DEED OF ASSIGNMENT OF LIFE POLICY BY WAY OF GIFT

DEED OF ASSIGNMENT OF LIFE POLICY BY WAY OF GIFT

Guidance notes please read carefully you are responsible for ensuring correct completion 1. GIFT Assigning your policy means that you are giving away all the benefits of your policy. This form must NOT be used: if any form of consideration is being given by the Assignee(s) to the Assignor(s) eg sold policies, or if the policy is being assigned by Trustees, or if the policy is being assigned as part of a divorce settlement or the dissolution of a Civil Partnership which is NOT under a court order made for financial provision under the Matrimonial Causes Act 1973 or the Family Law (Scotland) Act 1985 or Civil Partnership Act 2005, whether before or after the divorce or dissolution is final. 2. COMPLETING THE FORM Please enter details carefully in the allocated spaces. These deeds are legal documents and all parties to the deed must initial any deletion or amendments. You, as Assignor(s), and the person(s) to whom you are assigning your policy, the Assignee(s), must sign the form and have these signatures witnessed by an independent witness. One person may witness all the signatures. Whilst every attempt has been made to ensure the accuracy of this deed, Scottish Widows can accept no liability for the tax, financial or other consequences or the legal effect of this deed and if you are uncertain as to its suitability, independent legal and/or taxation advice should be obtained. Please return this form to: Scottish Widows Limited, 15 Dalkeith Road, Edinburgh EH16 5BU. 1

BOX A DATE OF RELEVANT LIFE POLICY TRUST Please enter the date last person signs the execution clause at the end of this Deed This Deed of Assignment of Life Policy is made on (DD MM YYYY) BOX B ASSIGNOR Please give your full name(s) and address(es) as owner(s) of the policy. Assignor name Assignor address Assignor name Assignor address BOX C ASSIGNEE Please give the name(s) and address(es) of the new owner(s) of the policy. Assignee name Assignee address Date of birth (DD MM YYYY) Nationality (list all if more than one held) Town/city of birth Country of birth Country of residence (if different or not UK) Country of any residential addresses (e.g. British, French, Irish) If you are a US Citizen or resident in the US for tax purposes by any other means, then the US must also be included as one of your countries of tax residency. Which countries are you tax resident in? By TIN, we mean your Taxpayer Identification Number or similar tax payer reference you hold for countries you are tax resident in. Please provide your TIN: 2

BOX C ASSIGNEES (CONTINUED) Please give your full name(s) and address(es) as owner(s) of the policy. Assignee name Assignee address Date of birth (DD MM YYYY) Nationality (list all if more than one held) (e.g. British, French, Irish) Town/city of birth Country of birth Country of residence (if different or not UK) Country of any residential addresses If you are a US Citizen or resident in the US for tax purposes by any other means, then the US must also be included as one of your countries of tax residency. Which countries are you tax resident in? By TIN, we mean your Taxpayer Identification Number or similar tax payer reference you hold for countries you are tax resident in. Please provide your TIN: BOX D POLICY DETAILS 1 The Assignor is the policyholder of the following Policy issued by Scottish Widows Limited: Policy number Life/lives assured 2 The Assignor wishes to assign and convey the Policy to the Assignee. 3 The Assignor is absolutely entitled to the Policy. 4 The Assignor hereby assigns and conveys the Policy and all monies assured thereby and all benefits and other monies which may become payable in respect thereof to the Assignee. 5 The Assignee accepts intimation of the assignation as evidenced by his/her signature to this deed. The Law of Scotland or England and Wales shall apply, depending on the law which applies to the policy. This deed shall be interpreted in accordance with the law of the Policy. 3

BOX E SIGNATURES IMPORTANT The Assignor and the Assignee must sign. The parties to this deed, or any of their relatives, must not witness each other s signatures. It is necessary to obtain an independent witness, who may witness all the signatures. Signed as a deed and delivered by: First Assignor name First Assignor signature Second Assignor name (if any) Second Assignor signature First Assignee name First Assignee signature 4

BOX E SIGNATURES (CONTINUED) Second Assignee name Second Assignee signature Scottish Widows Limited. Registered in England and Wales No. 3196171. Registered office in the United Kingdom at 25 Gresham Street, London EC2V 7HN. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services Register number 181655. 12265 09 /16