Registered Pension Schemes Dependant s Benefit Election Form. Form

Transcription

1 Registered Pension Schemes Dependant s Benefit Election Form Form

2 Policyholder/Member details (Office use) Policyholder/Member Policy number(s) Scheme name Electing a benefit option Please read the enclosure, Dependant s Pension Benefit Options, and select the required option by ticking the appropriate box, completing and returning the sections / forms requested. Option 1 Dependant s Lifetime Annuity with Canada Life Limited (Canada Life) Please complete and return (and tick below, to indicate you have enclosed the completed sections / forms): Application for a Dependant s Lifetime Annuity pages 3, 4, 5 & 6. Option 2 Open Market Option purchasing a lifetime annuity with an alternative provider Please complete and return (and tick below, to indicate you have enclosed the completed sections / forms): Instruction to pay fund(s) to an alternative provider, pages 7 & 8. A copy of the quotation, together with any application form that the alternative provider needs us to complete. General requirements The following ticked documents are required, please tick to indicate you have enclosed them. Required Enclosed All applicants proof of your date of birth and any change of name (including marriage, civil partnership or deed poll) Identity verification requirements form to protect you and us from financial crime we will need you to confirm your identity before making a claim. If you have not sent this to us already we will require you to provide identification from the separate list enclosed. We may also use reference agencies to search sources of information about you (an identity search). This will not affect your credit rating. 2

3 Option 1 Application for a Dependant s Lifetime Annuity HM Revenue & Customs Statement It is a serious offence to make a false statement. The penalties are severe and could lead to prosecution. Please complete in block capitals and tick small boxes where appropriate 1. Canada Life policy number(s) 2. Personal details of surviving spouse/ civil partner/financial dependant Title Surname Forenames Main residential address (including postcode) Telephone numbers Home Business Mobile address Date of birth (day, month, year) Sex Male Female National Insurance number (Please note that evidence of age, marriage, civil partnership will be required as stated on page 2.) 3. Basis of the annuity and payment details Personal Example reference number: The annuity payments are to be made to: (Bank/Building society name and address, including postcode) This must be an account of which the applicant is the sole or joint account holder Please enter the Personal Example reference number of the illustration which you wish to form the basis of the annuity contract. This is on the top lefthand side of the Personal Example. The Personal Examples you have received are not guaranteed. They are for information purposes only as prices fluctuate on a daily basis. Account number (must be 8 digits, including any leading zeros) Roll number (for building society accounts) Account holder s name Sort code (on your cheque book) If payments are to be made to an account outside of the UK, please complete the payment form on page 9. 3

4 Option 1 Application for a Dependant s Lifetime Annuity 4a. Adviser remuneration/payment to your professional adviser Do you want Canada Life to deduct the payment of an adviser charge to pay your professional adviser for advice in respect of this application? If Yes, please complete 4b below Canada Life is only able to deduct and pay an adviser charge for advice or services given to you by your professional adviser if it is wholly connected to the purchase of this annuity and is appropriate to the advice and service the adviser has provided you with in relation to this annuity purchase. Yes No If this is not the case then some or all of the adviser charge may become liable to a tax charge, which you may be responsible for. 4b. Adviser charge How much would you like Canada Life to deduct from the purchase money? Percentage of total purchase money % or Monetary amount Important information adviser charges Whether Canada Life choose to deduct and pay any adviser charge is at our discretion and we will notify you in the event we decide not to. There may be instances where Canada Life may need to query the level of adviser charge with your adviser, in which instance we will notify you and get further instructions from you. If you cancel before your annuity is issued or if you complete and return the cancellation notice then the money returned to the pension policy will include any adviser charge you have asked us to pay. Canada Life will reclaim any payments from your professional adviser. Depending on the agreement between you and your professional adviser, you may have to settle any outstanding fee directly with your adviser. 4c. Commission payments If advice has not been given in respect of this annuity purchase your intermediary may have agreed with you to receive commission for the services provided. Initial commission agreed with your intermediary and as shown on the attached Personal Example % or Monetary amount 4

5 Option 1 Application for a Dependant s Lifetime Annuity (continued) 5. Data protection notice Any personal information you may provide to Canada Life Limited, (referred to as the Company in this notice) as data controller will be treated in accordance with the Data Protection Act By signing this form you consent to the Company using and sharing your personal information as set out in this notice including, without limitation, the processing of personal sensitive data. If submitting personal information about another person, by signing this form you confirm that you have their consent to provide such information to the Company and for their information to be used as set out in this notice. Using personal information The Company uses personal information to undertake any activity relating to its policies, products and services and, where relevant, to process applications, set up and administer policies, products and services and handle any claims. Given the global nature of Canada Life s business, it may be necessary to transfer information to countries outside the European Economic Area ( EEA ) in order to provide Canada Life s services. Sharing personal information The Company may share personal information: with other Canada Life companies including those outside the European Economic Area; with any of its or their service providers, reinsurers and regulators; with other insurers; with other companies, organisations and associations and/or credit reference agencies in order to prevent, detect or investigate financial crime or fraud; for employer-related products and services, with the employer, the trustee(s) and their agents; and/or in any circumstances if permitted or required to do so by law or if the Company has consent to do so. Accessing personal information A person whose personal information is held by the Company has various rights including the right to: have any incorrect personal information corrected; and/or access the personal information the Company holds for which a fee may be charged. To do so and/or if you need more information, please contact the Company at: Canada Life Limited Customer Service Department Canada Life Place Potters Bar Hertfordshire EN6 5BA. 6. Your declaration I would like to use the deceased s fund to buy a dependant s annuity with Canada Life. Where you have asked me to give you the deceased s original policy document(s) and I am unable to do so, I promise to accept responsibility for any claims, losses and expenses of any nature which you may incur as a result of having set-up the dependant s annuity. I agree that the payment made as requested shall discharge Canada Life of its obligation to make payments under the policy numbers in this application that have been issued by Canada Life. Please note, for the avoidance of doubt this release shall not prevent you from bringing any claim for any act or omission by Canada Life that is not related to Canada Life s obligation to make payments under the policy. I confirm that any adviser charge paid on my behalf by Canada Life on the initial set-up of this annuity: is wholly connected to the purchase of this annuity; and is appropriate to the advice and service my adviser provided me in relation to this annuity purchase. If this is not the case then some or all of the adviser charge may become liable to a tax charge, which I may be responsible for. I confirm that I have read the data protection notice and am satisfied that my personal information will be handled appropriately, in accordance with the notice. Your Dependant s Annuity with Canada Life Once this application has been accepted by us, we will tell you the actual amounts of money that you will receive. We will set up a new policy for the purposes of paying the income to you which you cannot cancel or exchange for a lump sum. To protect you and us from financial crime, we may need to confirm your identity from time to time. We may do this by using reference agencies to search sources of information about you (an identity search). This will not affect your credit rating. If this identity search fails, we may ask you for documents to confirm your identity. I consent to any adviser charge deductions as set out in the Adviser remuneration part of this application form. Signature of surviving spouse/civil partner/ financial dependant Date (day, month, year) 5

6 Option 1 Application for a Dependant s Lifetime Annuity (continued) 7. Professional adviser details For FCA reporting requirements please give the basis of sale or service in relation to this application Advised Independent Restricted Simplified Basic Non-advised No advice Execution only Commission (unavailable if the basis of sale is advised) Agency number if known (You will find this on your commission / adviser charge statement) L Professional adviser firm Name of person submitting the application Address including postcode Postcode Telephone number Fax number address Regulatory body Are you part of a network or national firm? If so please provide the name FCA number Tick the box if this is the first time you have placed business with Canada Life? If you have ticked the box to obtain our terms of business application form either phone us on or annuitybusiness@canadalife.co.uk How would you like to be contacted? /Phone/Fax 6

7 Option 2 Open Market Option purchasing a dependant s lifetime annuity with an alternative provider HM Revenue & Customs Statement It is a serious offence to make a false statement. The penalties are severe and could lead to prosecution. Please complete in block capitals and tick small boxes where appropriate 1. Canada Life policy number(s) 2. Personal details Title Surname Forenames Main residential address (including postcode) Telephone numbers Home Business Mobile address Date of birth (day, month, year) Sex Male Female National Insurance number 3. Destination of the fund Full name of new provider Annuity/membership number New provider s address (including postcode) Postcode SCON number of new scheme (if protected rights) Bank/Building Society name and address (including postcode) Postcode Bank/Building Society account number Roll number (for building society accounts only) (must be 8 digits, including any leading zeros) Account name Sort code A copy of the quotation, together with any application form from the new provider is enclosed Yes No Canada Life needs to see the quotation to make sure that the lifetime annuity to be purchased with the new provider is acceptable. 7

8 Option 2 Open Market Option purchasing a lifetime annuity with an alternative provider (continued) 4. Data protection notice Any personal information you may provide to Canada Life Limited, (referred to as the Company in this notice) as data controller will be treated in accordance with the Data Protection Act By signing this form you consent to the Company using and sharing your personal information as set out in this notice including, without limitation, the processing of personal sensitive data. If submitting personal information about another person, by signing this form you confirm that you have their consent to provide such information to the Company and for their information to be used as set out in this notice. Using personal information The Company uses personal information to undertake any activity relating to its policies, products and services and, where relevant, to process applications, set up and administer policies, products and services and handle any claims. Given the global nature of Canada Life s business, it may be necessary to transfer information to countries outside the European Economic Area ( EEA ) in order to provide Canada Life s services. Sharing personal information The Company may share personal information: with other Canada Life companies including those outside the European Economic Area; with any of its or their service providers, reinsurers and regulators; with other insurers; with other companies, organisations and associations and/or credit reference agencies in order to prevent, detect or investigate financial crime or fraud; for employer-related products and services, with the employer, the trustee(s) and their agents; and/or in any circumstances if permitted or required to do so by law or if the Company has consent to do so. Accessing personal information A person whose personal information is held by the Company has various rights including the right to: have any incorrect personal information corrected; and/or access the personal information the Company holds for which a fee may be charged. To do so and/or if you need more information, please contact the Company at: Canada Life Limited Customer Service Department Canada Life Place Potters Bar Hertfordshire EN6 5BA. 5. Declaration I would like to use the deceased s fund to buy a dependant s annuity with the new provider shown in Section 3 of this application. Where you have asked me to give the deceased s original policy document(s) and I am unable to do so, I promise to accept responsibility for any claims, losses and expenses of any naure which you may incur as a result of having transferred the funds. I agree that the payment made as requested shall discharge Canada Life of its obligation to make payments under the policy numbers in this application that have been issued by Canada Life. Please note, for the avoidance of doubt this release shall not prevent you from bringing any claim for any act or omission by Canada Life that is not related to Canada Life s obligation to make payments under the policy. I confirm that I have read the data protection notice and am satisfied that my personal information will be handled appropriately, in accordance with the notice. Signature of surviving spouse/civil partner/ financial dependant Date 8

9 Bank account details if resident outside the UK Please complete in block capitals. 1. Personal details Name(s) Policy number National Insurance number Date of birth (day, month, year) Correspondence address 2. Bank details Your name as it appears on your bank account Currency of your bank account Payments will be remitted in local currency wherever possible or in GBP unless otherwise specified. Your account number or IBAN Name of your bank Bank address National clearing code BIC code / SWIFT address Signature Date (day, month, year) 9

10 Your right to think over your options Date Personal Example Reference number Warning You have a period of 30 days from the date your policy is issued to change your mind. After this 30 day period you cannot change your mind. Do you know what your pension options are? Any one company can offer you a wide choice of pension arrangements to suit your circumstances. The Key Features document will explain some of the options. If you want to go ahead what do you do? Fill in the application and send it to Canada Life Limited. If you change your mind after sending in the application, but within the 30 day period, you should inform Canada Life by sending in the slip below or alternatively by writing to us. If you want other pension options to consider what do you do? You contact your adviser, Canada Life or any other provider you choose for alternative quotes. Should you change your mind after sending in the application In all circumstances, you have 30 days from the date your policy is issued to change your mind. There are no other charges or deductions for changing your mind. Do you know how much the advice you have received will cost? If your adviser is paid by Canada Life as a result of your accepting this offer, you will find details in the Personal Example. Cancellation notice To be returned only if you have submitted an application form and you wish to cancel that application. To: Annuity New Business Department, Canada Life Limited I have decided not to proceed with this policy. If you received any money from the purchaser, please return it. Signed Date Name Address This relates to Personal Example Reference number Postcode Canada Life Limited, registered in England no Registered office: Canada Life Place, Potters Bar, Hertfordshire EN6 5BA. Telephone: Fax: Member of the Association of British Insurers. Canada Life Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. CSD R