	New business application form for the Select Client Plan product – Belgium Application Form Select Client Plan ULU CONT1730
Verklaring omtrent „Non-U.S. Person”-status	Use this form to declare a status of “Non-U.S. Person”	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOS		Use this form to declare a status of “Non-U.S. Person” Operational Forms Verklaring omtrent „Non-U.S. Person”-status ULU CONT1634
Déclaration de Statut de « Non-U.S. Person »	Use this form to declare a status of “Non-U.S. Person”	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOS		Use this form to declare a status of “Non-U.S. Person” Operational Forms Déclaration de Statut de « Non-U.S. Person » ULU CONT1632
Investissements Spécialisés	Stand-alone Notice on the risks of acceptance when investing in Specialised Investments – Belgium (FOS) – French version	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	French (FR)	Non Product Specific	FOS		Stand-alone Notice on the risks of acceptance when investing in Specialised Investments – Belgium (FOS) – French version Client Letters/Indemnity/Data Protection Investissements Spécialisés ULU CONT1590
Gespecialiseerde Investeringen	Stand-alone Notice on the risks of acceptance when investing in Specialised Investments – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	Dutch (NL)	Non Product Specific	FOS		Stand-alone Notice on the risks of acceptance when investing in Specialised Investments – Belgium (FOS) – Dutch version Client Letters/Indemnity/Data Protection Gespecialiseerde Investeringen ULU CONT1586
Depotbank buiten de EER	Declaration for the Use of a Custodian Bank located outside of the EEA – Belgium (FOS) – Dutch version	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	Dutch (NL)	Non Product Specific	FOS		Declaration for the Use of a Custodian Bank located outside of the EEA – Belgium (FOS) – Dutch version Client Letters/Indemnity/Data Protection Depotbank buiten de EER ULU CONT1441
Déclaration pour l’utilisation d’une banque dépositaire hors de l’EEE	Declaration for the Use of a Custodian Bank located outside of the EEA – France – Liberté product	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	French (FR)	Non Product Specific	FOS		Declaration for the Use of a Custodian Bank located outside of the EEA – France – Liberté product Client Letters/Indemnity/Data Protection Déclaration pour l’utilisation d’une banque dépositaire hors de l’EEE ULU CONT1434-2
Confirmation des coordonnées du Client utilisées pour la signature électronique des documents	Confirmation of Client contact details used for the Electronic Signing of documents	Utmost Luxembourg S.A	Operational Forms	French (FR)	Non Product Specific	FOE FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Confirmation des coordonnées du Client utilisées pour la signature électronique des documents ULU CONNECT1048
Bevestiging van contactgegevens van de Cliënt die worden gebruikt voor de elektronische ondertekening van documenten	Confirmation of Client contact details used for the Electronic Signing of documents	Utmost Luxembourg S.A	Operational Forms	Dutch (NL)	Non Product Specific	FOE FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Bevestiging van contactgegevens van de Cliënt die worden gebruikt voor de elektronische ondertekening van documenten ULU CONNECT1049
Document d’informations clés (“DIC”)	Private Client Policy – This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A. - Belgian Branch	Key Information Document	French (FR)	Private Client Policy	FOE		Private Client Policy – This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Document d’informations clés (“DIC”) ULBE_KID_BE_BE_EUR_PCP-BE_FR PR
Essentiële-informatiedocument (“Eid”)	Private Client Policy – This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A. - Belgian Branch	Key Information Document	Dutch (NL)	Private Client Policy	FOE		Private Client Policy – This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Essentiële-informatiedocument (“Eid”) ULBE_KID_BE_BE_EUR_PCP-BE_NL PR
Document d’informations clés (“DIC”)	This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A. - Belgian Branch	Key Information Document	French (FR)	Select Client Policy	FOE		This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Document d’informations clés (“DIC”) ULBE_KID_BE_BE_EUR_SCP-BE_FR PR
Essentiële-informatiedocument (“Eid”)	This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A. - Belgian Branch	Key Information Document	Dutch (NL)	Select Client Policy	FOE		This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Essentiële-informatiedocument (“Eid”) ULBE_KID_BE_BE_EUR_SCP-BE_NL PR
Document d’informations clés (“DIC”)	This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A. - Belgian Branch	Key Information Document	French (FR)	Corporate Select Plan	FOE		This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Document d’informations clés (“DIC”) ULBE_KID_BE_BE_EUR_CSP-BE_FR PR
Essentiële-informatiedocument (“Eid”)	This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses.	Utmost Luxembourg S.A. - Belgian Branch	Key Information Document	Dutch (NL)	Corporate Select Plan	FOE		This document contains key information about this investment product. The information, prescribed by law, is intended to clarify the product’s features, risks, costs, potential gains and losses. Key Information Document Essentiële-informatiedocument (“Eid”) ULBE_KID_BE_BE_EUR_CSP-BE_NL PR
Modification des caractéristiques principales d’un Fonds Interne Dédié existant	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Non Product Specific	FOE		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Modification des caractéristiques principales d’un Fonds Interne Dédié existant ULBE PCON1560
Wijziging van de voornaamste kenmerken van een bestaand Intern Toegewezen Fonds	Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Non Product Specific	FOE		Use this form to request a change to one or more key characteristics of an Internal Dedicated Fund; such as Change of Fund Manager and Custodian Bank Operational Forms Wijziging van de voornaamste kenmerken van een bestaand Intern Toegewezen Fonds ULBE PCON1561
Keuzeformulier Voor de ‘Opt-Out’-Optie	Operational Forms Keuzeformulier Voor de ‘Opt-Out’-Optie ULBE PR 00007	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Non Product Specific	FOE	Addition to your Policy, Making a change to your policy	Operational Forms Keuzeformulier Voor de ‘Opt-Out’-Optie ULBE PR 00007
Formulaire de Choix Option « Opt-Out » (FR)	Operational Forms Formulaire de Choix Option « Opt-Out » (FR) ULBE PR 00008	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Non Product Specific	FOE	Addition to your Policy, Making a change to your policy	Operational Forms Formulaire de Choix Option « Opt-Out » (FR) ULBE PR 00008
Wijziging van het communicatiemiddel voor correspondentie en het gebruik van elektronische handtekeningen	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Non Product Specific	FOE		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Wijziging van het communicatiemiddel voor correspondentie en het gebruik van elektronische handtekeningen ULBE PCON1529
Formulaire de changement de moyen de communication et utilisation des signatures électroniques	Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Non Product Specific	FOE		Use this form to request a change of communication means; change of address; change of correspondence address and consent to the use of electronic signatures Operational Forms Formulaire de changement de moyen de communication et utilisation des signatures électroniques ULBE PCON1530
Désignation d’Intermédiaire	Use this form to request an appointment or change of broker	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Non Product Specific	FOE		Use this form to request an appointment or change of broker Operational Forms Désignation d’Intermédiaire ULBE PCON1429
Aanstelling van Tussenpersoon	Use this form to request an appointment or change of broker	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Non Product Specific	FOE		Use this form to request an appointment or change of broker Operational Forms Aanstelling van Tussenpersoon ULBE PCON1430
Demande d’Arbitrage	Use this form to request a switch of investments on your policy/contract – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Surrender/Claim/Withdrawal/Switch	French (FR)	Non Product Specific	FOE		Use this form to request a switch of investments on your policy/contract – Belgium (Branch) – French version Surrender/Claim/Withdrawal/Switch Demande d’Arbitrage ULBE PCON1432
Arbitrageverzoek	Use this form to request a switch of investments on your policy/contract – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Surrender/Claim/Withdrawal/Switch	Dutch (NL)	Non Product Specific	FOE		Use this form to request a switch of investments on your policy/contract – Belgium (Branch) – Dutch version Surrender/Claim/Withdrawal/Switch Arbitrageverzoek ULBE PCON1433
Aanvraag tot Regelmatige Terugtrekking (Branch)	Use this form to request a regular withdrawal from your policy/contract – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Surrender/Claim/Withdrawal/Switch	Dutch (NL)	Non Product Specific	FOE		Use this form to request a regular withdrawal from your policy/contract – Belgium (Branch) – Dutch version Surrender/Claim/Withdrawal/Switch Aanvraag tot Regelmatige Terugtrekking (Branch) ULBE PCON1400
Rachat Partiel Programmé (Branch)	Use this form to request a regular withdrawal from your policy/contract – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Surrender/Claim/Withdrawal/Switch	French (FR)	Non Product Specific	FOE		Use this form to request a regular withdrawal from your policy/contract – Belgium (Branch) – French version Surrender/Claim/Withdrawal/Switch Rachat Partiel Programmé (Branch) ULBE PCON1401
Aanvraag tot Gedeeltelijke Afkoop (Branch)	Use this form to request a withdrawal from your policy/contract – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Surrender/Claim/Withdrawal/Switch	Dutch (NL)	Non Product Specific	FOE		Use this form to request a withdrawal from your policy/contract – Belgium (Branch) – Dutch version Surrender/Claim/Withdrawal/Switch Aanvraag tot Gedeeltelijke Afkoop (Branch) ULBE PCON1342
Demande de Rachat Partiel (Branch)	Use this form to request a withdrawal from your policy/contract – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Surrender/Claim/Withdrawal/Switch	French (FR)	Non Product Specific	FOE		Use this form to request a withdrawal from your policy/contract – Belgium (Branch) – French version Surrender/Claim/Withdrawal/Switch Demande de Rachat Partiel (Branch) ULBE PCON1343
Verzoek tot Afkoop (Branch)	Use this form to request the surrender of your policy/contract – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Surrender/Claim/Withdrawal/Switch	Dutch (NL)	Non Product Specific	FOE		Use this form to request the surrender of your policy/contract – Belgium (Branch) – Dutch version Surrender/Claim/Withdrawal/Switch Verzoek tot Afkoop (Branch) ULBE PCON1344
Demande de Rachat Total (Branch)	Use this form to request the surrender of your policy/contract – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Surrender/Claim/Withdrawal/Switch	French (FR)	Non Product Specific	FOE		Use this form to request the surrender of your policy/contract – Belgium (Branch) – French version Surrender/Claim/Withdrawal/Switch Demande de Rachat Total (Branch) ULBE PCON1345
Verklaring van Verlies van Polisdocument (Branch)	Form to be used to declare the loss of policy documents – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	Dutch (NL)	Non Product Specific	FOE		Form to be used to declare the loss of policy documents – Belgium (Branch) – Dutch version Client Letters/Indemnity/Data Protection Verklaring van Verlies van Polisdocument (Branch) ULBE PCON1336
Déclaration de Perte de Documents (Branch)	Form to be used to declare the loss of policy documents – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	French (FR)	Non Product Specific	FOE		Form to be used to declare the loss of policy documents – Belgium (Branch) – French version Client Letters/Indemnity/Data Protection Déclaration de Perte de Documents (Branch) ULBE PCON1337
Formulier voor de storting van een bijkomende Premie (Branch)	Use this form for an addition to your policy/contract – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Top Up/Additional Investment	Dutch (NL)	Select Client Policy	FOE	Addition to your Policy	Use this form for an addition to your policy/contract – Belgium (Branch) – Dutch version Top Up/Additional Investment Formulier voor de storting van een bijkomende Premie (Branch) ULBE PCON1338
Formulaire de versement de Prime complémentaire (Branch)	Use this form for an addition to your policy/contract – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Top Up/Additional Investment	French (FR)	Select Client Policy	FOE	Addition to your Policy	Use this form for an addition to your policy/contract – Belgium (Branch) – French version Top Up/Additional Investment Formulaire de versement de Prime complémentaire (Branch) ULBE PCON1339
Select Client Policy / Corporate Select Plan – ODDO Global Private Equity Evergreen Fund – Règlement de Gestion	Internal Collective Fund for Belgian market	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	French (FR)	Corporate Select Plan, Select Client Policy	FOE		Internal Collective Fund for Belgian market Investment literature/Strategies Select Client Policy / Corporate Select Plan – ODDO Global Private Equity Evergreen Fund – Règlement de Gestion ULBE CONT4911
Select Client Policy / Corporate Select Plan – ODDO Global Private Equity Evergreen Fund – Beheersreglement	Internal Collective Fund for Belgian market	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	Dutch (NL)	Corporate Select Plan, Select Client Policy	FOE		Internal Collective Fund for Belgian market Investment literature/Strategies Select Client Policy / Corporate Select Plan – ODDO Global Private Equity Evergreen Fund – Beheersreglement ULBE CONT4912
FOR INTERMEDIARIES – Document d’entrée enrelation / Version pour l’Intermédiaire – Société	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. French version	Utmost Luxembourg S.A. - Belgian Branch	Fact Find	French (FR)	Non Product Specific	FOE	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. French version Fact Find FOR INTERMEDIARIES – Document d’entrée enrelation / Version pour l’Intermédiaire – Société ULBE CONT4475
FOR INTERMEDIARIES – Identifiedocument – Versie voor de Tussenpersoon (Vennootschap)	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Fact Find	Dutch (NL)	Non Product Specific	FOE	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. Dutch version Fact Find FOR INTERMEDIARIES – Identifiedocument – Versie voor de Tussenpersoon (Vennootschap) ULBE CONT4476
Corporate Select Plan – Belgique – Annexe : liste des Fonds Externes disponibles	This form shows the list of available external funds for the Corporate Select Plan product	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	French (FR)	Corporate Select Plan	FOE	New Business Pack	This form shows the list of available external funds for the Corporate Select Plan product Investment literature/Strategies Corporate Select Plan – Belgique – Annexe : liste des Fonds Externes disponibles ULBE CONT4535
Corporate Select Plan – België – Bijlage: lijst van beschikbare Externe Fondsen	This form shows the list of available external funds for the Corporate Select Plan product	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	Dutch (NL)	Corporate Select Plan	FOE	New Business Pack	This form shows the list of available external funds for the Corporate Select Plan product Investment literature/Strategies Corporate Select Plan – België – Bijlage: lijst van beschikbare Externe Fondsen ULBE CONT4536
Corporate Select Plan – Algemene Voorwaarden	Stand-alone version of General Conditions for the Corporate Select Plan product – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Policy Conditions	Dutch (NL)	Corporate Select Plan	FOE		Stand-alone version of General Conditions for the Corporate Select Plan product – Belgium (Branch) – Dutch version Policy Conditions Corporate Select Plan – Algemene Voorwaarden ULBE CONT4182
Déclaration des associés d’une société civile en tant que Preneur d’Assurance	Declaration of the Legal Representative acting as Policyholder. To be used with Belgian application form	Utmost Luxembourg S.A. - Belgian Branch	Application Form	French (FR)	Select Client Policy	FOE	New Business Pack	Declaration of the Legal Representative acting as Policyholder. To be used with Belgian application form Application Form Déclaration des associés d’une société civile en tant que Preneur d’Assurance ULBE CONT4198
Désignation des Bénéficiaires	Use this form to nominate beneficiaries	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Non Product Specific	FOE		Use this form to nominate beneficiaries Operational Forms Désignation des Bénéficiaires ULBE CONT4382
Benoeming van Begunstigden	Use this form to nominate beneficiaries	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Non Product Specific	FOE		Use this form to nominate beneficiaries Operational Forms Benoeming van Begunstigden ULBE CONT4383
Corporate Select Plan	New business application form for the Corporate Select Plan product – Belgium; Capitalisation contract	Utmost Luxembourg S.A. - Belgian Branch	Application Form	Dutch (NL)	Corporate Select Plan	FOE	New Business Pack	New business application form for the Corporate Select Plan product – Belgium; Capitalisation contract Application Form Corporate Select Plan ULBE CONT4177
Corporate Select Plan – Conditions Générales	Stand-alone version of General Conditions for the Corporate Select Plan product – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Policy Conditions	French (FR)	Corporate Select Plan	FOE		Stand-alone version of General Conditions for the Corporate Select Plan product – Belgium (Branch) – French version Policy Conditions Corporate Select Plan – Conditions Générales ULBE CONT4181
FOR INTERMEDIARIES – Identificatiedocument – Versie voor de Tussenpersoon / Naturlijke persoon	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to PHYSICAL PERSONS subscribing. To be used in combination with the new business application forms for this market. Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Fact Find	Dutch (NL)	Select Client Policy	FOE	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to PHYSICAL PERSONS subscribing. To be used in combination with the new business application forms for this market. Dutch version Fact Find FOR INTERMEDIARIES – Identificatiedocument – Versie voor de Tussenpersoon / Naturlijke persoon ULBE CONT3969
FOR INTERMEDIARIES – Document d’entrée en relation – Version pour l’Intermédiaire / Société simple-Fondation	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. French version	Utmost Luxembourg S.A. - Belgian Branch	Fact Find	French (FR)	Select Client Policy	FOE	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. French version Fact Find FOR INTERMEDIARIES – Document d’entrée en relation – Version pour l’Intermédiaire / Société simple-Fondation ULBE CONT3970
FOR INTERMEDIARIES – Identificatiedocument – Versie voor de Tussenpersoon – Burgerlijke maatschap	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Fact Find	Dutch (NL)	Select Client Policy	FOE	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to FIDUCIARIES subscribing. To be used in combination with the new business application forms for this market. Dutch version Fact Find FOR INTERMEDIARIES – Identificatiedocument – Versie voor de Tussenpersoon – Burgerlijke maatschap ULBE CONT3971
Corporate Select Plan	New business application form for the Corporate Select Plan product – Belgium; Capitalisation contract	Utmost Luxembourg S.A. - Belgian Branch	Application Form	French (FR)	Corporate Select Plan	FOE	New Business Pack	New business application form for the Corporate Select Plan product – Belgium; Capitalisation contract Application Form Corporate Select Plan ULBE CONT4176
Bijlage: beleggingsregels en -limieten voor Interne en Externe Fondsen	Table of Luxembourg Investment Rules	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	Dutch (NL)	Non Product Specific	FOE		Table of Luxembourg Investment Rules Investment literature/Strategies Bijlage: beleggingsregels en -limieten voor Interne en Externe Fondsen ULBE CONT3684
Select Client Policy – Caractéristiques principales du (family shared) Fonds interne dédié	Annex to add additional Family Shared Internal Dedicated Funds to the contract/policy	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Select Client Policy	FOE	New Policy	Annex to add additional Family Shared Internal Dedicated Funds to the contract/policy Operational Forms Select Client Policy – Caractéristiques principales du (family shared) Fonds interne dédié ULBE CONT3786
Select Client Policy – Voornaamste kenmerken van het (family shared) Intern Toegewezen Fonds	Annex to add additional Family Shared Internal Dedicated Funds to the contract/policy	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Select Client Policy	FOE	New Policy	Annex to add additional Family Shared Internal Dedicated Funds to the contract/policy Operational Forms Select Client Policy – Voornaamste kenmerken van het (family shared) Intern Toegewezen Fonds ULBE CONT3787
FOR INTERMEDIARIES – Document d’entrée en relation – Version pour l’Intermédiaire / Personne physique	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to PHYSICAL PERSONS subscribing. To be used in combination with the new business application forms for this market. French version	Utmost Luxembourg S.A. - Belgian Branch	Fact Find	French (FR)	Non Product Specific	FOE	New Business Pack	Fact Find for INTERMEDIARIES for the Belgian market (Branch); dedicated to PHYSICAL PERSONS subscribing. To be used in combination with the new business application forms for this market. French version Fact Find FOR INTERMEDIARIES – Document d’entrée en relation – Version pour l’Intermédiaire / Personne physique ULBE CONT3968
Select Client Policy (Multi-Support) – Fonds Interne Dédié additionnel	Annex to add additional Internal Dedicated Funds to the contract/policy	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Select Client Policy	FOE	New Policy	Annex to add additional Internal Dedicated Funds to the contract/policy Operational Forms Select Client Policy (Multi-Support) – Fonds Interne Dédié additionnel ULBE CONT3635
Annexe: règles et limites d’investissement pour les Fonds Internes et Externes	Table of Luxembourg Investment Rules	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	French (FR)	Non Product Specific	FOE		Table of Luxembourg Investment Rules Investment literature/Strategies Annexe: règles et limites d’investissement pour les Fonds Internes et Externes ULBE CONT3682
Select Client Policy – Annexe : liste des Fonds Externes disponibles	This form shows the list of available internal collective funds for the Select Client Policy product	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	French (FR)	Select Client Policy	FOE	New Business Pack	This form shows the list of available internal collective funds for the Select Client Policy product Investment literature/Strategies Select Client Policy – Annexe : liste des Fonds Externes disponibles ULBE CONT3604-2
Select Client Policy – België / Bijlage: lijst van beschikbare Interne Collectieve Fondsen	This form shows the list of available external funds for the Select Client Policy product	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	Dutch (NL)	Select Client Policy	FOE	New Business Pack	This form shows the list of available external funds for the Select Client Policy product Investment literature/Strategies Select Client Policy – België / Bijlage: lijst van beschikbare Interne Collectieve Fondsen ULBE CONT3621-1
Select Client Policy – Bijlage: lijst van beschikbare Externe Fondsen	This form shows the list of available internal collective funds for the Select Client Policy product	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	Dutch (NL)	Select Client Policy	FOE	New Business Pack	This form shows the list of available internal collective funds for the Select Client Policy product Investment literature/Strategies Select Client Policy – Bijlage: lijst van beschikbare Externe Fondsen ULBE CONT3621-2
Select Client Policy (Multi-Support) – Bijkomend Intern Toegewezen Fonds	Annex to add additional Internal Dedicated Funds to the contract/policy	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Select Client Policy	FOE	New Policy	Annex to add additional Internal Dedicated Funds to the contract/policy Operational Forms Select Client Policy (Multi-Support) – Bijkomend Intern Toegewezen Fonds ULBE CONT3634
Profil d’investissement et évaluation de l’adéquation	Use this form to complete an investment profile questionnaire and request a deviation from your investment profile	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	French (FR)	Non Product Specific	FOE	Addition to your Policy	Use this form to complete an investment profile questionnaire and request a deviation from your investment profile Investment literature/Strategies Profil d’investissement et évaluation de l’adéquation ULBE CONT3475
Select Client Policy – Belgique – Annexe : liste des Fonds Internes Collectifs disponibles	Internal Collective Funds list – Belgium	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	French (FR)	Select Client Policy	FOE	New Business Pack	Internal Collective Funds list – Belgium Investment literature/Strategies Select Client Policy – Belgique – Annexe : liste des Fonds Internes Collectifs disponibles ULBE CONT3604-1
ACCORD DE COMMUNICATION D’INFORMATION	Information Disclosure Agreement	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	French (FR)	Non Product Specific	FOE		Information Disclosure Agreement Client Letters/Indemnity/Data Protection ACCORD DE COMMUNICATION D’INFORMATION ULBE CONT3287
Taxe sur les Opérations d’Assurance	Back-end tax annex – Belgium	Utmost Luxembourg S.A. - Belgian Branch	Tax and regulatory Literature/technical sales aids and literature	French (FR)	Non Product Specific	FOE		Back-end tax annex – Belgium Tax and regulatory Literature/technical sales aids and literature Taxe sur les Opérations d’Assurance ULBE CONT3402
Taks op de Verzekeringsverrichtingen	Back-end tax annex – Belgium	Utmost Luxembourg S.A. - Belgian Branch	Tax and regulatory Literature/technical sales aids and literature	Dutch (NL)	Non Product Specific	FOE		Back-end tax annex – Belgium Tax and regulatory Literature/technical sales aids and literature Taks op de Verzekeringsverrichtingen ULBE CONT3403
Beleggingsprofiel en geschiktheidsevaluatie	Use this form to complete an investment profile questionnaire and request a deviation from your investment profile	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	Dutch (NL)	Non Product Specific	FOE	Addition to your Policy	Use this form to complete an investment profile questionnaire and request a deviation from your investment profile Investment literature/Strategies Beleggingsprofiel en geschiktheidsevaluatie ULBE CONT3474
Verzoek om een hogere investeringscategorie	Use this form to request a upgrade of your investment category	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	Dutch (NL)	Non Product Specific	FOE		Use this form to request a upgrade of your investment category Investment literature/Strategies Verzoek om een hogere investeringscategorie ULBE CONT3238
Afwijking van het Beleggingsprofiel	Use this form to request a deviation from your investment profile	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	Dutch (NL)	Non Product Specific	FOE		Use this form to request a deviation from your investment profile Investment literature/Strategies Afwijking van het Beleggingsprofiel ULBE CONT3269
Déviation du Profil d’investissement	Use this form to request a deviation from your investment profile	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	French (FR)	Non Product Specific	FOE		Use this form to request a deviation from your investment profile Investment literature/Strategies Déviation du Profil d’investissement ULBE CONT3270
OVEREENKOMST INZAKE OPENBAARMAKING VAN INFORMATIE	Information Disclosure Agreement	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	Dutch (NL)	Non Product Specific	FOE		Information Disclosure Agreement Client Letters/Indemnity/Data Protection OVEREENKOMST INZAKE OPENBAARMAKING VAN INFORMATIE ULBE CONT3286
Verzoek om een lagere investeringscategorie	Use this form to request a downgrade of your investment category	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	Dutch (NL)	Non Product Specific	FOE		Use this form to request a downgrade of your investment category Investment literature/Strategies Verzoek om een lagere investeringscategorie ULBE CONT3236
Demande de classement dans une catégorie d’investissement supérieure	Use this form to request a upgrade of your investment category	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	French (FR)	Non Product Specific	FOE		Use this form to request a upgrade of your investment category Investment literature/Strategies Demande de classement dans une catégorie d’investissement supérieure ULBE CONT3237
Keuze van de Toepasbare Wet / Choice of Law	Use this form to perform a choice of law	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL), English (EN)	Non Product Specific	FOE		Use this form to perform a choice of law Operational Forms Keuze van de Toepasbare Wet / Choice of Law ULBE CONT3196
Aanvraag van het Statuut van Professionele Cliënt / Request for Professional Client Status (Branch)	Request for Professional Client Status	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL), English (EN)	Non Product Specific	FOE		Request for Professional Client Status Operational Forms Aanvraag van het Statuut van Professionele Cliënt / Request for Professional Client Status (Branch) ULBE CONT3208
Demande de Statut de Client Professionnel / Request for Professional Client Status (Branch)	Request for Professional Client Status	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	English (EN), French (FR)	Non Product Specific	FOE		Request for Professional Client Status Operational Forms Demande de Statut de Client Professionnel / Request for Professional Client Status (Branch) ULBE CONT3209
Demande de classement dans une catégorie d’investissement inférieure	Use this form to request a downgrade of your investment category	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	French (FR)	Non Product Specific	FOE		Use this form to request a downgrade of your investment category Investment literature/Strategies Demande de classement dans une catégorie d’investissement inférieure ULBE CONT3235
Banque Dépositaire hors de l’EEE (Branch)	Declaration for the Use of a Custodian Bank located outside of the EEA – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	French (FR)	Non Product Specific	FOE		Declaration for the Use of a Custodian Bank located outside of the EEA – Belgium (Branch) – French version Client Letters/Indemnity/Data Protection Banque Dépositaire hors de l’EEE (Branch) ULBE CONT2948
Overzicht van bijkomende administratieve vergoedingen	Annex showing the activity-based charging grid	Utmost Luxembourg S.A. - Belgian Branch	Commission Documents/Fees & Charges Literature and Illustrations	Dutch (NL)	Non Product Specific	FOE		Annex showing the activity-based charging grid Commission Documents/Fees & Charges Literature and Illustrations Overzicht van bijkomende administratieve vergoedingen ULBE CONT3181
Aperçu des frais administratifs additionnels	Annex showing the activity-based charging grid	Utmost Luxembourg S.A. - Belgian Branch	Commission Documents/Fees & Charges Literature and Illustrations	French (FR)	Non Product Specific	FOE		Annex showing the activity-based charging grid Commission Documents/Fees & Charges Literature and Illustrations Aperçu des frais administratifs additionnels ULBE CONT3182
Choix de la Loi Applicable / Choice of Law (Branch)	Use this form to perform a choice of law	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	English (EN), French (FR)	Non Product Specific	FOE		Use this form to perform a choice of law Operational Forms Choix de la Loi Applicable / Choice of Law (Branch) ULBE CONT3195
Verklaring betreffende de Fiscale Verplichtingen – Branch	Stand-alone Tax Compliance Certification form – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	Dutch (NL)	Non Product Specific	FOE		Stand-alone Tax Compliance Certification form – Belgium (Branch) – Dutch version Client Letters/Indemnity/Data Protection Verklaring betreffende de Fiscale Verplichtingen – Branch ULBE CONT2831
Depotbank buiten de EER (Branch)	Declaration for the Use of a Custodian Bank located outside of the EEA – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	Dutch (NL)	Non Product Specific	FOE		Declaration for the Use of a Custodian Bank located outside of the EEA – Belgium (Branch) – Dutch version Client Letters/Indemnity/Data Protection Depotbank buiten de EER (Branch) ULBE CONT2947
FATCA Zelfcertificering	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Non Product Specific	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms FATCA Zelfcertificering ULBE CONT2824
FATCA Auto-certification	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Non Product Specific	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms FATCA Auto-certification ULBE CONT2825
FATCA Self-Certification	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	English (EN)	Non Product Specific	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms FATCA Self-Certification ULBE CONT2826
Déclaration relative aux Obligations Fiscales – Branch	Stand-alone Tax Compliance Certification form – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Client Letters/Indemnity/Data Protection	French (FR)	Non Product Specific	FOE		Stand-alone Tax Compliance Certification form – Belgium (Branch) – French version Client Letters/Indemnity/Data Protection Déclaration relative aux Obligations Fiscales – Branch ULBE CONT2830
Questionnaire financier confidentiel (Branch)	Confidential Financial Questionnaire – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Underwriting guides/questionnaires/brochures	French (FR)	Non Product Specific	FOE		Confidential Financial Questionnaire – Belgium (Branch) – French version Underwriting guides/questionnaires/brochures Questionnaire financier confidentiel (Branch) ULBE CONT2818
Vertrouwelijke Financiële Vragenlijst (Branch)	Confidential Financial Questionnaire – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Underwriting guides/questionnaires/brochures	Dutch (NL)	Non Product Specific	FOE		Confidential Financial Questionnaire – Belgium (Branch) – Dutch version Underwriting guides/questionnaires/brochures Vertrouwelijke Financiële Vragenlijst (Branch) ULBE CONT2819
Rapport d’Examen médical (Branch)	Medical Examination Report – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Underwriting guides/questionnaires/brochures	French (FR)	Non Product Specific	FOE		Medical Examination Report – Belgium (Branch) – French version Underwriting guides/questionnaires/brochures Rapport d’Examen médical (Branch) ULBE CONT2814
Verslag Medisch Onderzoek (Branch)	Medical Examination Report – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Underwriting guides/questionnaires/brochures	Dutch (NL)	Non Product Specific	FOE		Medical Examination Report – Belgium (Branch) – Dutch version Underwriting guides/questionnaires/brochures Verslag Medisch Onderzoek (Branch) ULBE CONT2815
Questionnaire complémentaire Contrats d’assurance-vie et Demandes existantes (Branch)	Additional Questionnaire on Preexisting Life Policies and Applications – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Underwriting guides/questionnaires/brochures	French (FR)	Non Product Specific	FOE		Additional Questionnaire on Preexisting Life Policies and Applications – Belgium (Branch) – French version Underwriting guides/questionnaires/brochures Questionnaire complémentaire Contrats d’assurance-vie et Demandes existantes (Branch) ULBE CONT2816
Bijkomende Vragenlijst over Bestaande Levensverzekeringsovereenkomsten en Aanvragen (Branch)	Additional Questionnaire on Preexisting Life Policies and Applications – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Underwriting guides/questionnaires/brochures	Dutch (NL)	Non Product Specific	FOE		Additional Questionnaire on Preexisting Life Policies and Applications – Belgium (Branch) – Dutch version Underwriting guides/questionnaires/brochures Bijkomende Vragenlijst over Bestaande Levensverzekeringsovereenkomsten en Aanvragen (Branch) ULBE CONT2817
Bijvoegsel bij de levensverzekeringsovereenkomst – Aanvaarding van de begunstiging (Branch)	Annex to the application form for beneficiary acceptance	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Non Product Specific	FOE		Annex to the application form for beneficiary acceptance Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Aanvaarding van de begunstiging (Branch) ULBE CONT2804
Avenant au contrat d’assurance-vie – Acceptation du bénéfice (Branch)	Annex to the application form for beneficiary acceptance	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Non Product Specific	FOE		Annex to the application form for beneficiary acceptance Operational Forms Avenant au contrat d’assurance-vie – Acceptation du bénéfice (Branch) ULBE CONT2805
Questionnaire médical complémentaire (Branch)	Additional Medical Questionnaire – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Underwriting guides/questionnaires/brochures	French (FR)	Non Product Specific	FOE		Additional Medical Questionnaire – Belgium (Branch) – French version Underwriting guides/questionnaires/brochures Questionnaire médical complémentaire (Branch) ULBE CONT2812
Bijkomende Medische Vragenlijst (Branch)	Additional Medical Questionnaire – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Underwriting guides/questionnaires/brochures	Dutch (NL)	Non Product Specific	FOE		Additional Medical Questionnaire – Belgium (Branch) – Dutch version Underwriting guides/questionnaires/brochures Bijkomende Medische Vragenlijst (Branch) ULBE CONT2813
Bijvoegsel bij de levensverzekeringsovereenkomst – Ontbinding van de overdracht van verzekeringsrechten (Branch)	Annex to the application form for signing the dissolution of the transfer of insurance rights	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Non Product Specific	FOE		Annex to the application form for signing the dissolution of the transfer of insurance rights Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Ontbinding van de overdracht van verzekeringsrechten (Branch) ULBE CONT2800
Avenant au contrat d’assurance-vie – Dissolution de cession de droits (Branch)	Annex to the application form for signing the dissolution of the transfer of insurance rights	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Non Product Specific	FOE		Annex to the application form for signing the dissolution of the transfer of insurance rights Operational Forms Avenant au contrat d’assurance-vie – Dissolution de cession de droits (Branch) ULBE CONT2801
Automatische Uitwisseling van Inlichtingen Zelfcertificering (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Non Product Specific	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Automatische Uitwisseling van Inlichtingen Zelfcertificering (AEoI) ULBE CONT2793
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes physiques (Branch) (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Non Product Specific	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes physiques (Branch) (AEoI) ULBE CONT2794
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les entités (Branch) (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Non Product Specific	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les entités (Branch) (AEoI) ULBE CONT2795
Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes détenant le contrôle (Branch) (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons.	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Non Product Specific	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for controlling persons. Operational Forms Echange Automatique de Renseignements – Formulaire d’Autocertification pour les personnes détenant le contrôle (Branch) (AEoI) ULBE CONT2796
Automatische Uitwisseling van Inlichtingen Zelfcertificering (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders.	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Non Product Specific	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders. Operational Forms Automatische Uitwisseling van Inlichtingen Zelfcertificering (AEoI) ULBE CONT2791
Automatische Uitwisseling van Inlichtingen Zelfcertificering (AEoI)	Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications.	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Non Product Specific	FOE		Please complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for corporate applications. Operational Forms Automatische Uitwisseling van Inlichtingen Zelfcertificering (AEoI) ULBE CONT2792
Beleggingsstrategie (Branch)	Generic investment strategy form for the Belgian market (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	Dutch (NL)	Non Product Specific	FOE		Generic investment strategy form for the Belgian market (Branch) – Dutch version Investment literature/Strategies Beleggingsstrategie (Branch) ULBE CONT2778
Stratégie d’Investissement (Branch)	Generic investment strategy form for the Belgian market (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Investment literature/Strategies	French (FR)	Non Product Specific	FOE		Generic investment strategy form for the Belgian market (Branch) – French version Investment literature/Strategies Stratégie d’Investissement (Branch) ULBE CONT2779
Bijvoegsel bij de levensverzekeringsovereenkomst – Overeenkomst van Overdracht Post Mortem van de uit de Overeenkomst voortvloeiende rechten (Branch)	Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	Dutch (NL)	Non Product Specific	FOE		Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy Operational Forms Bijvoegsel bij de levensverzekeringsovereenkomst – Overeenkomst van Overdracht Post Mortem van de uit de Overeenkomst voortvloeiende rechten (Branch) ULBE CONT2788
Avenant au contrat d’assurance-vie – Convention de Cession Post Mortem des droits découlant du Contrat (Branch)	Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy	Utmost Luxembourg S.A. - Belgian Branch	Operational Forms	French (FR)	Non Product Specific	FOE		Annex to the application form for signing a post-mortem transfer agreement of the rights arising from the contract/policy Operational Forms Avenant au contrat d’assurance-vie – Convention de Cession Post Mortem des droits découlant du Contrat (Branch) ULBE CONT2789
Select Client Policy – Algemene Voorwaarden	Stand-alone version of General Conditions for the Select Client Policy product – Belgium (Branch) – Dutch version	Utmost Luxembourg S.A. - Belgian Branch	Policy Conditions	Dutch (NL)	Non Product Specific	FOE		Stand-alone version of General Conditions for the Select Client Policy product – Belgium (Branch) – Dutch version Policy Conditions Select Client Policy – Algemene Voorwaarden ULBE CONT2693
Select Client Policy – Conditions Générales	Stand-alone version of General Conditions for the Select Client Policy product – Belgium (Branch) – French version	Utmost Luxembourg S.A. - Belgian Branch	Policy Conditions	French (FR)	Non Product Specific	FOE		Stand-alone version of General Conditions for the Select Client Policy product – Belgium (Branch) – French version Policy Conditions Select Client Policy – Conditions Générales ULBE CONT2694
Select Client Policy	New business application form for the Select Client Policy product – Belgium	Utmost Luxembourg S.A. - Belgian Branch	Application Form	Dutch (NL)	Select Client Policy	FOE	New Business Pack	New business application form for the Select Client Policy product – Belgium Application Form Select Client Policy ULBE CONT2689
Select Client Policy	New business application form for the Select Client Policy product – Belgium	Utmost Luxembourg S.A. - Belgian Branch	Application Form	French (FR)	Select Client Policy	FOE	New Business Pack	New business application form for the Select Client Policy product – Belgium Application Form Select Client Policy ULBE CONT2690

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