NEXUIVIE

Blends Adherence form ZURICH

PN 5720427
Blends and Lifestyle Blends are a wealth management solution, put together by Nexus Group ("Nexus")
consisting of a blend of funds offered to you through your policy/policies with Zurich lnternational Life
Limited ("Zurich").

Completing thrs form

Use blue or black ink and write clearly in BLOCK CAPITAL letters. Please complete this form in English. lf your application does not include all
the information we ask for, it will result in delays.
By completing this form you adhere to Blends and/or Lifestyle Blends, and you agree to start investing your new policy premiums and/or switch
your current fund investments to Blends as selected below.
Please note you will incur Blend adviser fees for your holding within the Blends funds only.
For more information about Blends and/or Lifestyle Blends, please refer to the Lifestyle Blends brochure and Lifestyle Blends fund factsheets,

Blends fund names and rodes are listed below for your reference:
(1) US Dollar Low Risk - Code B0'126 (2) U5 Dollar Medium-Low Risk - Code 80127 (3) US Dollar lr,4edium Risk - Code B0128
(4) US Dollar Medium-High Risk - Code 80129 (5) US Dollar High Risk - Code B0130

1. lnvestment details
Select one option per policy only

Option 1 - lnvest your new or existing policy in Lifestyle Blends

Blends lnvestment Strategies - with automatic Blends Lifestyling
Please write the policy/application number and tick a box to select the investment strategy for each policy.
Policy number US Dollar Blends lnvestment Strategies
Low Risk l\ledium-Low Risk lvledium risk lvledium-High Risk Hig h Risk

m m n n m
m m n n m
m ru n n m
m n n ru m
m n n l*l
ll m
m n T n m
Option 2 - Ior new business applications only
Create your own investment strategy (Use a combination of Blends funds and other investment funds available to your policy)

Policy number(s)
Note: The same investment strategy will apply to all policies given above
Fund Name Fund Code Allocation %
Option 3 - For your existing policy only

Switch funds of your existing policy and create your own investment strategy.

Policy number(s) 5720427

Note: The same switch and redirection will apply to all policies given above.

Sell from the present fund holding Buy into new fund holding
Fund name Fund code Percentage Fund name Fund code Percentage
to sell to buy
LOOMIS SAYLES MULTISECTOR INCOME XTUSD 100 USDOLLAR MEDIUM-HIGH RISK 80129 100

EMIRATES IVENA FIXED INCOME TTUSD 100

Please ensure the total adds up to 'lO0% 100.00

@

Redirect f uture payments

Select the f unds where your future premiums will be invested.

Fund Name Fund Code Allocation %

USDOLLAR IVIEDIUM.HIGH RISK 801 29 100

Please ensure the total adds up to i 00% TOTAL 100

2. Blends administrator details

Company name Nexus lnsurance Brokers LLC

Company registered address P O Box 124422, office 402,4th floor, Emaar Square building 1, Downtown, Dubai, UAE

Company regulation number 583 403

Company regulated by UAE lnsurance Authority - registration number 207

3. Customer declaration
l/We request Zurich to switch and/or invest in Blends and/or Lifestyle Blends for the policy/policies stated above. l/We confirm that l/we have
received and read a copy of the Lifestyle Blends brochure.

l/We understand that Nexus has selected the blend of funds and will administer the Blends and provide instructions to Zurich accordingly.
l/We understand that mylour Blends investment(s) will incur blend advrserfees and fund charges and confirm that l/we have been provided
with a copy o{ the brochure which includes written details of those charges.
l/We understand that the charges will be calculated and deducted daily using the current value of the underlying assets within each blend
fund held in the policy/policies at the time in accordance with the charges set out in the brochure, a copy of which has been provided to
me/us by Nexus.

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4. lmportant information
Before signing this form you should be aware that:

This form confirms the basis on which you have made the investment choices within your Zurich policy.
Zurich does not accept any responsibility in respect of the fund choice offered within the Blends which is administered by Nexus.

Zurich has absolute discretion to reject or accept investment instructlons from Nexus or you in respect of Blends and/or Lifestyle Blends.
Zurich will not be liable for any loss caused to your policy as a consequence of Zurich acting on instructions received in connection with your
choice of or changes to the Blends.

The Blends will only comprise of assets that are o{fered by Zurich within the range of f unds available for investment in connection with
your policy.
Zurich does not endorse the ability or suitability of any of the Blends that you choose.

Zurich is not responsible for the investment selection made by Nexus in respect of the Blends in accordance with your investment objectives
and attitude to risk.
Zurich does not give advice on the financial or tax implications of changes to your policy.

5. Termination
This instruction to Zurich can be terminated at any time by switching out of Blends and/or Lifestyle Blends. lf you inform us that you are
changing your appointed financial adviser from Nexus Group, we will ask you to select alternative investment funds for your current fund
holding and for your future premiums. You will need to provide Zurich a switch and redirection form or submlt an online portfolio
management request using your secure ZIO account.

6. Privacy notice
The personal information requested in this form is collected and used by Zurich lnternational Life Limited as Data Controller in line with the
Data Protection Policy. Full details can be found online at https://www.zurichinternational.com/en/zurich-international-life/about-us/privacy or
contact us for a copy.

7. Policy owner authorisation

l/We confirm that this/these signature(s) below islare mine/ours or that/those of my/our appointed legal representative(s).

Policy owner/Authorised signatory 1 Policy owner/Authorised signatory 2

Signature Signature

L-
Full name VIJAYA SARATHI UPALA Full name

Date I o 0 4 2 0 2 0 Date

This section is only for completion by those acting on behalf of a company or trust
Name of the company/trust (policy owner)

Regrstered company number (if applicable)

Name of company/trustee representative for correspondence

)
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8. Blends administrator - declaration and authorisation

We confirm that we have the necessary level of authorisation f rom the regulatory organisation to act in the capacity appointed and that we
will notify the policy owner and Zurich if this authorisation changes or any regulator disciplinary action is taken against us.
Notwithstanding any other terms under this agreement, no insurer shall be deemed to provide coverage or will make any payments or provide
any service or benefit to any insured or other party to the extent that such cover, payment, service, benefit and/or any business or activity of
the insured would violate any applicable trade or economic sanctions law or regulation.
We confirm that we have read and understood this Blends Adherence Form in conjunction with the Brochure setting out all the applicable
terms and conditions of the Blends.

On behalf of the Blends administrator company.

Authorised signatory

S ignatu re

,fi* Print

Date
name

1 o
SNEHAL URANKAR

0 4 2 n 2 0

lmportant information
Zurich lnternational Life is a business name of Zurich lnternational Life Limited.
Zurich lnternational Life Limited is fully authorised under the lsle of lVan lnsurance Act 2008 and is regulated
by the lsle of IVan Financial Services Authority which ensures that the company has sound and professional
management and provision has been made to protect policy owners.
For life assurance companies authorised in the Isle of Man, the lsle of lVlan's Life Assurance (Compensation
of Policyholders) Regulations 1991, ensure that in the event of a life assurance company being unable to
meet its liabilities to its policy owners, up to 90% of the Iiability to the protected policy owners will be
met. The protection only applies to the solvency of Zurich lnternational Life Limited and does not extend to
protecting the value of the assets held within any unit-linked funds lrnked to your policy.
Not for sale to residents or nationals of the United States including any Unrted States federally controlled territory.
Zurich lnternational Life Limited is registered (Registration No.63) under UAE Federal Law Number 6 of
2007, and its activities in the UAE are governed by such law.
Zurich lnternational Life Limited is registered in Bahrain under Commercial Regrstration No. 17444 and is
licensed as an Overseas lnsurance Firm - Life lnsurance by the Central Bank of Bahrain.

Zurich lnternational Life Limited provides life assurance, investment and protection products and is
authorised by the lsle of ltzlan Frnancial Services Authority.
Registered in the lsle of l\rlan number 20126C.
Registered office: Zurich House, lsle of l\,4an Business Park, Douglas, lsle of l\.rlan, ll422Q7, British lsles.
Telephone +44 1624 662266 Telefax +44 1624 662038 www.zurichinternational.com
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t/t!P13727 (7 19A09004) (08/18) RRD ZURICH