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ALLENBRIDGECARE REGISTRATION FORM - Postal Request for Change of Agency

Please complete, sign, date and post this form to Allenbridge Group plc, FREEPOST 12 LON20597, London W1E 5JD.

Important Note: Each applicant should complete, sign and submit a separate form for each fund manager with whom he/she has funds and each form must be transferred by the registered fund holder.

Personal Details (Fund Holder):
Are you an Allenbridge customer?	Account No: - if available
Your Name:	Title: Initials: Surname:
Your Address:
Postcode:	e.g. W1J 8lY
Telephone Numbers:	1. 2.
Fax Number:
E-mail Address:

Funds Belonging to Above:

Name of Plan Manager
e.g. Perpetual, Gartmore, Newton

Fund Account No.
Shown on your Fund Statement

Fund Names
please list your funds with the above Plan Manager

Fund Name:	No of Units	Dist / Acc *

* Distribution or Accumulation: Put D if you have dividend income paid to you or A if you do not and it is accumulated in the fund.