Momentum Wealth Retirement Income Option Application (WIS060E) Instructions

Check this box if you are completing the application for yourself (you are the applicant).

Check this box if you are completing the application for another person — you must also complete the Personal details declaration and self‑certification form.

Enter your cell phone number (use the adjacent country/area code box for the international prefix and enter the local number in this field).

Enter an alternative contact phone number (use the adjacent country/area code box for the international prefix and enter the local number in this field).

Enter your primary email address where the organisation can electronically communicate with you.

Check this box to agree that the organisation may send you communications and documents electronically to protect your information and ensure speedy delivery.

Enter the first character of the investment number exactly as shown (an alphanumeric prefix or letter).

Check this box if the applicant's gender is female.

Check this box if the applicant's gender is male.

Enter the full ID or passport number exactly as it appears on your identity document, including any letters or punctuation.

Enter your date of birth as shown on your official identity document.

Enter the expiration date of your passport as shown on the passport.

Enter the name of the country that issued your passport (the country shown on the passport).

Enter your title (for example Mr, Mrs, Miss, Ms, Dr) as you want it recorded on the application.

Enter the initial(s) of your given name(s) (for example J T for John Thomas).

Enter your full given name(s) exactly as shown on your legal identity documents.

Enter your current family or last name exactly as shown on your legal identity documents.

Enter any former family or last name(s) you have used (for example maiden name), or leave blank if none.

Enter the country of which you are a national; if you have more than one nationality, list them separated by commas.

Enter the country where you were born.

Enter the country or countries in which you hold citizenship; if more than one, separate with commas.

Enter the country where you currently reside as your principal place of residence.

Enter the unit, apartment or flat number for your physical address (e.g., 12B or Unit 3).

Enter the name of the complex, estate or building where your unit is located, if applicable.

Enter the numeric street number of the property (include any letter suffixes if part of the official number).

Enter the full street name or farm name for your physical address.

Enter the suburb, district or neighborhood for your physical address.

Enter the city or town where your physical address is located.

Enter the postal or ZIP code for your physical address.

Enter the given name(s) of the family member or known close associate of the politically-exposed or prominent influential person. Fill only if 'Family member/close associate of Domestic politically-exposed person', 'Family member/close associate of Foreign politically-exposed person', 'Family member/close associate of Prominent influential person' Domestic politically-exposed person (family member), Foreign politically-exposed person (family member) or Prominent influential person (family member) is 'Yes' (any).

Enter the official position or job title held by the family member or known close associate (if applicable). Fill only if 'Family member/close associate of Domestic politically-exposed person', 'Family member/close associate of Foreign politically-exposed person', 'Family member/close associate of Prominent influential person' Domestic politically-exposed person (family member), Foreign politically-exposed person (family member) or Prominent influential person (family member) is 'Yes' (any).

Enter the family member's or known close associate's surname (last name). Fill only if 'Family member/close associate of Domestic politically-exposed person', 'Family member/close associate of Foreign politically-exposed person', 'Family member/close associate of Prominent influential person' Domestic politically-exposed person (family member), Foreign politically-exposed person (family member) or Prominent influential person (family member) is 'Yes' (any).

Check this box if you are a family member of or a known close associate to a domestic politically-exposed person.

Check this box if you are a family member of or a known close associate to a foreign politically-exposed person.

Check this box if you are a family member of or a known close associate to a prominent influential person.

Enter the official position or job title you currently hold as a politically-exposed or prominent influential person (include the office/role and the organisation or institution). Fill only if 'You are a: Domestic politically-exposed person', 'You are a: Foreign politically-exposed person', 'You are a: Prominent influential person' Domestic politically-exposed person, Foreign politically-exposed person or Prominent influential person is 'Yes' (any).

Check this box if you personally are a domestic politically-exposed person (you hold or have held a prominent public function in your country).

Check this box if you personally are a foreign politically-exposed person (you hold or have held a prominent public function in a country other than your country of residence).

Check this box if you personally are a prominent influential person (you are a high-profile individual with significant public or societal influence).

Check this box if none of the other listed options (domestic politically-exposed, foreign politically-exposed, or prominent influential person) apply to you.