dps Select / Corporate Investment Instruction
Dated:
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Part 1 Provider Details
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Investor Account Name
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Product Provider / Provider Reference No.
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Product Type
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Part 2 Adviser Details
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Adviser Firm Name / Adviser Firm Reg. Number
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Adviser Name / Adviser Reg. Number
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Part 3 – InvestmentSelection
Initial Investment Amount* / £
Regular Investment Amount / £ / RegularWithdrawal Amount / £
Please select the Investment Manager and Investment Mandate(s) in which you wish to invest and/or make regular withdrawals from.
Investment Manager / Strategy Name / Weighting
Smartfund Administration Ltd / - please select the model -Defensive Strategy - GIA/SIPP/OSBCautious Strategy - GIA/SIPP/OSBBalanced Strategy - GIA/SIPP/OSBGrowth Strategy - GIA/SIPP/OSB Aggressive Growth Strategy - GIA/SIPP/OSBUK Ethical Equity Strategy - GIA/SIPP / %
Smartfund Administration Ltd / - please select the model -Defensive Strategy - GIA/SIPP/OSBCautious Strategy - GIA/SIPP/OSBBalanced Strategy - GIA/SIPP/OSBGrowth Strategy - GIA/SIPP/OSBAggressive Growth Strategy - GIA/SIPP/OSBUK Ethical Equity Strategy - GIA/SIPP / %
SmartfundAdministration Ltd / - please select the model -Defensive Strategy - GIA/SIPP/OSBCautious Strategy - GIA/SIPP/OSBBalanced Strategy - GIA/SIPP/OSBGrowth Strategy - GIA/SIPP/OSBAggressive Growth Strategy - GIA/SIPP/OSBUK Ethical Equity Strategy - GIA/SIPP / %
Reinvest Income?
Part 4 Fees Payable
The below fees will be paid by Smartfund Administration Ltd directly to the adviser firm. / (Charging is shown exclusive of any applicable VAT)
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Fixed Fee / %
Initial Adviser Fee - Lump Sum Investment / or
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Initial Adviser Fee – Regular Investment / or
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Annual Fee
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Part 5 Bank Account Details(only if requiredfor SIPPs)
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Bank * / Account Name *
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Branch / Account Number * / Sort Code *
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IBAN No. / BIC No.
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Part 6 Fund Transmission
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Bank / Al Rayan Bank PLC / Account Name / Sharia DPS Client Account
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Branch / Account Number / 01227501 / Sort Code / 30-00-83
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IBAN No. / - / BIC No. / -
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Date Transmitted / Estimated arrival date
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Part 7 Signature(only if required for SIPPs)
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Name
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Signature
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Date
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Name
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Signature
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Date
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This Corporate Investment Instruction must be returned by the Provider to:-
Smartfund Administration Ltd, PO Box 60294, London, EC2P 2DL
Email: Fax: 020 7562 2451
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Smartfund Administration Ltd: 6 Broad Street Place London EC2M 7JH T: +44 (0)844801 0700 F: +44 (0)207 562 2451 E: W:
Registered Office Address:6 Broad Street Place London EC2M 7JH Company Registration No. 06016828 (England and Wales) VAT No. 100 1037 06
Smartfund Administration Ltd is authorised and regulated by the Financial Conduct Authority under reference 463566
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