RECORD OF ADVICE SECTION 1: Client Details Title: Initials: First Name: Surname: Identity/Passport number: SECTION 2: Advisor Details Please see attached disclosure about the Financial Services Provider. SECTION 3: Reason for the fact that there is no needs analysis in place (tick the appropriate box) The client did not wish to give all the necessary information that would enable me to do a complete financial needs analysis. Detail: I did not have enough time due to circumstances out of my control. Reason: SECTION 4: Advice record Summary of the information and material on which advice was based. Client’s financial situation, needs and objectives (e.g. long-term or short-term investment needs): Client’s risk profile (e.g. existing investment portfolio etc.): Actions considered SECTION 5: Declaration by the client 5.1. I hereby declare that I am aware of the fact that: a full analysis could not be undertaken and that there may thus be limitations on the appropriateness of the advice; and> that I must carefully consider whether the advice on its own is appropriate considering my objectives, financial situation and needs; to prevent the risk of concluding a transaction that is not appropriate to my needs, objectives and circumstances, I should obtain a full financial needs analysis. 5.2. Either A or B A – I, the client, hereby declare that I accept the advice provided to me as set out above, and that: the adviser provided me with his practice’s details; the adviser discussed the quote/s, attached to this document and signed by myself, with me in detail; the adviser discussed the replacement policy advice record / replacement disclosure document with me in detail (please scrap if not relevant); I did not sign the application form while any part of it was not completed yet; I am aware of the fact that I take full responsibility for all the information provided in the application form, whether provided by myself or on my behalf. B – I, the client, hereby declare that I do not accept the advice provided to me as set out above. I CONFIRM having been duly and properly advised of the full implications of my actions and, having considered same, I fully understand the course of action that I am about to undertake. I declare that I am aware of the fact that I must carefully consider whether the product selected is appropriate considering my objectives, circumstances and needs.