Executive Pension Statement of Suitability - New Ireland Assurance

_________________________________________________________________________________________________________________________________________________Re: Executive Pension Term AssuranceImportant Notice – Statement of SuitabilityThis is an important document which sets out the reasons why the product(s) orservice(s) offered or recommended is/are considered suitable, or the most suitable, foryour particular needs, objectives and circumstances.After considering the information you provided in the Financial Review carried out on theday of 20 , my analysis has identified:• You wish to provide life cover for a key employee through an occupational pensionscheme.I have provided you with a document with key information on New Ireland Executive PensionTerm Assurance policy and explained the product features to you. I recommend that you takeout a New Ireland Executive Pension Term Assurance policy, which I consider to be suitable foryou and in your best interests for the following reasons:• The plan is designed to provide life cover until your employee’s retirement.• The Plan is a Revenue exempt approved retirement benefits scheme and tax relief can beclaimed on contributions paid to the Plan, within overall Revenue limits. There is noemployee benefit-in-kind charge in respect of employer contributions.• It offers a tax efficient way of providing protection during the term of the Plan.• You can opt at the outset for benefit and premiums to increase at 5% per annum during theterm. This option helps maintain the “real” value of the benefit when inflation is taken intoaccount.• The life cover can be altered at any stage during the term of your Plan, provided allunderwriting requirements are met.• A conversion option is available from the outset. This option allows the extension of lifecover beyond the original term of the policy without the need for any further medicalevidence. The premium for this option will be higher than for a level term assurance plan.The New Ireland Executive Pension Term Assurance policy is described in more detail in theImportant Information provided to you. Revenue conditions and limits apply to all exemptapproved retirement benefits schemes.Comhlucht na hÉireann um Árachas cpt (New Ireland Assurance Company plc)11-12 Dawson Street, Dublin 2. T: 01 617 2000 E: info@newireland.ie W: www.newireland.ieRegistered in Ireland No. 7336. Registered office as above. New Ireland Assurance Company plc is regulated by the Central Bank of Ireland.A member of Bank of Ireland Group.Chairman: John Collins. Managing Director: Sean Casey.Directors: Des Crowley, Ashok Gupta (British), Pat Healy, Denis Kelleher, Paul Kelly, Liam McLoughlin, Dermot Murray, David Roberts,David Swanton, Mick Sweeney.Secretary: Peter Gray.

New Ireland Assurance Company plc is regulated by the Central Bank of Ireland. A member ofBank of Ireland Group.This document, your Important Information document and your Financial Review form yourStatement of Suitability. This document does not constitute a contract or any part of a contract.For completion by Client(s):I have read the above and confirm that I agree with the recommendation made by my FinancialAdvisor and wish to take out the policy recommended._____________________________Client 1___________________Date_____________________________Client 2 (if applicable)___________________DateFor completion by Financial Advisor:_____________________________Financial Advisor___________________Date302486 v1.02.2013