1. Healthcare

Flexible Lifetime® – Investments
Additional investments form
(for Series 1 Investment Options)
Please staple all relevant material together
Office/Planner use only
Complete this form to:
Client number
– make a one-off additional Investment of $500 or more,
and/or
– start a Regular Investment Plan for $100 or more per month.
Request ID
For assistance in completing this form, speak to your financial
planner or call Customer Service on 133 267.
Planner ID
A Regular Investment Plan allows you to invest regularly
through market highs and lows, which smoothes the effects of
market fluctuations and averages the cost of your units.
Regular Investment Plan amounts are deducted from your
nominated bank account around the 20th of each month and
will be invested in the investment option(s) selected.
Please print in CAPITAL LETTERS and place a cross ✗ in any
applicable boxes.
1. Investor details
Client number (7 digit number)
Account name
Account reference
2. How are we receiving the funds?
Source of funds – one-off additional investment only
Direct debit
Cheque
External source
AMP Policy(ies)
Total
$
$
(from the bank account nominated in section 5)
All cheques made payable to AMPCI acf AMPCFM (Investor’s name)
$
$
Policy numbers
$
Note: If the amount is to be transferred from another AMP policy, please complete the relevant withdrawal form.
Issued by AMP Capital Funds Management Limited ABN 15 159 557 721, AFSL No. 426455
the Responsible Entity of the investment options in Flexible Lifetime – Investments.
® Registered trademark of AMP Life Limited ABN 84 079 300 379.
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3. Investment options
A. Auto-rebalancing
Only complete this section if you have an existing ‘nominated investment profile’ under the auto-rebalancing facility, and would
like this additional contribution to be invested according to this profile. Otherwise, skip to section B.
I have previously selected the auto-rebalancing facility and would like this additional contribution invested as per my existing
‘nominated investment profile’ (if this box is selected, please skip to section 4).
B. Investment option selection
You may invest in up to 15 investment options. If you previously selected the auto-rebalancing facility and are adding an
investment option to your investment account, you must advise us that you want to change your ‘nominated investment profile’.
If you do not advise us that you want to change your ‘nominated investment profile’, we will automatically cancel the autorebalancing facility from your account. You can advise us of changes to your ‘nominated investment profile’ by completing a
Switch form available on amp.com.au/investments/brochures or by calling us on 133 267.
Investment option
Code
Write your
additional
investment amount
Total
Regular Investment Plan (deducted from
your nominated bank account – Section 5)
Distribution method
(please ✗ your choice)
Write your monthly
amount here
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
$/%
Reinvest
Bank
$
For indexation write
CPI or a %
$/%
4. Fee structure
Contribution Fee
Please indicate the Contribution Fee to be charged for this contribution.
.
%
(excluding GST) up to 4%
Please be aware that this fee will be the fee for all future contributions (including Regular Investment Plan).
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5. Bank account details
Direct debit from:
My existing nominated bank account. Skip to section 6.
The bank account provided below.
Note: If you are establishing a Regular Investment Plan, the bank account details provided below will replace your existing
nominated bank account.
BSB number
Account number
Branch location
Account in the name of
Name of your financial institution (eg bank, credit union)
Please mark ✗ this box if the bank account provided above is to replace your existing nominated bank account with us.
This box must be marked ✗ if you are establishing a Regular Investment Plan.
If you supply your bank account details above, you automatically gain access to the InvestEasy servicing facility. InvestEasy allows
you to make additional investments into your account without the need to complete more forms. If you do not wish to access this
service, please write to us to request this.
I/We authorise and request AMP Capital Investors Limited (User ID 031825) to debit the nominated bank account (details provided
above) with any amount AMP Capital Investors Limited may debit or charge me/us through the Direct Debit System, and
acknowledge that I/we have read, understood and agree to be bound by the Direct Debit Request Terms and Conditions set out in
the current Product Disclosure Statement.
Signature of account holder
✗
Signature of account holder
✗
Date
D D MM Y Y Y Y
Date
D D MM Y Y Y Y
6. Agreement and declaration
All investors must sign and date here. We cannot process your application without these signatures.
I/We declare that I/we:
1. Have received and been given the opportunity to read the current Flexible Lifetime – Investments Product Disclosure
Statement (PDS).
2. Want to apply for additional units in the investment option(s) comprising Flexible Lifetime – Investments in accordance with
the current Flexible Lifetime – Investments Product Disclosure Statement, and agree to be bound by the terms of the
Constitution(s) (as amended) and the Product Disclosure Statement.
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Your signature(s)
Important: If you are signing as a trustee, you warrant that, at the time of signing, you are authorised under the relevant trust
deed to apply and to do all things necessary as a result of becoming a unitholder.
If you are signing under Power of Attorney, you verify that, at the time of signing, you had not received notice of revocation of that
Power of Attorney. In the event that a certified copy of the Power of Attorney has not been previously provided, you must submit
this with the completed application form.
Investor A
Title
Surname
Given name(s)
Contact phone number
(
)
Power of Attorney
Signature
Date
✗
D D MM Y Y Y Y
Investor B
Title
Surname
Given name(s)
Contact phone number
(
)
Power of Attorney
Signature
Date
✗
D D MM Y Y Y Y
Financial planner details (Planner use only)
Financial planner name
Planner
number
Phone number
Dealer group
Servicing financial
planner ( ✗ one)
Where to send this form:
Mail (no stamp required), fax or email the completed form to:
Flexible Lifetime – Investments
Reply Paid 79281
PARRAMATTA NSW 2124
02 8837 7860
Make your cheque payable to:
AMPCI acf AMPCFM (Investor’s name)
Please note: If you send your application electronically or via
fax, you do not need to mail the original.
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[email protected]
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