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Market: Luxembourg (LU)

Documents

Title	Description	Insurer	Asset Type	Language	Product	Regime	Process	Excerpt
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
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)	Private Client Portfolio	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_LU_EUR_PCP_FR PR
Key Information Document (‘KID’)	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	English (EN)	Private Client Portfolio	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 Key Information Document (‘KID’) ULU_KID_LU_LU_EUR_PCP_EN 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)	Luxembourg Capitalisation Bond	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_LU_EUR_LCB_FR PR
Key Information Document (‘KID’)	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	English (EN)	Luxembourg Capitalisation Bond	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 Key Information Document (‘KID’) ULU_KID_LU_LU_EUR_LCB_EN PR
Key Information Document (‘KID’)	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	English (EN)	Luxembourg Capitalisation Bond	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 Key Information Document (‘KID’) ULU_KID_LU_LU_EUR_LC_EN 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)	Luxembourg Capitalisation Bond	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_LU_EUR_LC_FR PR
Change of Communication Means and Use of Electronic Signatures Form / 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	English (EN), 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 Change of Communication Means and Use of Electronic Signatures Form / Formulaire de changement de moyen de communication et utilisation des signatures électroniques ULU PCON1514
Switch form / Formulaire d’arbitrage	Use this form to request a switch of investments on your policy/contract – Luxembourg	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	English (EN), French (FR)	Non Product Specific	FOS		Use this form to request a switch of investments on your policy/contract – Luxembourg Surrender/Claim/Withdrawal/Switch Switch form / Formulaire d’arbitrage ULU PCON1391
Partial surrender request / Demande de rachat partiel	Use this form to request a withdrawal from your policy/contract – Luxembourg	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	English (EN), French (FR)	Non Product Specific	FOS		Use this form to request a withdrawal from your policy/contract – Luxembourg Surrender/Claim/Withdrawal/Switch Partial surrender request / Demande de rachat partiel ULU PCON1387
Surrender request / Demande de rachat total	Use this form to request the surrender of your policy/contract – Luxembourg	Utmost Luxembourg S.A	Surrender/Claim/Withdrawal/Switch	English (EN), French (FR)	Non Product Specific	FOS		Use this form to request the surrender of your policy/contract – Luxembourg Surrender/Claim/Withdrawal/Switch Surrender request / Demande de rachat total ULU PCON1386
Additional Premium Form / Formulaire de versement de Prime complémentaire	Use this form for an addition to your policy/contract – Luxembourg	Utmost Luxembourg S.A	Top Up/Additional Investment	English (EN), French (FR)	Luxembourg Capitalisation Bond, Private Client Portfolio	FOS	Addition to your Policy	Use this form for an addition to your policy/contract – Luxembourg Top Up/Additional Investment Additional Premium Form / Formulaire de versement de Prime complémentaire ULU PCON1385
Power of Attorney / Procuration – Luxembourg Capitalisation Bond	Power of Attorney for the Investment Advisor – Luxembourg – Capitalisation Bond	Utmost Luxembourg S.A	Operational Forms	English (EN), French (FR)	Non Product Specific	FOS		Power of Attorney for the Investment Advisor – Luxembourg – Capitalisation Bond Operational Forms Power of Attorney / Procuration – Luxembourg Capitalisation Bond ULU CONT4549
Private Client Portfolio – Annex relating to the Buy & Hold management of the Specialised Assurance Funds / Annexe relative à la gestion Buy & Hold des Fonds d’Assurance Spécialisés	Annex to the Private Client Portfolio for Specialised Assurance Fund Buy and Hold	Utmost Luxembourg S.A	Investment literature/Strategies	English (EN), French (FR)	Private Client Portfolio	FOS		Annex to the Private Client Portfolio for Specialised Assurance Fund Buy and Hold Investment literature/Strategies Private Client Portfolio – Annex relating to the Buy & Hold management of the Specialised Assurance Funds / Annexe relative à la gestion Buy & Hold des Fonds d’Assurance Spécialisés ULU CONT4372
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
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
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
FOR INTERMEDIARIES – Fact find (Company)/ Document d’entrée en relation (Société)- Intermediary version / Version pour l’Intermédiaire	Fact Find for INTERMEDIARIES for the Luxembourg market; dedicated to CORPORATE ENTITIES subscribing. To be used in combination with the new business application forms for this market	Utmost Luxembourg S.A	Fact Find	English (EN), French (FR)	Capitalisation Bond, Private Client Portfolio	FOS	New Business Pack	Fact Find for INTERMEDIARIES for the Luxembourg market; dedicated to CORPORATE ENTITIES subscribing. To be used in combination with the new business application forms for this market Fact Find FOR INTERMEDIARIES – Fact find (Company)/ Document d’entrée en relation (Société)- Intermediary version / Version pour l’Intermédiaire ULU CONT3975
FOR INTERMEDIARIES – Fact find (Individual)/ Document d’entrée en relation (Individu)- Intermediary version / Version pour l’Intermédiaire	Fact Find for INTERMEDIARIES for the Luxembourg market; dedicated to PHYSICAL PERSONS subscribing. To be used in combination with the new business application forms for this market.	Utmost Luxembourg S.A	Fact Find	English (EN), French (FR)	Capitalisation Bond, Private Client Portfolio	FOS	New Business Pack	Fact Find for INTERMEDIARIES for the Luxembourg market; dedicated to PHYSICAL PERSONS subscribing. To be used in combination with the new business application forms for this market. Fact Find FOR INTERMEDIARIES – Fact find (Individual)/ Document d’entrée en relation (Individu)- Intermediary version / Version pour l’Intermédiaire ULU CONT3937
Règles d’investissement pour les Fonds Internes et Externes (15/3)	Table of Luxembourg Investment Rules	Utmost Luxembourg S.A	Investment literature/Strategies	English (EN), French (FR)	Non Product Specific	FOS		Table of Luxembourg Investment Rules Investment literature/Strategies Règles d’investissement pour les Fonds Internes et Externes (15/3) ULU CONT3807
Private Client Portfolio – Additional IDF / FID supplémentaire	Annex to add additional Internal Dedicated Funds to the contract/policy	Utmost Luxembourg S.A	Operational Forms	French (FR)	Private Client Portfolio	FOS	New Policy	Annex to add additional Internal Dedicated Funds to the contract/policy Operational Forms Private Client Portfolio – Additional IDF / FID supplémentaire ULU CONT3185
Private Client Portfolio – Additional SAF / FAS supplémentaire	Annex to add additional Specialised Assurance Funds to the contract/policy	Utmost Luxembourg S.A	Operational Forms	French (FR)	Private Client Portfolio	FOS	New Policy	Annex to add additional Specialised Assurance Funds to the contract/policy Operational Forms Private Client Portfolio – Additional SAF / FAS supplémentaire ULU CONT3186
Request for Investment Category Upgrade / 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	English (EN), French (FR)	Non Product Specific	FOS		Use this form to request a upgrade of your investment category Investment literature/Strategies Request for Investment Category Upgrade / Demande de classement dans une catégorie d’investissement supérieure ULU CONT3194
Power of Attorney / Procuration (Adviser)	Power of Attorney for the Investment Advisor – Luxembourg	Utmost Luxembourg S.A	Operational Forms	English (EN), French (FR)	Non Product Specific	FOS		Power of Attorney for the Investment Advisor – Luxembourg Operational Forms Power of Attorney / Procuration (Adviser) ULU CONT3198
Schedule of Additional Administrative Charges / Aperçu des frais administratifs additionnels	Annex showing the activity-based charging grid	Utmost Luxembourg S.A	Commission Documents/Fees & Charges Literature and Illustrations	English (EN), French (FR)	Non Product Specific	FOS		Annex showing the activity-based charging grid Commission Documents/Fees & Charges Literature and Illustrations Schedule of Additional Administrative Charges / Aperçu des frais administratifs additionnels ULU CONT3179
Investment Profile and Suitability Assessment / 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	English (EN), French (FR)	Luxembourg Capitalisation Bond, Private Client Portfolio	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 Investment Profile and Suitability Assessment / Profil d’investissement et évaluation de l’adéquation ULU CONT2992
Investment Profile (Deviation) / Profil d’Investissement (Déviation)	Use this form to request a deviation from your investment profile	Utmost Luxembourg S.A	Investment literature/Strategies	English (EN), French (FR)	Non Product Specific	FOS		Use this form to request a deviation from your investment profile Investment literature/Strategies Investment Profile (Deviation) / Profil d’Investissement (Déviation) ULU CONT2993
INFORMATION DISCLOSURE AGREEMENT / ACCORD DE COMMUNICATION D’INFORMATION	Information Disclosure Agreement	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	English (EN), French (FR)	Non Product Specific	FOS		Information Disclosure Agreement Client Letters/Indemnity/Data Protection INFORMATION DISCLOSURE AGREEMENT / ACCORD DE COMMUNICATION D’INFORMATION ULU CONT2868
INFORMATION DISCLOSURE AGREEMENT / 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 INFORMATION DISCLOSURE AGREEMENT / ACCORD DE COMMUNICATION D’INFORMATION ULU CONT2867
Addendum to Life Assurance Policy (PPB Addendum) – Discretionary Mandates	Addendum to the Personalised Portfolio Bond – Luxembourg	Utmost Luxembourg S.A	Operational Forms	English (EN)	Non Product Specific	FOS		Addendum to the Personalised Portfolio Bond – Luxembourg Operational Forms Addendum to Life Assurance Policy (PPB Addendum) – Discretionary Mandates ULU CONT2688
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
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
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
Declaration of “Non-U.S. Person” Status / Declaration de statut de « Non-U.S. Person »	Use this form to declare a status of “Non-U.S. Person” for the Capitalisation Bond product – Luxembourg	Utmost Luxembourg S.A	Operational Forms	English (EN), French (FR)	Non Product Specific	FOS		Use this form to declare a status of “Non-U.S. Person” for the Capitalisation Bond product – Luxembourg Operational Forms Declaration of “Non-U.S. Person” Status / Declaration de statut de « Non-U.S. Person » ULU CONT2043
Declaration of “Non-U.S. Person” Status / Declaration 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	English (EN), French (FR)	Non Product Specific	FOS		Use this form to declare a status of “Non-U.S. Person” Operational Forms Declaration of “Non-U.S. Person” Status / Declaration de statut de « Non-U.S. Person » ULU CONT2042
Custodian Bank located outside the EEA / Banque Depositaire hors de l’EEE	Declaration for the Use of a Custodian Bank located outside of the EEA – Luxembourg Capitalisation product	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	English (EN), French (FR)	Non Product Specific	FOS		Declaration for the Use of a Custodian Bank located outside of the EEA – Luxembourg Capitalisation product Client Letters/Indemnity/Data Protection Custodian Bank located outside the EEA / Banque Depositaire hors de l’EEE ULU CONT2037
Custodian Bank located outside the EEA / Banque Depositaire hors de l’EEE	Declaration for the Use of a Custodian Bank located outside of the EEA – Luxembourg	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	English (EN), French (FR)	Non Product Specific	FOS		Declaration for the Use of a Custodian Bank located outside of the EEA – Luxembourg Client Letters/Indemnity/Data Protection Custodian Bank located outside the EEA / Banque Depositaire hors de l’EEE ULU CONT2036
Tax Compliance Certification – Capitalisation Bond (PH) / Déclaration relative aux Obligations fiscales	Stand-alone Tax Compliance Certification form – Luxembourg Capitalisation Bond	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	English (EN), French (FR)	Non Product Specific	FOS		Stand-alone Tax Compliance Certification form – Luxembourg Capitalisation Bond Client Letters/Indemnity/Data Protection Tax Compliance Certification – Capitalisation Bond (PH) / Déclaration relative aux Obligations fiscales ULU CONT2026
Tax Compliance Certification (PH) / Déclaration relative aux Obligations fiscales	Stand-alone Tax Compliance Certification form – Luxembourg	Utmost Luxembourg S.A	Client Letters/Indemnity/Data Protection	English (EN), French (FR)	Non Product Specific	FOS		Stand-alone Tax Compliance Certification form – Luxembourg Client Letters/Indemnity/Data Protection Tax Compliance Certification (PH) / Déclaration relative aux Obligations fiscales ULU CONT2025
Luxembourg Capitalisation Bond – General Conditions/Conditions Générales	Stand-alone version of General Conditions for the Luxembourg Capitalisation Bond product – Luxembourg	Utmost Luxembourg S.A	Policy Conditions	English (EN), French (FR)	Capitalisation Bond	FOS		Stand-alone version of General Conditions for the Luxembourg Capitalisation Bond product – Luxembourg Policy Conditions Luxembourg Capitalisation Bond – General Conditions/Conditions Générales ULU CONT1983
Private Client Portfolio – General Conditions/Conditions Générales	Stand-alone version of General Conditions for the Private Client Portfolio product – Luxembourg	Utmost Luxembourg S.A	Policy Conditions	English (EN), French (FR)	Private Client Portfolio	FOS		Stand-alone version of General Conditions for the Private Client Portfolio product – Luxembourg Policy Conditions Private Client Portfolio – General Conditions/Conditions Générales ULU CONT1952
Luxembourg Capitalisation Bond	New business application form for the Luxembourg Capitalisation Bond product – Luxembourg	Utmost Luxembourg S.A	Application Form	English (EN), French (FR)	Luxembourg Capitalisation Bond	FOS	New Business Pack	New business application form for the Luxembourg Capitalisation Bond product – Luxembourg Application Form Luxembourg Capitalisation Bond ULU CONT1862
Private Client Portfolio	New business application form for the Private Client Portfolio product – Luxembourg	Utmost Luxembourg S.A	Application Form	English (EN), French (FR)	Private Client Portfolio	FOS	New Business Pack	New business application form for the Private Client Portfolio product – Luxembourg Application Form Private Client Portfolio ULU CONT1784
Confirmation of Client contact details used for the Electronic Signing of documents / 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	English (EN), French (FR)	Non Product Specific	FOS		Confirmation of Client contact details used for the Electronic Signing of documents Operational Forms Confirmation of Client contact details used for the Electronic Signing of documents / Confirmation des coordonnées du Client utilisées pour la signature électronique des documents ULU CONNECT1056

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