Stellar AIM ISA IHT Service

Application Form

How to complete this application form

Read carefully all the offer information and documents

This includes all the provider documents and details of risks and What happens next?
charges in the Wealth Club review at www.wealthclub.co.uk. Please
contact us to request hard copies. You’ll receive a confirmation from
us and usually from the relevant
Complete the application in full in BLOCK CAPITALS provider.
This includes both the product application form and Wealth Club
Investor Declarations. Next, your money will be invested
and shares allotted.
Return your application with your payment, if applicable
Please post in a stamped envelope to: At that point, you’ll be able
to monitor your Wealth Club
Wealth Club Ltd
investment on our online portal,
20 Richmond Hill, which we set up for you the first
Bristol, BS8 1BA time you invest if you provide an
email address.
If you would prefer to use a pre-paid envelope, please contract us on
0117 929 0511 and we shall send you one.
Timescales will depend on the
Please note: to benefit from Wealth Club terms, you must send this form to Wealth provider and offer.
Club. These instructions override any instructions contained in the application form.

Need any help? Have any questions?

Call 0117 929 0511 or email enquiries@wealthclub.co.uk
WůĞĂƐĞŶŽƚĞƚŚŝƐƉƉůŝĐĂƚŝŽŶ&ŽƌŵĐŽŶƚĂŝŶƐŝŶƚĞƌĂĐƚŝǀĞďŽdžĞƐ͕ƚŽŚĞůƉLJŽƵĨŝůůŝŶƚŚĞĨŽƌŵ
online. You have the choice of either filling in this Application Form online or on hard copy.
In order to use this functionality please download and open the form in the latest version
of Adobe Acrobat. You must print and sign a hard copy of this Application Form.

ΉWW>/EdWZ^KE>d/>^

Title

&ŽƌĞŶĂŵĞ;ƐͿ

Surname

Address

Postcode Country of residence*

Date of birth Town of birth

EĂƟŽŶĂůŝƚLJ** EĂƟŽŶĂů/ŶƐƵƌĂŶĐĞŶŽ͘

ƌĞLJŽƵĂh^ĐŝƟnjĞŶŽƌƌĞƐŝĚĞŶƚŝŶƚŚĞh^ĨŽƌƚĂdžƉƵƌƉŽƐĞƐ͍ Yes No

Home phone no. Mobile phone no.

Email address
Email address

Employment status :ŽďƟƚůĞ

Income band άϬʹάϮϰϵ͕ϵϵϵ͘ϵϵ άϮϱϬ͕ϬϬϬʹάϵϵϵ͕ϵϵϵ͘ϵϵ Over £1 million

ƌĞLJŽƵ͕ŽƌŚĂǀĞLJŽƵďĞĞŶǁŝƚŚŝŶƚŚĞƉĂƐƚϭϮŵŽŶƚŚƐ͕ĂWW;ƉŽůŝƟĐĂůůLJĞdžƉŽƐĞĚƉĞƌƐŽŶͿ͍ Yes No
Ύ /ĨLJŽƵƌĐŽƵŶƚƌLJŽĨƚĂdžƌĞƐŝĚĞŶĐLJŝƐŶŽƚƚŚĞh<͕ƉůĞĂƐĞĮůůŽƵƚƚŚĞdĂdžZĞƐŝĚĞŶĐLJ&Žƌŵ͘
ΎΎ /ĨLJŽƵƌŶĂƟŽŶĂůŝƚLJŝƐŶŽƚƌŝƟƐŚŽƌŝĨLJŽƵŚŽůĚĚƵĂůŶĂƟŽŶĂůŝƚLJ͕ƉůĞĂƐĞĐŽŶƚĂĐƚƵƐďĞĨŽƌĞƉƌŽĐĞĞĚŝŶŐ͘

POWER OF ATTORNEY

/ƐĂƉĞƌƐŽŶǁŝƚŚĂƉŽǁĞƌŽĨĂƩŽƌŶĞLJŵĂŬŝŶŐƚŚŝƐĂƉƉůŝĐĂƟŽŶ͍ Yes No
/ĨLJĞƐ͕ƉůĞĂƐĞƉƌŽǀŝĚĞƚŚĞŝƌŶĂŵĞĂŶĚĂĚĚƌĞƐƐ͗
Title

&ŽƌĞŶĂŵĞ;ƐͿ

Surname

Address

Postcode Date of birth

,ŽǁŵĂŶLJƉŽǁĞƌƐŽĨĂƩŽƌŶĞLJĂƌĞƚŚĞƌĞ͍
/ĨƚŚĞƌĞŝƐŵŽƌĞƚŚĂŶŽŶĞƉŽǁĞƌŽĨĂƩŽƌŶĞLJ͕ƉůĞĂƐĞƉƌŽǀŝĚĞƚŚĞŝƌŶĂŵĞĂŶĚĂĚĚƌĞƐƐŽŶĂƐĞƉĂƌĂƚĞƐŚĞĞƚ͘

ŽĞƐƚŚĞƉŽǁĞƌŽĨĂƩŽƌŶĞLJĂůůŽǁƚŚĞĚĞůĞŐĂƟŽŶ
Yes No
ŽĨĚŝƐĐƌĞƟŽŶĂƌLJƉŽǁĞƌƐ͍

/ŚĂǀĞĞŶĐůŽƐĞĚĂĐĞƌƟĮĞĚĐŽƉLJŽĨƚŚĞƉŽǁĞƌŽĨĂƩŽƌŶĞLJ Yes
STELLAR AIM ISA IHT SERVICE | 3
FINANCIAL SITUATION

dŽƚĂů/ŶĐŽŵĞ;ŝŶĐů͘ŽƚŚĞƌ
sources such as dividends or
rental income)

Total Net Worth

Source of Funds to be
Invested – e.g. transfer from
ƉƌĞǀŝŽƵƐŵĂŶĂŐĞƌ͕ƉƌŽĐĞĞĚƐ
ŽĨŚŽƵƐĞƐĂůĞ͕ďĂŶŬĂĐĐŽƵŶƚ

Source of Total Net Worth -

Please provide a brief
ĚĞƐĐƌŝƉƟŽŶŽĨLJŽƵƌƐŽƵƌĐĞ
ŽĨǁĞĂůƚŚ͕Ğ͘Ő͘ƐĂǀŝŶŐƐ͕
ƐĂůĂƌLJ͕ŝŶŚĞƌŝƚĂŶĐĞ͕ĞdžŝƐƟŶŐ
ŝŶǀĞƐƚŵĞŶƚƐ͕ƉƌŽĐĞĞĚƐĨƌŽŵ
property sale

STELLAR AIM ISA IHT SERVICE | 4

ΉE<d/>^

IMPORTANT:ĂƐƉĂƌƚŽĨƚŚĞĂƉƉůŝĐĂƟŽŶƉƌŽĐĞƐƐ͕ǁĞƌĞƋƵŝƌĞĚĞƚĂŝůƐŽĨƚŚĞĂƉƉůŝĐĂŶƚ͛ƐďĂŶŬĂĐĐŽƵŶƚ͘

Bank name

Bank address

Postcode

Account name

Account number Bank sort code

Building Society reference

ISA SUBSCRIPTION

WůĞĂƐĞůĞƚƵƐŬŶŽǁŚŽǁLJŽƵǁŽƵůĚůŝŬĞƚŽŝŶǀĞƐƚŝŶ^ƚĞůůĂƌŝD/^/ŶŚĞƌŝƚĂŶĐĞdĂdž^ĞƌǀŝĐĞďLJƟĐŬŝŶŐƚŚĞƌĞůĞǀĂŶƚ
ďŽdžĞƐďĞůŽǁ;LJŽƵŵĂLJĐŽŵƉůĞƚĞŵŽƌĞƚŚĂŶŽŶĞͿ͘

EĞǁ^ƵďƐĐƌŝƉƟŽŶ
I wish to open a new Stocks and Shares ISA using my 2021/22 tax year ISA allowance and invest £

I wish to open a new Stocks and Shares ISA using my 2022/23 tax year ISA allowance and invest £

WůĞĂƐĞƐĞĞƉĂŐĞϮŽĨƚŚŝƐƉƉůŝĐĂƟŽŶ&ŽƌŵĨŽƌƉĂLJŵĞŶƚĚĞƚĂŝůƐ͘

ISA Transfer
ƌĞŶĞǁĨƵŶĚƐĐŽŵŝŶŐĨƌŽŵLJŽƵƌƉĞƌƐŽŶĂůďĂŶŬĂĐĐŽƵŶƚ͍

/ǁŝƐŚƚŽŵĂŬĞĂƚƌĂŶƐĨĞƌĨƌŽŵŵLJĞdžŝƐƟŶŐ/^;ƐͿŽĨĂƉƉƌŽdžŝŵĂƚĞůLJά

Please complete a Stellar AIM ISA Inheritance Tax Service ISA Transfer Form for each ISA you hold with
ĂĚŝīĞƌĞŶƚDĂŶĂŐĞƌ͘

Total investment £

ISA DECLARATION
/ĚĞĐůĂƌĞƚŽtĞĂůƚŚdĞŬ>>W͕ĂƐƚŚĞ/^DĂŶĂŐĞƌ͕ƚŚĂƚ͗
ŝͿ ůůƐƵďƐĐƌŝƉƟŽŶƐŵĂĚĞ͕ĂŶĚƚŽďĞŵĂĚĞ͕ďĞůŽŶŐƚŽŵĞ͖
ŝŝͿ /ĂŵϭϴLJĞĂƌƐŽĨĂŐĞŽƌŽǀĞƌ͖
ŝŝŝͿ/ŚĂǀĞŶŽƚƐƵďƐĐƌŝďĞĚĂŶĚǁŝůůŶŽƚƐƵďƐĐƌŝďĞŵŽƌĞƚŚĂŶƚŚĞƉĞƌŵŝƩĞĚƚŽƚĂůƐƵďƐĐƌŝƉƟŽŶĂůůŽǁĂŶĐĞĨŽƌƚŚĞĐƵƌƌĞŶƚƚĂdžLJĞĂƌ
ƚŽĂĐĂƐŚ/^͕ĂƐƚŽĐŬƐĂŶĚƐŚĂƌĞƐ/^͕ĂŶĚĂŶŝŶŶŽǀĂƟǀĞĮŶĂŶĐĞ/^͖
ŝǀͿ/ŚĂǀĞŶŽƚƐƵďƐĐƌŝďĞĚĂŶĚǁŝůůŶŽƚƐƵďƐĐƌŝďĞƚŽĂŶŽƚŚĞƌƐƚŽĐŬƐĂŶĚƐŚĂƌĞƐ/^ŝŶƚŚĞƐĂŵĞƚĂdžLJĞĂƌƚŚĂƚ/ƐƵďƐĐƌŝďĞƚŽƚŚŝƐ/^͖ĂŶĚ
ǀͿ /ĂŵƌĞƐŝĚĞŶƚĂŶĚŽƌĚŝŶĂƌŝůLJƌĞƐŝĚĞŶƚŝŶƚŚĞhŶŝƚĞĚ<ŝŶŐĚŽŵĨŽƌƚĂdžƉƵƌƉŽƐĞƐŽƌ͕ŝĨŶŽƚƐŽƌĞƐŝĚĞŶƚ͕ĞŝƚŚĞƌƉĞƌĨŽƌŵĚƵƟĞƐ
ǁŚŝĐŚ͕ďLJǀŝƌƚƵĞŽĨ^ĞĐƟŽŶϮϴŽĨƚŚĞ/ŶĐŽŵĞdĂdž;ĂƌŶŝŶŐƐĂŶĚWĞŶƐŝŽŶƐͿĐƚϮϬϬϯ;ƌŽǁŶŵƉůŽLJĞĞƐ^ĞƌǀŝŶŐKǀĞƌƐĞĂƐͿ͕
ĂƌĞƚƌĞĂƚĞĚĂƐďĞŝŶŐƉĞƌĨŽƌŵĞĚŝŶƚŚĞhŶŝƚĞĚ<ŝŶŐĚŽŵ͕Žƌ/ĂŵŵĂƌƌŝĞĚƚŽĂƉĞƌƐŽŶǁŚŽƉĞƌĨŽƌŵƐƐƵĐŚĚƵƟĞƐ͘/ǁŝůůŝŶĨŽƌŵ
tĞĂůƚŚdĞŬ>>WŝĨ/ĐĞĂƐĞƚŽďĞƐŽƌĞƐŝĚĞŶƚĂŶĚŽƌĚŝŶĂƌŝůLJƌĞƐŝĚĞŶƚŽƌƚŽƉĞƌĨŽƌŵƐƵĐŚĚƵƟĞƐŽƌďĞŵĂƌƌŝĞĚƚŽĂƉĞƌƐŽŶǁŚŽ
ƉĞƌĨŽƌŵƐƐƵĐŚĚƵƟĞƐ͘
/ŚĞƌĞďLJĂƵƚŚŽƌŝƐĞtĞĂůƚŚdĞŬ>>WƉůĐƚŽ͗
ŝͿ KƉĞŶĂŶĚŽƉĞƌĂƚĞĂŶ/^ĂĐĐŽƵŶƚŽŶŵLJďĞŚĂůĨ͖
ŝŝͿ ,ŽůĚŵLJĐĂƐŚƐƵďƐĐƌŝƉƟŽŶ͕/^ŝŶǀĞƐƚŵĞŶƚƐ͕ŝŶƚĞƌĞƐƚ͕ĚŝǀŝĚĞŶĚƐĂŶĚĂŶLJŽƚŚĞƌƌŝŐŚƚƐŽƌƉƌŽĐĞĞĚƐŝŶƌĞƐƉĞĐƚŽĨƚŚŽƐĞ
ŝŶǀĞƐƚŵĞŶƚƐĂŶĚĂŶLJŽƚŚĞƌĐĂƐŚ͖ĂŶĚ
ŝŝŝͿDĂŬĞŽŶŵLJďĞŚĂůĨĂŶLJĐůĂŝŵƐƚŽƌĞůŝĞĨĨƌŽŵƚĂdžŝŶƌĞƐƉĞĐƚŽĨ/^ŝŶǀĞƐƚŵĞŶƚƐ͖
/ĂŐƌĞĞƚŽƚŚĞ/^ƚĞƌŵƐĂŶĚĐŽŶĚŝƟŽŶƐƉƌĞƐĞŶƚĞĚƚŽŵĞďLJtĞĂůƚŚdĞŬ>>W͘
/ĚĞĐůĂƌĞƚŚĂƚƚŚŝƐƉƉůŝĐĂƟŽŶ&ŽƌŵŚĂƐďĞĞŶĐŽŵƉůĞƚĞĚƚŽƚŚĞďĞƐƚŽĨŵLJŬŶŽǁůĞĚŐĞĂŶĚďĞůŝĞĨ͘

Applicant name
ƉƉůŝĐĂŶƚƐŝŐŶĂƚƵƌĞ;ŽƌƉŽǁĞƌŽĨĂƩŽƌŶĞLJͿ Date
STELLAR AIM ISA IHT SERVICE | 5
Ή t>d,>hd/>^

Registered name Wealth Club Limited Trading name Wealth Club

FCA reference no. 725176

Registered address ϮϬZŝĐŚŵŽŶĚ,ŝůů͕ƌŝƐƚŽů

Postcode BSϴ ϭ Telephone no. 0117 929 0511

ƵƚŚŽƌŝƐĂƟŽŶ FCA 

Ή ,Z'^

ŶŝŶǀĞƐƚŵĞŶƚǁŝƚŚtĞĂůƚŚůƵďŝƐĂŶŽŶͲĂĚǀŝƐĞĚ;ĞdžĞĐƵƟŽŶŽŶůLJͿŝŶǀĞƐƚŵĞŶƚ͘dŚĞĨŽůůŽǁŝŶŐĐŚĂƌŐĞƐǁŝůůĂƉƉůLJ͗
/ŶŝƟĂů&ĞĞƐ
• /ŶŝƟĂů&ĞĞϮй͕ĚŝƐĐŽƵŶƚĞĚƚŽϭйĨŽƌtĞĂůƚŚůƵďůŝĞŶƚƐ͘
ŶŶƵĂůĨĞĞƐ
• ŶŶƵĂůDĂŶĂŐĞŵĞŶƚĨĞĞϭй
• ^ĞƌǀŝĐĞĨĞĞϬ͘ϱй
• ĚŵŝŶŝƐƚƌĂƟŽŶĨĞĞϬ͘ϮϮϱй
ůůĂŶŶƵĂůĨĞĞƐĂƌĞƐƚĂƚĞĚŶĞƚŽĨsdĂŶĚĂƌĞďĂƐĞĚŽŶƚŚĞƉŽƌƞŽůŝŽEsĂƚƚŚĞĞŶĚŽĨƚŚĞƌĞůĞǀĂŶƚƋƵĂƌƚĞƌ͘
These fees are paid quarterly in arrears.
tĞĂůƚŚůƵďǁŝůůƌĞĐĞŝǀĞϳϱďƉƐŽĨƚŚĞϭйŝŶŝƟĂůĐŽŵŵŝƐƐŝŽŶĂŶĚϬ͘ϱйŽŶŐŽŝŶŐƚƌĂŝůĐŽŵŵŝƐƐŝŽŶ;ƉĂŝĚĨƌŽŵƚŚĞ
ƐĞƌǀŝĐĞĨĞĞͿĂƐƉĂƌƚŽĨƚŚĞŝƌĞŶŚĂŶĐĞĚƐĞƌǀŝĐĞƉƌŽƉŽƐŝƟŽŶ͘

Limited offer: £0 initial charge and up to £500 towards transfer cost

Until the end of the 2021/22 tax year – the Stellar AIM Inheritance Tax ISA is exclusively available through
Wealth Club with no initial charge (normally 2%). In addition, if you transfer AIM shares you hold
elsewhere (e.g. from another AIM IHT ISA) Stellar will pay transfer costs, capped at £500. For the period
of this offer, Wealth Club will receive no initial commission.

STELLAR AIM ISA IHT SERVICE | 6

E) DECLARATION
LJƚŚĞƉƉůŝĐĂŶƚ
LJƐŝŐŶŝŶŐƚŚŝƐĨŽƌŵ͕/ŚĞƌĞďLJĚĞĐůĂƌĞƚŚĂƚ͗
ĂͿ ůůŵŽŶŝĞƐŝŶǀĞƐƚĞĚŽƌƚŽďĞŝŶǀĞƐƚĞĚŝŶ^ƚĞůůĂƌ/D/^/ŶŚĞƌŝƚĂŶĐĞdĂdž^ĞƌǀŝĐĞďLJŵĞ͕ďĞůŽŶŐƚŽŵĞ͖
ďͿ /ĂŵϭϴLJĞĂƌƐŽĨĂŐĞŽƌŽǀĞƌ͖
ĐͿ dŽƚŚĞďĞƐƚŽĨŵLJŬŶŽǁůĞĚŐĞĂŶĚďĞůŝĞĨƚŚĞŝŶĨŽƌŵĂƟŽŶŝŶƚŚŝƐƉƉůŝĐĂƟŽŶ&ŽƌŵŝƐĐŽƌƌĞĐƚ͕ĂŶĚ/ǁŝůůŝŶĨŽƌŵ^ƚĞůůĂƌŝŵŵĞĚŝĂƚĞůLJ
ŽĨĂŶLJĐŚĂŶŐĞƚŚĂƚŵĂLJĂīĞĐƚƚŚŝƐŝŶĨŽƌŵĂƟŽŶ͖
ĚͿ /ĂŐƌĞĞƚŽĂůůŽĨƚŚĞƉƌŽǀŝƐŝŽŶƐŽĨƚŚĞ^ĞƌǀŝĐĞŐƌĞĞŵĞŶƚ;ŝŶĐůƵĚŝŶŐƚŚĞƚĞƌŵƐĂŶĚĐŽŶĚŝƟŽŶƐ͕ĨĞĞƐĂŶĚĂŶLJŽƚŚĞƌƐĐŚĞĚƵůĞƐ
ĐŽŶƚĂŝŶĞĚŝŶƚŚĞdĞƌŵƐĂŶĚ^ĞƌǀŝĐĞŐƌĞĞŵĞŶƚĂŶĚƚŚĞƌŽĐŚƵƌĞĚĂƚĞĚϭ:ƵŶĞϮϬϮϭ͕ĂƐĂŵĞŶĚĞĚĨƌŽŵƟŵĞƚŽƟŵĞ;ƚŽŐĞƚŚĞƌ
ƚŚĞ͚dĞƌŵƐĂŶĚŽŶĚŝƟŽŶƐ͛Ϳ͕ǁŚŝĐŚ/ŚĂǀĞĨƵůůLJƵŶĚĞƌƐƚŽŽĚĂŶĚ/ƵŶĚĞƌƐƚĂŶĚƚŚĂƚďLJƐŝŐŶŝŶŐĂŶĚĐŽŵƉůĞƟŶŐƚŚŝƐƉƉůŝĐĂƟŽŶ
&Žƌŵ͕/ƐŚĂůůďĞĚĞĞŵĞĚƚŽŚĂǀĞĞŶƚĞƌĞĚŝŶƚŽĂŶĚƐŚĂůůďĞďŽƵŶĚďLJƚŚĞdĞƌŵƐĂŶĚŽŶĚŝƟŽŶƐ͖
ĞͿ /ŚĂǀĞƌĞĂĚĂŶĚƵŶĚĞƌƐƚŽŽĚƚŚĞƚĞƌŵƐĂŶĚƚŚĞŬĞLJƌŝƐŬƐƐĞƚŽƵƚŝŶƚŚĞdĞƌŵƐĂŶĚŽŶĚŝƟŽŶƐ͖
ĨͿ /ƵŶĚĞƌƐƚĂŶĚƚŚĂƚLJŽƵǁŝůůƌĞůLJŽŶŵLJĐŽŶĮƌŵĂƟŽŶƚŚĂƚ/ŚĂǀĞƌĞĂĚƚŚĞdĞƌŵƐĂŶĚŽŶĚŝƟŽŶƐĂŶĚƚŚĂƚLJŽƵǁŝůů͕ĂĐĐŽƌĚŝŶŐůLJ͕
ƌĞůLJŽŶŝƚƐƚĞƌŵƐĂƐƚŚĞďĂƐŝƐŽĨƚŚĞƌĞůĂƟŽŶƐŚŝƉďĞƚǁĞĞŶƵƐ͖
g) /ĂŐƌĞĞƚŽƚŚĞƉƌŽǀŝƐŝŽŶƐŽĨƚŚĞdĞƌŵƐĂŶĚŽŶĚŝƟŽŶƐĂŶĚƚŚĞƉƌŝǀĂĐLJƉŽůŝĐLJŽĨƚŚĞĚŵŝŶŝƐƚƌĂƚŽƌ͕ĂĐŽƉLJŽĨǁŚŝĐŚŝƐĂǀĂŝůĂďůĞŽŶƌĞƋƵĞƐƚ͖
ŚͿ /ĂŐƌĞĞƚŽƚŚĞĐŚĂƌŐĞƐĂƐƐĞƚŽƵƚŝŶƐĞĐƟŽŶ͖
ŝͿ /ĐŽŶĮƌŵƚŚĂƚ/ĂŵŶŽƚĂh^ƉĞƌƐŽŶĨŽƌƚŚĞƉƵƌƉŽƐĞƐŽĨh^&ĞĚĞƌĂů/ŶĐŽŵĞdĂdžĂŶĚƚŚĂƚ/ĂŵŶŽƚĂĐƟŶŐĨŽƌ͕ŽƌŽŶďĞŚĂůĨŽĨĂh^
ƉĞƌƐŽŶ͘/ƵŶĚĞƌƐƚĂŶĚƚŚĂƚĂĨĂůƐĞƐƚĂƚĞŵĞŶƚŽƌŵŝƐƌĞƉƌĞƐĞŶƚĂƟŽŶŽĨƚĂdžƐƚĂƚƵƐďLJĂh^ƉĞƌƐŽŶĐŽƵůĚůĞĂĚƚŽƉĞŶĂůƟĞƐƵŶĚĞƌh^
ůĂǁ͘/ĂŐƌĞĞƚŚĂƚŝĨŵLJƚĂdžƐƚĂƚƵƐĐŚĂŶŐĞƐŽƌ/ďĞĐŽŵĞĂh^ĐŝƟnjĞŶŽƌĂh^ƌĞƐŝĚĞŶƚ͕/ǁŝůůŶŽƟĨLJLJŽƵǁŝƚŚŝŶϯϬĚĂLJƐ͖
ũͿ /ƵŶĚĞƌƚĂŬĞƚŽĂĚǀŝƐĞ^ƚĞůůĂƌǁŝƚŚŝŶϯϬĚĂLJƐŽĨĂŶLJĐŚĂŶŐĞŝŶĐŝƌĐƵŵƐƚĂŶĐĞƐǁŚŝĐŚĂīĞĐƚŵLJƚĂdžƌĞƐŝĚĞŶĐLJƐƚĂƚƵƐŽƌĐĂƵƐĞƐƚŚĞ
ŝŶĨŽƌŵĂƟŽŶĐŽŶƚĂŝŶĞĚŚĞƌĞŝŶƚŽďĞĐŽŵĞŝŶĐŽƌƌĞĐƚŽƌŝŶĐŽŵƉůĞƚĞ͖
ŬͿ /ĂĐŬŶŽǁůĞĚŐĞƚŚĂƚƚŚĞŝŶĨŽƌŵĂƟŽŶĐŽŶƚĂŝŶĞĚŝŶƚŚŝƐƉƉůŝĐĂƟŽŶ&ŽƌŵĂŶĚŝŶĨŽƌŵĂƟŽŶĂďŽƵƚŵĞŵĂLJďĞƉƌŽǀŝĚĞĚƚŽ,DZ
ĂŶĚĞdžĐŚĂŶŐĞĚǁŝƚŚƚŚĞƚĂdžĂƵƚŚŽƌŝƟĞƐŽĨĂŶŽƚŚĞƌĐŽƵŶƚƌLJŽƌĐŽƵŶƚƌŝĞƐŝŶǁŚŝĐŚƚŚĞĂƉƉůŝĐĂŶƚŵĂLJďĞƚĂdžƌĞƐŝĚĞŶƚƉƵƌƐƵĂŶƚƚŽ
ŝŶƚĞƌͲŐŽǀĞƌŶŵĞŶƚĂůĂŐƌĞĞŵĞŶƚƐƚŽĞdžĐŚĂŶŐĞĮŶĂŶĐŝĂůĂĐĐŽƵŶƚŝŶĨŽƌŵĂƟŽŶ͖
ůͿ /ĂƵƚŚŽƌŝƐĞ^ƚĞůůĂƌƚŽĂƌƌĂŶŐĞƐĂĨĞͲŬĞĞƉŝŶŐŽĨŵLJĐĂƐŚŝŶǀĞƐƚŵĞŶƚƐ͕ŝŶƚĞƌĞƐƚ͕ĚŝǀŝĚĞŶĚƐĂŶĚĂŶLJŽƚŚĞƌƌŝŐŚƚƐŽƌƉƌŽĐĞĞĚƐĨƌŽŵ
ƚŚŽƐĞŝŶǀĞƐƚŵĞŶƚƐĂŶĚĂŶLJŽƚŚĞƌĐĂƐŚ͖ĂŶĚ
m) I authorise Stellar to manage my investments in the Stellar AIM ISA Inheritance Tax Service in accordance with the
^ĞƌǀŝĐĞŐƌĞĞŵĞŶƚ͖
ŶͿ/ĐŽŶƐĞŶƚƚŽƉĞƌƐŽŶĂůŝŶĨŽƌŵĂƟŽŶŽďƚĂŝŶĞĚŝŶƌĞůĂƟŽŶƚŽŵLJƉŽƌƞŽůŝŽďĞŝŶŐŚĂŶĚůĞĚďLJ^ƚĞůůĂƌƐƐĞƚDĂŶĂŐĞŵĞŶƚ>ŝŵŝƚĞĚĂŶĚ
ƚŚĞŝƌĚĞůĞŐĂƚĞƐ͕ĂŐĞŶƚƐŽƌĂƐƐŽĐŝĂƚĞƐŝŶĂĐĐŽƌĚĂŶĐĞǁŝƚŚƚŚŝƐĂƉƉůŝĐĂƟŽŶĂŶĚĚĂƚĂƉƌŽƚĞĐƟŽŶůĞŐŝƐůĂƟŽŶŝŶĨŽƌĐĞŝŶƚŚĞhŶŝƚĞĚ
<ŝŶŐĚŽŵĨƌŽŵƟŵĞƚŽƟŵĞ͘/ŶĨŽƌŵĂƟŽŶŝŶƌĞůĂƟŽŶƚŽŵĞǁŝůůďĞŚĞůĚ͕ƵƐĞĚ͕ĚŝƐĐůŽƐĞĚĂŶĚƉƌŽĐĞƐƐĞĚĨŽƌƚŚĞƉƵƌƉŽƐĞƐŽĨ
 ŝͿŵĂŶĂŐŝŶŐĂŶĚĂĚŵŝŶŝƐƚĞƌŝŶŐŵLJƉŽƌƞŽůŝŽĂŶĚĂŶLJƌĞůĂƚĞĚĂĐĐŽƵŶƚŽŶĂŶŽŶͲŐŽŝŶŐďĂƐŝƐ͖
 ŝŝͿĨŽƌĂŶLJŽƚŚĞƌƐƉĞĐŝĮĐƉƵƌƉŽƐĞǁŚĞƌĞ/ŚĂǀĞŐŝǀĞŶƐƉĞĐŝĮĐĐŽŶƐĞŶƚƚŽĚŽƐŽ͖
 ŝŝŝͿƚŽĐĂƌƌLJŽƵƚƐƚĂƟƐƟĐĂůĂŶĂůLJƐŝƐĂŶĚŵĂƌŬĞƚƌĞƐĞĂƌĐŚ͖
 ŝǀͿƚŽĐŽŵƉůLJǁŝƚŚĂŶLJĂƉƉůŝĐĂďůĞůĞŐĂůŽƌƌĞŐƵůĂƚŽƌLJŽďůŝŐĂƟŽŶƐŝŶĐůƵĚŝŶŐĐŽŵƉĂŶLJůĂǁŽďůŝŐĂƟŽŶƐĂŶĚĂŶƟͲŵŽŶĞLJůĂƵŶĚĞƌŝŶŐ
ůĞŐŝƐůĂƟŽŶĂŶĚƌƵůĞƐ͖ĂŶĚ
 ǀͿĨŽƌŽƚŚĞƌůĞŐŝƟŵĂƚĞďƵƐŝŶĞƐƐŝŶƚĞƌĞƐƚƐŽĨŵLJƉŽƌƞŽůŝŽ͘

Applicant name
ƉƉůŝĐĂŶƚƐŝŐŶĂƚƵƌĞ;ŽƌƉŽǁĞƌŽĨĂƩŽƌŶĞLJͿ
Date

LJtĞĂůƚŚůƵď
LJƐŝŐŶŝŶŐƚŚŝƐĨŽƌŵ͕tĞĂůƚŚůƵďĂŐƌĞĞƚŚĂƚ͗
ĂͿ tĞĂůƚŚůƵďŝƐĂƵƚŚŽƌŝƐĞĚĂŶĚƌĞŐƵůĂƚĞĚďLJdŚĞ&ŝŶĂŶĐŝĂůŽŶĚƵĐƚƵƚŚŽƌŝƚLJƚŽƚƌĂŶƐĂĐƚŝŶǀĞƐƚŵĞŶƚƐŝŶƚŚĞh<͖
ďͿ tĞĂůƚŚůƵďĐŽŶƐĞŶƚƚŽ^ƚĞůůĂƌĂŶĚƚŚĞĚŵŝŶŝƐƚƌĂƚŽƌƉůĂĐŝŶŐƌĞůŝĂŶĐĞŽŶĐĂƌƌLJŝŶŐŽƵƚǀĞƌŝĮĐĂƟŽŶĐŚĞĐŬƐŝŶůŝŶĞǁŝƚŚƚŚĞDŽŶĞLJ
>ĂƵŶĚĞƌŝŶŐ͕dĞƌƌŽƌŝƐƚ&ŝŶĂŶĐŝŶŐĂŶĚdƌĂŶƐĨĞƌŽĨ&ƵŶĚƐ;/ŶĨŽƌŵĂƟŽŶŽŶƚŚĞWĂLJĞƌͿZĞŐƵůĂƟŽŶƐϮϬϭϳĂŶĚ:D>^''ƵŝĚĂŶĐĞ
;͚DŽŶĞLJ>ĂƵŶĚĞƌŝŶŐZĞŐƵůĂƟŽŶƐ͛Ϳ͕ĂƐĂŵĞŶĚĞĚ͖
ĐͿ tĞĂůƚŚůƵďŚĂƐĐŽŵƉůŝĞĚǁŝƚŚƚŚĞƌĞƋƵŝƌĞŵĞŶƚƐŽĨƚŚĞDŽŶĞLJ>ĂƵŶĚĞƌŝŶŐZĞŐƵůĂƟŽŶƐĐƵƌƌĞŶƚůLJŝŶĨŽƌĐĞĂŶĚŚĂƐĚƵůLJ
ĐŽŵƉůĞƚĞĚƚŚĞĂƩĂĐŚĞĚŽŶĮƌŵĂƟŽŶŽĨsĞƌŝĮĐĂƟŽŶŽĨ/ĚĞŶƟƚLJ;Ks/ͿĂŌĞƌĐĂƌƌLJŝŶŐŽƵƚƚŚĞŝĚĞŶƟĮĐĂƟŽŶĂŶĚǀĞƌŝĮĐĂƟŽŶ
ĐŚĞĐŬƐƚŽĞƐƚĂďůŝƐŚƚŚĞŝĚĞŶƟƚLJŽĨƚŚĞĂƉƉůŝĐĂŶƚ͖
d) Wealth Club has understood and agrees to be bound by the Stellar Terms of Business for Intermerdiaries.

Wealth Club name Sheridan Leech

Wealth Club signature
Date

STELLAR AIM ISA IHT SERVICE | 7

&ͿKE&/ZDd/KEK&sZ/&/d/KEK&/Ed/dz;Ks/Ϳ

ϭ͘dŚĞĂƉƉůŝĐĂŶƚ͛ƐĚĞƚĂŝůƐ;ƐĞĞŶŽƚĞƐďĞůŽǁͿ
Applicant full name

Current address

Postcode

WƌĞǀŝŽƵƐĂĚĚƌĞƐƐ;ŝĨĐŚĂŶŐĞĚ
in the last three years)

Postcode Date of birth

Tick Ϯ͘ŽŶĮƌŵĂƟŽŶ

/ͬǁĞĐŽŶĮƌŵƚŚĂƚ͗
ŝ͘dŚĞŝŶĨŽƌŵĂƟŽŶŝŶƐĞĐƟŽŶϭ͕ĂďŽǀĞ͕ǁĂƐŽďƚĂŝŶĞĚďLJŵĞͬƵƐŝŶƌĞůĂƟŽŶƚŽƚŚĞĂƉƉůŝĐĂŶƚ͖
ŝŝ͘dŚĞĂƉƉůŝĐĂŶƚŶĂŵĞĚŝŶƐĞĐƟŽŶϭŝƐĂĐƟŶŐŽŶŚŝƐŽƌŚĞƌŽǁŶďĞŚĂůĨ͖
iii The applicant is
Ă͘ŶŽƚĂWW;WŽůŝƟĐĂůůLJdžƉŽƐĞĚWĞƌƐŽŶͿŽƌĂƉĞƌƐŽŶŬŶŽǁŶƚŽďĞĂĐůŽƐĞĂƐƐŽĐŝĂƚĞŽĨĂWW͖
ď͘ĂWWŽƌĂƉĞƌƐŽŶŬŶŽǁŶƚŽďĞĂĐůŽƐĞĂƐƐŽĐŝĂƚĞŽĨĂWW͖
ŝǀ͘dŚĞƌĞĂƌĞƉƌŽĐĞĚƵƌĞƐŝŶƉůĂĐĞƚŽŵŽŶŝƚŽƌƚŚĞĂĐƟǀŝƟĞƐŽĨƚŚĞĂƉƉůŝĐĂŶƚĂŶĚǁĞǁŝůůƌĞƉŽƌƚĂŶLJƐƵƐƉŝ-
ĐŝŽƵƐĂĐƟǀŝƟĞƐƚŽƚŚĞĂƉƉƌŽƉƌŝĂƚĞĂƵƚŚŽƌŝƟĞƐ͕ĂŶĚǁŚĞƌĞĂƉƉƌŽƉƌŝĂƚĞƚŽ^ƚĞůůĂƌƐƐĞƚDĂŶĂŐĞŵĞŶƚ
>ŝŵŝƚĞĚ;^ƚĞůůĂƌͿĂŶĚtĞĂůƚŚdĞŬ>>W;tĞĂůƚŚdĞŬͿ͖ĂŶĚ
ǀ͘dŚĞĞǀŝĚĞŶĐĞ/ͬǁĞŚĂǀĞŽďƚĂŝŶĞĚƚŽǀĞƌŝĨLJƚŚĞŝĚĞŶƟƚLJŽĨƚŚĞĂƉƉůŝĐĂŶƚ͗
Ă͘ŵĞĞƚƐƚŚĞŐƵŝĚĂŶĐĞĨŽƌƐƚĂŶĚĂƌĚĞǀŝĚĞŶĐĞƌĞƋƵŝƌĞĚďLJƚŚĞ&͕ƚŚĞĐƵƌƌĞŶƚŐƵŝĚĂŶĐĞŝƐƐƵĞĚďLJ
:D>^'ĂŶĚƚŚĞDŽŶĞLJ>ĂƵŶĚĞƌŝŶŐZĞŐƵůĂƟŽŶƐ͖OR
ď͘ĞdžĐĞĞĚƐƚŚĞƐƚĂŶĚĂƌĚĞǀŝĚĞŶĐĞƌĞƋƵŝƌĞĚďLJƚŚĞ&͕ƚŚĞĐƵƌƌĞŶƚŐƵŝĚĂŶĐĞŝƐƐƵĞĚďLJ:D>^'ĂŶĚ
ƚŚĞDŽŶĞLJ>ĂƵŶĚĞƌŝŶŐZĞŐƵůĂƟŽŶƐ;ǁƌŝƩĞŶĚĞƚĂŝůƐŽĨƚŚĞĨƵƌƚŚĞƌǀĞƌŝĮĐĂƟŽŶĞǀŝĚĞŶĐĞƚĂŬĞŶĂƌĞ
ĂƩĂĐŚĞĚƚŽƚŚŝƐĐŽŶĮƌŵĂƟŽŶͿ͘
vi. I/We agree to Stellar and WealthTek LLP placing reliance on me to carry out the appropriate level of
due diligence on the applicant.
ǀŝŝ͘/ͬtĞǁŝůůƉƌŽǀŝĚĞŝŵŵĞĚŝĂƚĞůLJŽŶƌĞƋƵĞƐƚĨƌŽŵ^ƚĞůůĂƌĂŶĚͬŽƌtĞĂůƚŚdĞŬ>>W;ŽƌĂƚƚŚĞůĂƚĞƐƚǁŝƚŚŝŶƚǁŽ
ǁŽƌŬŝŶŐĚĂLJƐͿĐŽƉŝĞƐŽĨĂŶLJŝĚĞŶƟĮĐĂƟŽŶĂŶĚǀĞƌŝĮĐĂƟŽŶĚĂƚĂĂŶĚĂŶLJŽƚŚĞƌƌĞůĞǀĂŶƚĚŽĐƵŵĞŶƚĂƟŽŶ
ŽŶƚŚĞŝĚĞŶƟƚLJŽĨƚŚĞĂƉƉůŝĐĂŶƚŽƌǁŚĞƌĞĂƉƉůŝĐĂďůĞƚŚĞďĞŶĞĮĐŝĂůŽǁŶĞƌ͖
viii. I/We will retain copies of the data and documents referred to above for six years beginning on
ƚŚĞĚĂƚĞŽĨƚŚŝƐĐĞƌƟĮĐĂƚĞ͖
ŝdž͘ /ĂŵͬtĞĂƌĞŶŽƚƐƵďũĞĐƚƚŽĂŶLJĚŝƐĐŝƉůŝŶĂƌLJĂĐƟŽŶŽƌĞŶƋƵŝƌLJĨƌŽŵƚŚĞ&ŽƌĂŶLJŽƚŚĞƌƌĞŐƵůĂƚŽƌ
ŶŽƌĚŽǁĞŬŶŽǁŽĨĂŶLJƌĞĂƐŽŶĨŽƌƚŚĞŝŶƐƟƚƵƟŽŶŽĨƐƵĐŚĞŶƋƵŝƌLJ͘

STELLAR AIM ISA IHT SERVICE | 8

 ϯ͘ ĞƚĂŝůƐŽĨŝŶƚƌŽĚƵĐŝŶŐĮƌŵ;ŽƌƐŽůĞƚƌĂĚĞƌͿ
&ƵůůŶĂŵĞŽĨƌĞŐƵůĂƚĞĚĮƌŵͬ
Wealth Club Limited
sole trader
&ƌĞĨĞƌĞŶĐĞŶƵŵďĞƌ;&ZEͿ 725176

Signed

Name Sheridan Leech

WŽƐŝƟŽŶ Client Service Director

Date
1. ƐĞƉĂƌĂƚĞĐŽŶĮƌŵĂƟŽŶŝƐƚŽďĞĐŽŵƉůĞƚĞĚĨŽƌĞĂĐŚĂƉƉůŝĐĂŶƚ;Ğ͘Ő͘ũŽŝŶƚŚŽůĚĞƌƐŽƌƚƌƵƐƚĞĞƐͿ͘tŚĞƌĞĂƚŚŝƌĚƉĂƌƚLJŝƐŝŶǀŽůǀĞĚ͕Ğ͘Ő͘ĂƉĂLJĞƌŽĨĐŽŶƚƌŝďƵƟŽŶƐ
ǁŚŽŝƐĚŝīĞƌĞŶƚĨƌŽŵƚŚĞĂƉƉůŝĐĂŶƚ͕ƚŚĞŝĚĞŶƟƚLJŽĨƚŚĂƚƉĞƌƐŽŶŵƵƐƚĂůƐŽďĞǀĞƌŝĮĞĚ͕ĂŶĚĂĐŽŶĮƌŵĂƟŽŶƉƌŽǀŝĚĞĚ͘
2. dŚŝƐĨŽƌŵĐĂŶŶŽƚďĞƵƐĞĚƚŽǀĞƌŝĨLJƚŚĞŝĚĞŶƟƚLJŽĨĂŶLJĂƉƉůŝĐĂŶƚƚŚĂƚĨĂůůƐŝŶƚŽŽŶĞŽĨƚŚĞĨŽůůŽǁŝŶŐĐĂƚĞŐŽƌŝĞƐ͗
ͻdŚŽƐĞĞdžĞŵƉƚĨƌŽŵǀĞƌŝĮĐĂƟŽŶĂƐďĞŝŶŐĂŶĞdžŝƐƟŶŐĐůŝĞŶƚŽĨƚŚĞŝŶƚƌŽĚƵĐŝŶŐĮƌŵƉƌŝŽƌƚŽƚŚĞŝŶƚƌŽĚƵĐƟŽŶŽĨƚŚĞƌĞƋƵŝƌĞŵĞŶƚĨŽƌƐƵĐŚǀĞƌŝĮĐĂƟŽŶ͖
ͻdŚŽƐĞǁŚŽƐĞŝĚĞŶƟƚLJŚĂƐŶŽƚďĞĞŶǀĞƌŝĮĞĚďLJǀŝƌƚƵĞŽĨƚŚĞĂƉƉůŝĐĂƟŽŶŽĨĂƉĞƌŵŝƩĞĚĞdžĞŵƉƟŽŶƵŶĚĞƌƚŚĞDŽŶĞLJ>ĂƵŶĚĞƌŝŶŐZĞŐƵůĂƟŽŶƐ͖
ͻdŚŽƐĞǁŚŽŚĂǀĞďĞĞŶƐƵďũĞĐƚƚŽ^ŝŵƉůŝĮĞĚƵĞŝůŝŐĞŶĐĞƵŶĚĞƌƚŚĞDŽŶĞLJ>ĂƵŶĚĞƌŝŶŐZĞŐƵůĂƟŽŶƐ͖Žƌ
ͻdŚŽƐĞǁŚŽƐĞŝĚĞŶƟƚLJŚĂƐďĞĞŶǀĞƌŝĮĞĚƵƐŝŶŐƚŚĞƐŽƵƌĐĞŽĨĨƵŶĚƐĂƐĞǀŝĚĞŶĐĞ͘

STELLAR AIM ISA IHT SERVICE | 9

SUITABILITY QUESTIONNAIRE

WůĞĂƐĞŶŽƚĞƚŚŝƐƋƵĞƐƚŝŽŶŶĂŝƌĞĐŽŶƚĂŝŶƐŝŶƚĞƌĂĐƚŝǀĞďŽdžĞƐ͕ƚŽŚĞůƉLJŽƵĨŝůůŝŶƚŚĞĨŽƌŵŽŶůŝŶĞ͘
You have the choice of either filling in this questionnaire online or on hard copy. In order
to use this functionality please download and open the form in the latest version of Adobe
Acrobat. You must print and sign a hard copy of this questionnaire.

/ŶǀĞƐƚŵĞŶƚKďũĞĐƟǀĞ
dŚĞƐĞƌǀŝĐĞŝƐĚĞƐŝŐŶĞĚƚŽƉƌŽǀŝĚĞŝŶǀĞƐƚŽƌƐǁŝƚŚĂĐĐĞƐƐƚŽĂƉŽƌƞŽůŝŽŽĨŝŶǀĞƐƚŵĞŶƚƐŝŶ/DĐŽŵƉĂŶŝĞƐ͕ǁŚŝĐŚ
ƋƵĂůŝĨLJĨŽƌ/,dďĞŶĞĮƚƐĂŶĚŚĂǀĞƚŚĞƉŽƚĞŶƟĂůĨŽƌĐĂƉŝƚĂůĂƉƉƌĞĐŝĂƟŽŶ͘dŚĞŝŶǀĞƐƚŵĞŶƚŝƐĚĞƐŝŐŶĞĚƚŽďĞŚĞůĚ
ĨŽƌƚŚĞŵĞĚŝƵŵƚŽůŽŶŐƚĞƌŵďĞĐĂƵƐĞŝŶǀĞƐƚŵĞŶƚƐŝŶ/DĐŽŵƉĂŶŝĞƐŵƵƐƚďĞŚĞůĚĨŽƌĂƚůĞĂƐƚƚǁŽLJĞĂƌƐ;ĂŶĚĂƚ
ĚĞĂƚŚͿŝŶŽƌĚĞƌƚŽďĞŶĞĮƚƌĞůŝĞĨĨƌŽŵ/,d͘/ŶǀĞƐƚŵĞŶƚƐŝŶ/DĐŽŵƉĂŶŝĞƐĂƌĞŚŝŐŚĞƌƌŝƐŬƚŚĂŶƐŚĂƌĞƐƋƵŽƚĞĚŽŶƚŚĞ
main market of the London Stock Exchange.

/Es^dKZd/>^

Title

&ŽƌĞŶĂŵĞ;ƐͿ

Surname

Date of birth EĂƟŽŶĂůŝŶƐƵƌĂŶĐĞŶŽ͘

IHT TAX RELIEF

The service may not be an appropriate investment if you cannot take advantage of relief from IHT.

ŽLJŽƵŚĂǀĞĂĐŚĂƌŐĞĂďůĞĞƐƚĂƚĞŐƌĞĂƚĞƌƚŚĂŶάϯϮϱ͕ϬϬϬ͍ Yes No

ƌĞLJŽƵƐĞĞŬŝŶŐƚŽďĞŶĞĮƚĨƌŽŵŝŶŚĞƌŝƚĂŶĐĞƚĂdžƌĞůŝĞĨ͍
Yes No
;ĂŌĞƌƚǁŽLJĞĂƌƐĨƌŽŵƚŚĞĚĂƚĞŽĨƚŚĞƵŶĚĞƌůLJŝŶŐŝŶǀĞƐƚŵĞŶƚƐͿ

Are you aware that we cannot guarantee this investment will

ƋƵĂůŝĨLJĨŽƌ/,dƌĞůŝĞĨĂŶĚƚŚĂƚƚĂdžůĞŐŝƐůĂƟŽŶĐŽƵůĚĐŚĂŶŐĞŝŶƚŚĞ
Yes No
ĨƵƚƵƌĞ͕ǁŚŝĐŚŵĂLJĐĂƵƐĞƚŚŝƐŝŶǀĞƐƚŵĞŶƚƚŽŶŽůŽŶŐĞƌƋƵĂůŝĨLJ
ĨŽƌƚŚĞƌĞůĞǀĂŶƚƌĞůŝĞĨƐ͍

STELLAR AIM ISA IHT SERVICE | 10

KNOWLEDGE AND UNDERSTANDING

,ĂǀĞLJŽƵŝŶǀĞƐƚĞĚŝŶƚŚĞ^ƚĞůůĂƌ/D/^/,d^ĞƌǀŝĐĞďĞĨŽƌĞ͍ Yes No
,ĂǀĞLJŽƵƌĞĐĞŝǀĞĚĂŶLJƐƉĞĐŝĮĐŝŶǀĞƐƚŵĞŶƚĂĚǀŝĐĞ͍
Yes No
;Ğ͘Ő͘ĨƌŽŵĂƌĞŐƵůĂƚĞĚŝŶƚĞƌŵĞĚŝĂƌLJͬƚĂdžƐƉĞĐŝĂůŝƐƚͿ͘
džĐůƵĚŝŶŐƚŚŝƐĂƉƉůŝĐĂƟŽŶ͕ƉůĞĂƐĞĐŽŶĮƌŵǁŚŝĐŚŽĨƚŚĞĨŽůůŽǁŝŶŐŝŶǀĞƐƚŵĞŶƚƐLJŽƵ͛ǀĞŵĂĚĞǁŝƚŚŝŶ
ƚŚĞůĂƐƚĮǀĞLJĞĂƌƐ͘
dĂdžƉƌŽĚƵĐƚƐ;Ğ͘Ő͘sdƐ͕/^Ɛ͕ƵƐŝŶĞƐƐZĞůŝĞĨͿ

/ŶǀĞƐƚŵĞŶƚŝŶĂŶƵŶƋƵŽƚĞĚĐŽŵƉĂŶLJĚŝƌĞĐƚůLJŽƌƚŚƌŽƵŐŚĂŶĞƚǁŽƌŬŽƌƐLJŶĚŝĐĂƚĞ͍

AIM listed or other smaller quoted companies

KŶĂǀĞƌĂŐĞ͕ŚŽǁŵƵĐŚĚŽLJŽƵŝŶǀĞƐƚŝŶƚŚĞƐĞƚLJƉĞƐŽĨŝŶǀĞƐƚŵĞŶƚƐĞĂĐŚLJĞĂƌ͍
>ĞƐƐƚŚĂŶάϱ͕ϬϬϬ άϱ͕ϬϬϭͲάϮϱ͕ϬϬϬ άϮϱ͕ϬϬϭͲάϱϬ͕ϬϬϬ
άϱϬ͕ϬϬϭͲάϭϬϬ͕ϬϬϬ DŽƌĞƚŚĂŶάϭϬϬ͕ϬϬϬ
ŽLJŽƵŚŽůĚĂƉƌŽĨĞƐƐŝŽŶĂůĮŶĂŶĐŝĂůƋƵĂůŝĮĐĂƟŽŶ͍
Yes No
;Ğ͘Ő͕͕͘ŽƌĞƋƵŝǀĂůĞŶƚͿ
ŽLJŽƵ͕ŽƌŚĂǀĞLJŽƵĞǀĞƌ͕ŚĂĚĂƉƌŽĨĞƐƐŝŽŶĂůƌŽůĞŝŶĮŶĂŶĐŝĂů
ƐĞƌǀŝĐĞƐ͍;Ğ͘Ő͘ĮŶĂŶĐĞĚŝƌĞĐƚŽƌ͕ĮŶĂŶĐŝĂůĂĚǀŝƐĞƌ͕ĂĐĐŽƵŶƚĂŶƚ Yes No
or investment manager)

FINANCIAL SITUATION

/ƚƐŝŵƉŽƌƚĂŶƚƚŚĂƚLJŽƵŚĂǀĞƐƵĸĐŝĞŶƚĐĂƐŚƌĞƐĞƌǀĞƐŽƌůŝƋƵŝĚĂƐƐĞƚƐƚŽŵĂŝŶƚĂŝŶLJŽƵƌƐƚĂŶĚĂƌĚŽĨůŝǀŝŶŐƐŚŽƵůĚƚŚĞ
value of the investment fall. IHT investments are designed to be held for the medium to long term.
WůĞĂƐĞŝŶĚŝĐĂƚĞƚŚĞĂƉƉƌŽdžŝŵĂƚĞǀĂůƵĞŽĨLJŽƵƌŶĞƚŝŶǀĞƐƚĂďůĞĂƐƐĞƚƐ;ƚŚŝƐƐŚŽƵůĚŶŽƚŝŶĐůƵĚĞƚŚĞǀĂůƵĞŽĨLJŽƵƌŚŽŵĞ
ŽƌƉĞŶƐŝŽŶĂŶĚLJŽƵƐŚŽƵůĚĚĞĚƵĐƚƚŚĞǀĂůƵĞŽƌĂŶLJŽƵƚƐƚĂŶĚŝŶŐůŽĂŶƐͿ͗
>ĞƐƐƚŚĂŶάϭϱϬ͕ϬϬϬ άϭϱϬ͕ϬϬϭͲάϮϱϬ͕ϬϬϬ άϮϱϬ͕ϬϬϭͲάϱϬϬ͕ϬϬϬ
άϱϬϬ͕ϬϬϭͲάϭŵŝůůŝŽŶ άϭ͕ϬϬϬ͕ϬϬϭͲάϮŵŝůůŝŽŶ More than £2 million
ŽLJŽƵŚĂǀĞĂŶLJƐŝŐŶŝĮĐĂŶƚĐĂƉŝƚĂůĐŽŵŵŝƚŵĞŶƚƐǁŚŝĐŚĐĂŶŶŽƚ
Yes No
ďĞĨƵŶĚĞĚĨƌŽŵLJŽƵƌĂŶŶƵĂůĚŝƐƉŽƐĂďůĞŝŶĐŽŵĞŽƌůŝƋƵŝĚƐĂǀŝŶŐƐ͍
/ĨLJŽƵĂŶƐǁĞƌĞĚ͚LJĞƐ͛ƚŽƚŚŝƐƋƵĞƐƟŽŶ͕ƉůĞĂƐĞĐŽŶĮƌŵŚŽǁƚŚŝƐĐŽŵŵŝƚŵĞŶƚǁŝůůďĞĨƵŶĚĞĚďĞůŽǁ͘

ŽLJŽƵĂŶƟĐŝƉĂƚĞĂŶLJƐŝŐŶŝĮĐĂŶƚĐŚĂŶŐĞƐƚŽLJŽƵƌĮŶĂŶĐŝĂů
ƐŝƚƵĂƟŽŶŽǀĞƌƚŚĞŝŶǀĞƐƚŵĞŶƚƉĞƌŝŽĚƚŚĂƚŵŝŐŚƚĂīĞĐƚLJŽƵƌ Yes No
ĚĞĐŝƐŝŽŶƚŽŝŶǀĞƐƚ͍
/ĨLJŽƵĂŶƐǁĞƌĞĚ͚LJĞƐ͛ƚŽƚŚŝƐƋƵĞƐƟŽŶ͕ƉůĞĂƐĞƉƌŽǀŝĚĞĨƵƌƚŚĞƌĚĞƚĂŝůƐďĞůŽǁ͘

/ĨLJŽƵǁĞƌĞƚŽůŽƐĞƚŚĞĞŶƟƌĞĂŵŽƵŶƚLJŽƵƉƌŽƉŽƐĞƚŽŝŶǀĞƐƚ
in the Stellar AIM IHT Service would your ability to meet your Yes No
ƌĞŐƵůĂƌĮŶĂŶĐŝĂůĐŽŵŵŝƚŵĞŶƚƐďĞŝŵƉĞĚĞĚ͍
ŽLJŽƵŚĂǀĞƐƵĸĐŝĞŶƚĂƐƐĞƚƐĂŶĚͬŽƌŝŶĐŽŵĞƚŽĂīŽƌĚĨŽƌƚŚŝƐ
ŝŶǀĞƐƚŵĞŶƚƚŽďĞƟĞĚƵƉĨŽƌƚŚĞŵĞĚŝƵŵƚŽůŽŶŐƚĞƌŵ;ŵŽƌĞ Yes No
ƚŚĂŶĮǀĞLJĞĂƌƐͿ͍

STELLAR AIM ISA IHT SERVICE | 11

RISK TOLERANCE AND CAPITAL LOSS

WůĞĂƐĞƌĞĂĚƚŚĞŝŶĨŽƌŵĂƟŽŶďĞůŽǁĂŶĚƌĂƚĞŚŽǁƐƚƌŽŶŐůLJLJŽƵĂŐƌĞĞǁŝƚŚƚŚĞĨŽůůŽǁŝŶŐƐƚĂƚĞŵĞŶƚƐ͘
dŚŝƐŝŶǀĞƐƚŵĞŶƚǁŝůůďĞŵĂĚĞŝŶƚŽĂƉŽƌƞŽůŝŽŽĨ/DͲƋƵŽƚĞĚĐŽŵƉĂŶŝĞƐ͘/DĐŽŵƉĂŶŝĞƐĂƌĞŚŝŐŚĞƌƌŝƐŬƚŚĂŶ
shares quoted on the main market of the London Stock Exchange and investors should understand that they
might fall or rise in value more sharply than those listed on the main market of the London Stock Exchange.
ƐƐƵĐŚ͕ƚŚŝƐŝŶǀĞƐƚŵĞŶƚǁŽƵůĚŶŽƚďĞĞdžƉĞĐƚĞĚƚŽĂƉƉĞĂůƚŽĐĂƵƟŽƵƐŝŶǀĞƐƚŽƌƐǁŚŽǁŽƵůĚƉƌĞĨĞƌƚŽƚĂŬĞůĞƐƐƌŝƐŬ
with their wealth.
/ǁŽƵůĚĚĞƐĐƌŝďĞŵLJƐĞůĨĂƐĂĐĂƵƟŽƵƐŝŶǀĞƐƚŽƌ͘ ůĂŵǁŝůůŝŶŐƚŽĂĐĐĞƉƚƚŚĞƌŝƐŬŽĨƐŝŐŶŝĮĐĂŶƚĨĂůůƐŝŶǀĂůƵĞ͘
Strongly disagree Strongly disagree
Disagree Disagree
Neither agree nor disagree Neither agree nor disagree
Agree Agree
Strongly agree Strongly agree

/ĂŵŚĂƉƉLJƚŽĂĐĐĞƉƚĂŚŝŐŚůĞǀĞůŽĨƌŝƐŬƚŽŵLJĐĂƉŝƚĂů͕ŬŶŽǁŝŶŐƚŚĂƚƚŚŝƐŝŶǀĞƐƚŵĞŶƚĂŝŵƐƚŽƋƵĂůŝĨLJĨŽƌ/,dƚĂdžƌĞůŝĞĨƐ͘

Strongly disagree Agree

Disagree Strongly agree
Neither agree nor disagree

CONFIRMATIONS

WůĞĂƐĞƟĐŬƚŚĞĨŽůůŽǁŝŶŐďŽdžĞƐƚŽĐŽŶĮƌŵƚŚĂƚLJŽƵ͗
hŶĚĞƌƐƚĂŶĚƚŚĞŚŝŐŚͲƌŝƐŬŝŶǀĞƐƚŵĞŶƚŽďũĞĐƟǀĞƐŽĨƚŚĞƐĞƌǀŝĐĞ;ŝŶĐůƵĚŝŶŐƚŚĞƌŝƐŬĨĂĐƚŽƌƐĚĞƚĂŝůĞĚŝŶƚŚĞ
ƉƌŽĚƵĐƚůŝƚĞƌĂƚƵƌĞͿĂŶĚƚŚĂƚƚŚĞƐĞĂƌĞĐŽŶƐŝƐƚĞŶƚǁŝƚŚLJŽƵƌƉĞƌƐŽŶĂůĮŶĂŶĐŝĂůŽďũĞĐƟǀĞƐ͘
tŝůůŶŽƚŶĞĞĚŝŶĐŽŵĞĨƌŽŵ͕ŽƌĂĐĐĞƐƐƚŽ͕ƚŚĞĐĂƉŝƚĂůŝŶǀĞƐƚĞĚĂƐƚŚĞŶĂƚƵƌĞŽĨƚŚĞŝŶǀĞƐƚŵĞŶƚƌĞƋƵŝƌĞƐLJŽƵ
ƚŽŚŽůĚƚŚĞĂƐƐĞƚƐĨŽƌĂŵŝŶŝŵƵŵŽĨƚǁŽLJĞĂƌƐĂŶĚĂƚĚĞĂƚŚƚŽďĞŶĞĮƚĨƌŽŵƚŚĞ/,dƌĞůŝĞĨ͘

/Es^dKZ>Zd/KE

LJƐŝŐŶŝŶŐďĞůŽǁLJŽƵĐŽŶĮƌŵƚŚĂƚLJŽƵŚĂǀĞƉƌŽǀŝĚĞĚĨƵůůĂŶĚĂĐĐƵƌĂƚĞŝŶĨŽƌŵĂƟŽŶŽŶLJŽƵƌƉĞƌƐŽŶĂůĂŶĚĮŶĂŶĐŝĂů
ĐŝƌĐƵŵƐƚĂŶĐĞƐĂƐĂƚƚŚĞĚĂƚĞŽĨƚŚĞƐŝŐŶĂƚƵƌĞďĞůŽǁĂŶĚĂŐƌĞĞƚŽŶŽƟĨLJ^ƚĞůůĂƌŝŶǁƌŝƟŶŐŝŵŵĞĚŝĂƚĞůLJŝĨƚŚŝƐĐŚĂŶŐĞƐ͘

Investor signature &ŽƌĞŶĂŵĞ;ƐͿ

Surname
;WůĞĂƐĞƉƌŝŶƚͿ

Date

WŽǁĞƌŽĨĂƩŽƌŶĞLJƐŝŐŶĂƚƵƌĞ;ŝĨĂƉƉůŝĐĂďůĞͿ &ŽƌĞŶĂŵĞ;ƐͿ
Surname
;WůĞĂƐĞƉƌŝŶƚͿ

Date

STELLAR AIM ISA IHT SERVICE | 12

Please note this Application Form contains interactive boxes, to help you fill in the form
online. You have the choice of either filling in this Application Form online or on hard copy.
In order to use this functionality please download and open the form in the latest version
of Adobe Acrobat. You must print and sign a hard copy of this Application Form.

ISA TRANSFER FORM

dŚŝƐĨŽƌŵŝƐĨŽƌĂŶŝŶǀĞƐƚŵĞŶƚŝŶ^ƚĞůůĂƌ/D/ŶŚĞƌŝƚĂŶĐĞdĂdž^ĞƌǀŝĐĞǁŚĞŶƚƌĂŶƐĨĞƌƌŝŶŐ/^ƉŽƌƞŽůŝŽƐĨƌŽŵĂŶ
ĞdžŝƐƟŶŐ/^DĂŶĂŐĞƌ͘LJĐŽŵƉůĞƟŶŐƚŚŝƐĨŽƌŵLJŽƵĂŐƌĞĞƚŽƚŚĞƚĞƌŵƐƐĞƚŽƵƚŝŶƚŚĞ^ƚĞůůĂƌ/D/^/ŶŚĞƌŝƚĂŶĐĞ
dĂdž^ĞƌǀŝĐĞƌŽĐŚƵƌĞĂŶĚĚĂƚĞĚϬϭ:ƵŶĞϮϬϮϭ͕ĂƐĂŵĞŶĚĞĚĨƌŽŵƟŵĞƚŽƟŵĞ͘
WůĞĂƐĞƵƐĞĂƐĞƉĂƌĂƚĞ/^dƌĂŶƐĨĞƌ&ŽƌŵĨŽƌĞĂĐŚĞdžŝƐƟŶŐ/^ŵĂŶĂŐĞƌ͛ƐƉŽƌƞŽůŝŽLJŽƵǁŝƐŚƚŽƚƌĂŶƐĨĞƌ͘

APPLICANT PERSONAL DETAILS

Title

Forename(s)

Surname

Address

Postcode Date of birth

EĂƟŽŶĂů/ŶƐƵƌĂŶĐĞŶŽ͘ WealthTek ISA account no.*

*Please complete if you already have an ISA account with WealthTek

TRANSFER DETAILS

zŽƵĐĂŶƚƌĂŶƐĨĞƌďŽƚŚLJŽƵƌĐƵƌƌĞŶƚLJĞĂƌĂŶĚLJŽƵƌƉƌĞǀŝŽƵƐƚĂdžLJĞĂƌƐ͛/^Ɛ͘

Current Tax Year ISA Previous Tax years’ ISA

WůĞĂƐĞƚƌĂŶƐĨĞƌŵLJĐƵƌƌĞŶƚƚĂdžLJĞĂƌ͛Ɛ/^ WĂƌƟĂůdƌĂŶƐĨĞƌor Full Transfer

WĂƌƟĂůdƌĂŶƐĨĞƌ

Amount in cash £ or

^ƉĞĐŝĮĐŚŽůĚŝŶŐƐĚŽĐƵŵĞŶƚĞĚďĞůŽǁ

Name of security Value of shares or number of units

WůĞĂƐĞĂƩĂĐŚĨƵƌƚŚĞƌĚĞƚĂŝůƐ͕ŝĨŶĞĞĚĞĚ͘

IF full transfer, please ƟĐŬ one

WůĞĂƐĞƚƌĂŶƐĨĞƌŝŶͲƐƉĞĐŝĞ;ƵŶůĞƐƐLJŽƵƌƚĞƌŵƐĚŽŶŽƚĂůůŽǁƚŚŝƐ͕ŝŶǁŚŝĐŚĐĂƐĞƟĐŬďĞůŽǁͿ

Please sell ISA investments and transfer in cash

STELLAR AIM ISA IHT SERVICE | 2

EXISTING ISA MANAGER DETAILS

Name

Address

Postcode Date of birth

Account no. Telephone no.

dƌĂŶƐĨĞƌƵƚŚŽƌŝƐĂƟŽŶďLJ/ŶǀĞƐƚŽƌƚŽdžŝƐƟŶŐ/^DĂŶĂŐĞƌ͘
I hereby give my authority for this transfer to take place.

Applicant name

Applicant signature
^ŝŐŶĂƚƵƌĞŽĨŝŶǀĞƐƚŽƌ;ŽƌƉŽǁĞƌŽĨĂƩŽƌŶĞLJͿ

Date

ISA DECLARATION

/ĚĞĐůĂƌĞƚŽtĞĂůƚŚdĞŬ>>W͕ĂƐƚŚĞ/^DĂŶĂŐĞƌ͕ƚŚĂƚ͗
ŝͿ ůůƐƵďƐĐƌŝƉƟŽŶƐŵĂĚĞ͕ĂŶĚƚŽďĞŵĂĚĞ͕ďĞůŽŶŐƚŽŵĞ͖
ŝŝͿ /ĂŵϭϴLJĞĂƌƐŽĨĂŐĞŽƌŽǀĞƌ͖
ŝŝŝͿ/ŚĂǀĞŶŽƚƐƵďƐĐƌŝďĞĚĂŶĚǁŝůůŶŽƚƐƵďƐĐƌŝďĞŵŽƌĞƚŚĂŶƚŚĞƉĞƌŵŝƩĞĚƚŽƚĂůƐƵďƐĐƌŝƉƟŽŶĂůůŽǁĂŶĐĞĨŽƌƚŚĞĐƵƌƌĞŶƚƚĂdžLJĞĂƌ
ƚŽĂĐĂƐŚ/^͕ĂƐƚŽĐŬƐĂŶĚƐŚĂƌĞƐ/^͕ĂŶĚĂŶŝŶŶŽǀĂƟǀĞĮŶĂŶĐĞ/^͖
ŝǀͿ/ŚĂǀĞŶŽƚƐƵďƐĐƌŝďĞĚĂŶĚǁŝůůŶŽƚƐƵďƐĐƌŝďĞƚŽĂŶŽƚŚĞƌƐƚŽĐŬƐĂŶĚƐŚĂƌĞƐ/^ŝŶƚŚĞƐĂŵĞƚĂdžLJĞĂƌƚŚĂƚ/ƐƵďƐĐƌŝďĞƚŽƚŚŝƐ/^͖ĂŶĚ
ǀͿ /ĂŵƌĞƐŝĚĞŶƚĂŶĚŽƌĚŝŶĂƌŝůLJƌĞƐŝĚĞŶƚŝŶƚŚĞhŶŝƚĞĚ<ŝŶŐĚŽŵĨŽƌƚĂdžƉƵƌƉŽƐĞƐŽƌ͕ŝĨŶŽƚƐŽƌĞƐŝĚĞŶƚ͕ĞŝƚŚĞƌƉĞƌĨŽƌŵĚƵƟĞƐ
ǁŚŝĐŚ͕ďLJǀŝƌƚƵĞŽĨ^ĞĐƟŽŶϮϴŽĨƚŚĞ/ŶĐŽŵĞdĂdž;ĂƌŶŝŶŐƐĂŶĚWĞŶƐŝŽŶƐͿĐƚϮϬϬϯ;ƌŽǁŶŵƉůŽLJĞĞƐ^ĞƌǀŝŶŐKǀĞƌƐĞĂƐͿ͕
ĂƌĞƚƌĞĂƚĞĚĂƐďĞŝŶŐƉĞƌĨŽƌŵĞĚŝŶƚŚĞhŶŝƚĞĚ<ŝŶŐĚŽŵ͕Žƌ/ĂŵŵĂƌƌŝĞĚƚŽĂƉĞƌƐŽŶǁŚŽƉĞƌĨŽƌŵƐƐƵĐŚĚƵƟĞƐ͘/ǁŝůůŝŶĨŽƌŵ
tĞĂůƚŚdĞŬ>>WŝĨ/ĐĞĂƐĞƚŽďĞƐŽƌĞƐŝĚĞŶƚĂŶĚŽƌĚŝŶĂƌŝůLJƌĞƐŝĚĞŶƚŽƌƚŽƉĞƌĨŽƌŵƐƵĐŚĚƵƟĞƐŽƌďĞŵĂƌƌŝĞĚƚŽĂƉĞƌƐŽŶǁŚŽ
ƉĞƌĨŽƌŵƐƐƵĐŚĚƵƟĞƐ͘
/ŚĞƌĞďLJĂƵƚŚŽƌŝƐĞtĞĂůƚŚdĞŬ>>WƚŽ͗
ŝͿ KƉĞŶĂŶĚŽƉĞƌĂƚĞĂŶ/^ĂĐĐŽƵŶƚŽŶŵLJďĞŚĂůĨ͖
ŝŝͿ ,ŽůĚŵLJĐĂƐŚƐƵďƐĐƌŝƉƟŽŶ͕/^ŝŶǀĞƐƚŵĞŶƚƐ͕ŝŶƚĞƌĞƐƚ͕ĚŝǀŝĚĞŶĚƐĂŶĚĂŶLJŽƚŚĞƌƌŝŐŚƚƐŽƌƉƌŽĐĞĞĚƐŝŶƌĞƐƉĞĐƚŽĨƚŚŽƐĞ
ŝŶǀĞƐƚŵĞŶƚƐĂŶĚĂŶLJŽƚŚĞƌĐĂƐŚ͖ĂŶĚ
ŝŝŝͿDĂŬĞŽŶŵLJďĞŚĂůĨĂŶLJĐůĂŝŵƐƚŽƌĞůŝĞĨĨƌŽŵƚĂdžŝŶƌĞƐƉĞĐƚŽĨ/^ŝŶǀĞƐƚŵĞŶƚƐ͖
/ĂŐƌĞĞƚŽƚŚĞ/^ƚĞƌŵƐĂŶĚĐŽŶĚŝƟŽŶƐƉƌĞƐĞŶƚĞĚƚŽŵĞďLJtĞĂůƚŚdĞŬ>>W͘
/ĚĞĐůĂƌĞƚŚĂƚƚŚŝƐƚƌĂŶƐĨĞƌĨŽƌŵŚĂƐďĞĞŶĐŽŵƉůĞƚĞĚƚŽƚŚĞďĞƐƚŽĨŵLJŬŶŽǁůĞĚŐĞĂŶĚďĞůŝĞĨ͘

^ŝŐŶĂƚƵƌĞŽĨŝŶǀĞƐƚŽƌ;ŽƌƉŽǁĞƌŽĨĂƩŽƌŶĞLJͿ
Applicant signature

Date

STELLAR AIM ISA IHT SERVICE | 3

/D/^WW>/d/KE&KZD
This form is for applicants seeking to invest through an ISA wrapper. Please use the Stellar AIM IHT Service
ƉƉůŝĐĂƟŽŶ&ŽƌŵŝĨLJŽƵ͛ƌĞŶŽƚƐĞĞŬŝŶŐƚŽŝŶǀĞƐƚŝŶĂŶ/^͘

DEFINITIONS
^ƚĞůůĂƌƐƐĞƚDĂŶĂŐĞŵĞŶƚ>ŝŵŝƚĞĚ - Investment Manager
WealthTek LLP - ISA Manager and Administrator
/^ĂŶŬ- Custodian
Wealth Club - Wealth Club Limited

APPLICATION CHECKLIST

WůĞĂƐĞĞŶƐƵƌĞƚŚĂƚƚŚĞƌĞƋƵŝƌĞĚŝŶĨŽƌŵĂƟŽŶŝŶĞĂĐŚƐĞĐƟŽŶŝƐĨƵůůLJĐŽŵƉůĞƚĞĚ͘

ͿWĞƌƐŽŶĂůĚĞƚĂŝůƐƚŽďĞĐŽŵƉůĞƚĞĚďLJƚŚĞĂƉƉůŝĐĂŶƚĂŶĚƉŽǁĞƌŽĨĂƩŽƌŶĞLJǁŚĞƌĞĂƉƉůŝĐĂďůĞ

B) Bank details to be completed by the applicant

C) Wealth Club details have been completed for you

D) Charges

ͿĞĐůĂƌĂƟŽŶƚŽďĞƐŝŐŶĞĚďLJďŽƚŚƚŚĞĂƉƉůŝĐĂŶƚĂŶĚtĞĂůƚŚůƵď

&ͿŽŶĮƌŵĂƟŽŶŽĨsĞƌŝĮĐĂƟŽŶŽĨ/ĚĞŶƟƚLJ;Ks/ͿƚŽďĞĐŽŵƉůĞƚĞĚďLJtĞĂůƚŚůƵď

/ĨƚŚĞĂƉƉůŝĐĂŶƚǁŝƐŚĞƐƚŽŵĂŬĞĂŶ/^dƌĂŶƐĨĞƌŽƌĚĚŝƟŽŶĂůWĞƌŵŝƩĞĚ^ƵďƐĐƌŝƉƟŽŶ͕ƉůĞĂƐĞĐŽŵƉůĞƚĞƚŚĞ
ƌĞůĞǀĂŶƚƐƵƉƉůĞŵĞŶƚĂƌLJĂƉƉůŝĐĂƟŽŶĨŽƌŵƐĂŶĚƐƵďŵŝƚƚŚĞŵŝŶĐŽŶũƵŶĐƟŽŶǁŝƚŚƚŚŝƐƉƉůŝĐĂƟŽŶ&Žƌŵ͘

PAYING BY CHEQUE
• Cheques should be made payable to “WealthTek Client Premium ME”.
• Payment should be made by means of a cheque drawn on an account in the name of the applicant.

PAYING BY BANK TRANSFER

• Bank transfers should be made to “WealthTek Client Premium ME”.
ͻdŽƉĂLJďLJďĂŶŬƚƌĂŶƐĨĞƌ͕LJŽƵǁŝůůŶĞĞĚLJŽƵƌĐůŝĞŶƚƌĞĨĞƌĞŶĐĞŶƵŵďĞƌǁŚŝĐŚŵƵƐƚďĞƋƵŽƚĞĚĂƐƚŚĞƌĞĨĞƌĞŶĐĞ
on any transfer.
• Your client reference number will be sent to you along with the bank details for WealthTek once we have
ƌĞĐĞŝǀĞĚLJŽƵƌĂƉƉůŝĐĂƟŽŶĂŶĚƐĞƚƵƉƚŚĞĂĐĐŽƵŶƚ͘

STELLAR AIM ISA IHT SERVICE | 2

 TAX RESIDENCY FORM (FOR INDIVIDUALS ONLY)

For joint applications please complete a separate form for each joint applicant.
This form is not for use by Trusts or corporate entities.

PLEASE READ THE INFORMATION BELOW

The UK Government has a number of inter- governmental agreements to share tax information,
(where applicable), with the tax authorities in other jurisdictions. UK legislation requires us to collect
certain information about our customers tax residency. We are asking for your tax residency and tax
ID numbers (where applicable) and we will record this in our records. We will only pass this
information to HMRC if and when we are required to under UK law. HMRC might pass this
information to the government of another jurisdiction under an inter-governmental agreement.

Your tax residence is the country in which you live for more than 6 months. There are special
circumstances which might mean you are a resident elsewhere or in more than one country (dual
residency) such as studying abroad, working overseas, or extended travel. The country/countries in
which you pay income tax are likely to be your country/ countries of tax residence.

If you are a US citizen or hold a US passport or green card, you will also be considered tax resident in
the US even if you live outside the US.

Please note that all references to UK in this form refer to England, Scotland, Wales and Northern
Ireland only. It doesn’t include Channel Islands and Isle of Man.

This declaration may be signed by the applicant or by someone with legal authority to sign on their
behalf e.g. through a power of attorney.

APPLICANT
Title

Surname

Forenames

Daytime telephone number

Gender

Date of birth

STELLAR ASSET MANAGEMENT | 1

 Are you a resident for tax purposes anywhere other
than the UK? (Yes/No)

If yes, please continue with the rest of the form. If no then please sign and return the completed
form. (Please note that for joint applicants we will need a tax residency form for each applicant).

Please list the non-UK country or countries in which you’re resident for tax purposes, together with
any Tax Identification Number(s) (“TIN”), if you have one.

Country of tax residency TIN

If no TIN has been given, tick this box if this is because the country of tax residence doesn’t
issue TINs to its residents.

If there is any other reason why a TIN is not available, please let us know the reason below:

DECLARATION
I confirm that the details given in this form are correct and complete. If the information provided
above becomes invalid, I agree to advise Stellar and provide an updated declaration form within 90
days of such change occurring.

Applicant name

Applicant signature (or

Power of Attorney)

Date signed

STELLAR ASSET MANAGEMENT | 2

 Investor Declarations
Please ensure you have read and fully understand these declarations, then complete in block capitals, date, sign and return it with your
application. If you have any questions, please call us on 0117 929 0511. When you use our services, we will take these declarations as
acceptance and agreement of our Terms, and you will be bound by them.

Please read Wealth Club’s Terms of Business available at www.wealthclub.co.uk/terms and the product provider’s information before
you invest. If anything is unclear, please contact us.

1. Eligibility Declaration (please tick as applicable)

Please confirm you are a High Net Worth Investor or Self-certified Sophisticated Investor (or both) and you agree to the relevant
statements below.
1.1 High Net Worth Investor Declaration 1.2 Self-certified Sophisticated Investor Declaration

I make this statement so I can receive promotional
communications exempt from the restriction on promotion
of non-readily realisable securities. The exemption relates to
certified high net worth investors and I declare I qualify as such
because at least one of the following applies to me throughout
the last financial year (please tick at least one, as applicable):
I declare I am a self-certified sophisticated investor for the
purposes of the restriction on promotion of non-readily
realisable securities. I understand this means I can receive
promotional communications from a person authorised by the
Financial Conduct Authority which relate to investments in non-
readily realisable securities.

I had an annual income of £100,000 or more. This excludes
money withdrawn from my pension (except where the
withdrawals are used directly for income in retirement).
I held net assets of £250,000 or more. These exclude:
(a) my primary residence or any money raised through a
loan secured on it; or
(b) any rights of mine under a qualifying contract of
insurance; or
(c) any benefits (in the form of pensions or otherwise)
payable on the termination of my service or on my death
or retirement and to which I am (or my dependants are),
or may be, entitled; or
(d) any withdrawals from my pension savings (except
where the withdrawals are used directly for income in
retirement).
I am a self-certified sophisticated investor because at least one
of the following applies (please tick at least one, as applicable):
I am a member of a network or syndicate of business angels
and have been so for at least the last six months;
I have made more than one investment in an unlisted
company in the last two years;
I am working, or have worked in the last two years in a
professional capacity in the private equity sector, or in the
provision of finance for small and medium enterprises;
I am currently, or have been in the last two years, a director
of a company with an annual turnover of at least £1 million.

Based on this statement, I confirm I am a High Net Worth Based on this statement, I confirm I am a Self-certified
Investor. Sophisticated Investor.
I accept that the investments to which the promotions will relate may expose me to a significant risk of losing all of the money or
other property invested. I am aware that it is open to me to seek advice from an authorised person who specialises in advising on
non-readily realisable securities.

2. Investor Declaration

I confirm: advisory product information and reviews on the Wealth Club

— I have read in full, understood, agreed to and retained:
› Wealth Club’s Terms of Business;
› The product information (including the Prospectus,
Securities Note, Brochure or Information Memorandum);
› The product provider’s Terms and Conditions.
— I understand the risks of this investment.
— I have read the information on fees on the Wealth Club website
and the Key Information Document, if available.
website). If I have any doubts I will seek personal advice.
— I am over age 18 and a UK resident. If I cease to be a UK
resident, I will inform Wealth Club in writing within 30 days.
— This declaration and any other declaration made by me in
connection with this application will be the basis of the contract
between me and Wealth Club Limited. I agree to be bound by
all statements made within these declarations. All the details
provided on this form are, to the best of my knowledge and
HNW/012020

— I have not received a personal recommendation from Wealth belief, true and complete, and I agree to keep Wealth Club
Club and have decided to invest based on the information updated about any changes to my circumstances which could
provided by the product provider (and, if applicable, the non- affect the statements made in this declaration.
✗ Name Signature
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(print) D D M M Y Y Y Y