TO BE COMPLETED BY THE VENDOR (WHETHER PRODUCT PRODUCER OR INTERMEDIARY).
Name of Consumer to whom a non-Standard PRSA has been offered or recommended: (Print name in block capital letters)
Name of Non-Standard PRSA offered to the Consumer:
Name of Non-Standard PRSA Product Producer:
- I declare that I have explained to this consumer that there are differences between a Non-Standard PRSA and Standard PRSA, and focused on the fact that the charges may be higher and the investment risks are greater for this non-Standard PRSA.
- I declare that in my opinion it is in the best interest of the above named consumer to purchase this non-Standard PRSA.
- I declare that in my opinion the non-Standard PRSA I have offered/recommended to the above named consumer is the PRSA product most suited to this consumer from among all those I am able to provide.
Signature of Salesperson:
Name of Salesperson (in block capitals):
Name of Regulated Entity:
Date of completion of the declaration: