The An Post and An Post Trade Union Group
Additional Voluntary Contribution Retirement Benefit Scheme.
The most Tax Efficient way to Save for your Retirement.
Section A - Employee Details
(Minimum age 66)
Section B - Contribution Details
Regular AVC Amount
Optional Lump Sum AVC Amount
Section C - Politically Exposed Person (PEP) or Relative or Close Associate (RCA) of a PEP
Who is a Politically Exposed Person (PEP)?
A ‘Politically Exposed Person' means an individual who is, or has at any time in the preceding 12 months been, entrusted with a prominent public function, (but not including any middle ranking or more junior official) and performs one of the following roles:
• a head of state, head of government, government minister or deputy or assistant government minister.
• a member of a parliament or a similar legislative body.
• a member of the governing body of a political party.
• a member of a supreme court, constitutional court or other high level judicial body whose decisions, other than in exceptional circumstances, are not subject to further appeal.
• a member of a court of auditors or of the board of a central bank.
• an ambassador, charge d'affairs or high-ranking officer in the armed forces.
• a director, deputy director or member of the board of, or person performing the equivalent function in relation to, an international organisation.
• a member of the administrative, management or supervisory body of a state-owned enterprise.
Who is a Relative of a PEP?
• any spouse of the politically exposed person.
• any person who is considered to be equivalent to a spouse of the politically exposed person under the national or other law of the place where the person or politically exposed person resides.
• any child of the politically exposed person.
• any spouse of a child of the politically exposed person.
• any person considered to be equivalent to a spouse of a child of the politically exposed person under the national or other law of the place where the person or child resides.
• any parent of the politically exposed person.
• any other family member of the politically exposed person who is of a prescribed class set out by the Department of Finance.
Who is a Close Associate of a PEP?
• any individual who has joint beneficial ownership of a legal entity or legal arrangement, or any other close business relations, with the politically exposed person.
• any individual who has sole beneficial ownership of a legal entity or legal arrangement set up for the actual benefit of the politically exposed person.
Section D - Retained Benefits
Please contact Halligan Insurances at info@halligan.ie
If the answer to questions (2) or (3) is YES, please give details below (continue on a separate sheet, if required).
Please include details of all retained benefits, including immediate and deferred pensions for you, your spouse and dependents, and lump sums and gratuities payable on death, retirement and leaving service.
Please also advise if any of these benefits are subject to a Pension Adjustment Order arising from a judicial separation or divorce.
Details of any retirement benefits payable from any source including those from outside the Republic of Ireland to be included here.
Section E - Declarations by Employee
(i) Data Protection Notice
Zurich Life Assurance plc (‘Zurich Life’, ‘we’, ‘our’) is a member of Zurich Insurance Group (‘the Group’). Zurich Life is the data controller for this contract under data protection legislation. Our Data Protection Notice (‘Notice’) for this product is detailed at the end of this form. Please read this carefully
By signing this form I confirm that I have read and understood the Data Protection Notice.
I authorise the Department of Employment Affairs and Social Protection or the Revenue Commissioners to advise Zurich Life of my most recent address on their records at any future time.
(ii) Marketing Preferences
From time to time, we would like to contact you to keep you up to date with news and offers from Zurich Life and those of the Zurich Group or third parties that we recommend. If you are happy for us to do this, please choose how you would like us to contact you.
If at any time you would like to change your preferences or remove your permission, all you need to do is contact us by phone on 01-799 2711, by email at customerservices@zurich.com, or by writing to Customer Services, Zurich Life Assurance plc, Zurich House, Frascati Road, Blackrock, FREEPOST, Co. Dublin. (iii) Policy Declaration
I have read the product information provided in respect of the Plan and I confirm the investment strategy selected.
I understand that I have a duty to answer all questions asked by Zurich Life in this application for a contract honestly and with reasonable care and failure to comply with these requirements could result in my contract being invalidated or my contract benefits being reduced.
I declare that all questions and statements in the application for this contract are answered honestly and with reasonable care (including any statements written down at my dictation).
Note: Zurich Life’s remedies in the event of misrepresentation are set out in the Consumer Insurance Contracts Act 2019.
I acknowledge that in order to administer the policy, it may be necessary for Zurich Life to seek information and benefit details from the administrator, Trustees or other relevant insurance office of any scheme, arrangement or contract of which I am or have been a member, and I authorise the giving of such information and details.
I also consent to any deduction of contributions set out in this application form.
I confirm that I have received the Member Information Booklet and that I have read and fully understand all parts of the above declaration and that I will be the beneficial owner of any benefits payable in accordance with the trust deed and rules.
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Signed Date
Data Protection Notice
About this Notice
Everyone has rights with regard to the way in which their personal data is handled. During the course of our activities we will collect, store and process personal data about you. The purpose of this Notice is to set out some information on the collection and processing of your personal data. Further information can be obtained in our Privacy Policy which is available at www.zurich.ie/privacy-policy.
The Data we collect
We collect the following personal data (‘Data’) from you (unless you are a member of a group scheme, in which case we may collect the Data from your employer or the trustee of the scheme):
- Contact and identifying information such as title, name, address, email, telephone number, gender, marital status, date of birth, occupation, PPS number, nationality, country of residence and photographic identification. We require this Data to identify you, contact you, conduct a suitability assessment (in the event of a sale via a financial advisor employed by or tied to Zurich Life), to fulfil our contract with you and to comply with legal obligations (e.g. performance of anti- money laundering checks). For investment products we also collect your US citizen status and your Tax Identification Numbers from other countries (if applicable) which we require to comply with Revenue law. If you are a member of a group scheme, we may also collect your employer’s details.
- Financial information such as bank details, credit/debit card details (where needed) and income details (where applicable). We require this Data so we can assess the premium to be paid, to fulfil our contract with you and to comply with legal obligations.
- Medical condition and health status for protection products and some pension and investment products which also offer life and serious illness benefits, we collect medical information relating to: personal habits (e.g. smoking or consumption of alcohol), prescription information and medical history. For pension products we may collect disability information (e.g. if you apply for an early retirement due to ill health). We require this Data so that we can fulfil our contract with you.
- Other sensitive information - in certain cases, we may receive sensitive information from which it may be possible to infer your trade union membership, religious or political beliefs (e.g. if you are a member of a group scheme through a professional, trade, religious, community or political organisation). In addition, we may obtain information about your criminal record or civil litigation history in the process of preventing, detecting and investigating fraud. We may obtain your PEP (politically exposed person) status, which is necessary for compliance with anti-money laundering legislation.
Data collected from third parties
We may collect Data from third parties if you engage with us through a third party e.g. through a financial broker/advisor or, in the case of a group scheme, through your employer. We do this in order to fulfil our contract and provide services to you. We may also obtain Data from third parties so that we can assess a claim.
What do we do with your Data?
We collect and process this Data to manage and administer our relationship with you. We may use, process and store the Data, for the following purposes:
- Risk evaluation, product suitability, policy execution, premium setting, premium collection, claims assessment, claims processing, claims payment, to provide annual statements, to create trustee annual reports (in the context of group schemes), for statistical evaluation, for survey purposes or to otherwise ensure the Group service delivery. Zurich Life or other members of the Group may contact you in connection with these purposes. We do this in order to provide you with the services for which you have contracted with us.
- We may check the Data you have provided against international/economic or financial sanctions laws or regulated listings to comply with legal obligations (e.g. anti-fraud and anti-money laundering requirements) or otherwise to protect our legitimate interests and/or the legitimate interests of others.
Sharing of Data
In order to provide a seamless service, we may share your Data (where appropriate):
- With other companies in the Group such as branches, subsidiaries, affiliates within the Group, partners of the Group, coinsurance and reinsurance companies located in Ireland and abroad, including outside the European Economic Area (‘EEA’).
- If you apply for, or purchase, one of our products through a financial broker/advisor or another third party (e.g. your employer if you are a member of a group scheme), we will, as appropriate, correspond with that third party in relation to your products: this may result in us sharing your Data with that third party.
- Without your consent or without consulting you, when we believe that it is appropriate to comply with our legal obligations, a Court Order or to cooperate with State bodies (e.g. Revenue, the Central Bank, The Pensions Authority and law enforcement agencies).
- On the sale, transfer or reorganisation of our or our Group’s business (or any part of it).
- With business partners, suppliers and sub-contractors with whom we work and/or engage (e.g. auditors, cloud service providers, medical professionals, third-party claim administrators and outsourced service providers) to assist us in carrying out business activities which are in our legitimate business interest and where such interests are not overridden by your interests.
- In order to enforce this Notice or other legal rights, to protect the security and safety of others, and to prevent fraud.
For further information with respect to the third parties that we may share Data with, please see our Privacy Policy which is available at www.zurich.ie/privacy-policy.
Where transfers of Data take place outside the European Economic Area (“EEA”), we ensure that they are undertaken lawfully and in accordance with appropriate safeguards. Data may be transferred to and stored outside the European Union (“EU”) or EEA and in a country for which there is no adequacy decision relating to the safeguards for Personal Data from the European Commission. In such instances, appropriate safeguards are put in place to protect your Data. For further information with respect to the non-EU or non-EEA countries to which your Data may be transferred and for which there
is no adequacy decision relating to the safeguards for Personal Data from the European Commission or for a copy of the safeguards put in place to protect your Data, please see our Privacy Policy which is available at www.zurich.ie/privacy-policy.
If you have any questions about your Data, you can contact our Data Protection Officer, free of charge, using the contact details below.
Marketing
Depending on the marketing preferences you have expressed in any application forms for our products or services, we may send you details of offers and news that we would like to share with you. Please note that you have the right to change your preferences at any time by contacting us by phone on 01 799 2711, by email at customerservices@zurich.com, or by writing to Customer Services, Zurich Life Assurance plc, Zurich House, Frascati Road, Blackrock, FREEPOST, Co. Dublin.
Data Retention
The time periods for which we retain your Data depend on the purposes for which we use it. We will keep your Data for no longer than is required or permitted. For more detail, see our Data Retention Policy at www.zurich.ie/privacy-policy.
Data Subject Rights
You have the following rights in relation to your Data which is held by Zurich Life:
- 1. To ask for details of your Data held by us.
- 2. To ask for a copy of your Data.
- 3. To have any inaccurate or misleading Data rectified.
- 4. To have your Data erased.
- 5. Torestrict the processing of your Data in certain circumstances.
- 6. To object to the processing of your Data.
- 7. To transfer your Data to a third party.
- 8. A right not to be subject to automated decision making.
- 9. The right to receive notification of a Data breach.
- 10. Where processing is based on consent, the right to withdraw such consent.
- The right to lodge a complaint to the Data Protection Commission.
If you wish to avail of these rights, a request must be submitted in writing to our Data Protection Officer. In order to protect your privacy, you may be asked to provide suitable proof of identification before we can process your request.
Our Data Protection Officer is contactable by phone, email, or post via:
- Zurich Life Customer Services on 01 799 2711
- dataprotectionofficer@zurich.ie
- Data Protection Officer, Zurich Life, Zurich House, Frascati Road, Blackrock, FREEPOST, Co. Dublin.
Privacy Policy
Please note that this Notice is not a stand-alone document and should be reviewed in conjunction with our Privacy Policy which is available at www.zurich.ie/privacy-policy.
Salary Deduction Instruction
Employee’s Agreement and Authority
to Deduct Contributions.
Please deduct from my gross salary until further notice the appropriate gross amount agreed by me in Section B, on the appropriate dates, in respect of my contributions and any increases in contributions under the policy(ies) and remit these contributions to Zurich Life Assurance plc.
Signature of Employee *
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Signed Date
Electronic Signature Agreement
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01 879 7100 