Group Personal Pension Plan/ Group Stakeholder Pension Plan Member s notification of a transfer value/single contribution

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1 Group Personal Pension Plan/ Group Stakeholder Pension Plan Member s notification of a transfer value/single contribution 1. Application notes This form can only be used if you re currently (whether paying contributions or not) a member of the Clerical Medical Group Personal Pension Plan or Group Stakeholder Plan. If you re currently a member of a Group Personal Pension Plan, then you joined the Clerical Medical Personal Pension Scheme. If you re currently a member of a Group Stakeholder Pension Plan, then you joined the Clerical Medical Stakeholder Pension Scheme. Please complete this notification if a transfer value or single contribution is to be paid to the Scheme and return it to Clerical Medical at: PO Box 28121, 15 Dalkeith Road, Edinburgh, EH16 9AS. 2. Personal details Plan name Member/Plan number You can get this information from your employer. Full name Address Postcode Telephone number address Occupation Country of residence Nationality Please tick if you are a foreign national National Insurance number Your National Insurance number can be found on a payslip, a P60 or a tax return and it is essential that you provide it. Without a National Insurance number, we are unable to accept contributions and cannot process your application. If you cannot find your National Insurance number, please phone HM Revenue & Customs National Insurance Registration Helpline

2 3. Amount of transfer value or single contribution Transfer value Employee single contribution (gross amount) Employer single contribution Please note: It is your responsibility to ensure that the amount you contribute does not exceed HM Revenue & Customs (HMRC) limits. Your own contributions must be paid net of basic rate tax. Clerical Medical will reclaim the difference from HMRC on your behalf. If you are a higher or additional rate taxpayer, you can reclaim the additional tax relief from your tax office. It is your responsibility to ensure that the regular and single contributions you (and/or a third party other than your employer) pay are relievable contributions. If you are unsure about whether your total contributions remain relievable, you should ask your financial adviser. Employer payments are paid gross. The value of the tax benefits of a personal pension depend on your personal circumstances. Both your circumstances and tax rules may change in the future. If you are a Scottish taxpayer the tax relief you will be entitled to will be at the Scottish rate of income tax, which may be different from the rest of the UK in the future. Transfer values Government rules allow certain individuals to protect entitlements to: tax-free cash which exceeded 25% of the value of that individual s pension fund as at 5 April 2006 and/or a lower or earlier pension age, where a right to take pension benefits at that age existed prior to 6 April This protection will be lost on transfer from one scheme to another unless the transfer is a block transfer. To be a block transfer, two or more members must transfer all sums and assets held within a scheme at the same time to a single receiving scheme. Please note that in any event you will lose tax free cash protection / protected pension age if you have already been a member of the receiving scheme for longer than 12 months before the transfer (please ensure that you check this with the receiving scheme prior to transfer). For further information please speak to your financial adviser. 2

3 4. Relievable contributions Tax relief is available on contributions to a pension plan only if you fall into one of the following categories: You have relevant UK earnings that are chargeable to income tax for the current tax year. You are resident in the UK at some time during the current tax year. You have, or your wife, husband or civil partner has, earnings for the current tax year from overseas Crown employment that are subject to UK tax. You are not currently resident in the UK but were when you joined the plan and have been at some time in the last five tax years immediately before the current tax year. Relevant UK earnings are income from employment or self-employment, or patent income in respect of inventions. Maximum contributions In a tax year, you (and/or a third party other than your employer) can pay up to 100% of your relevant UK earnings, or 3,600 if this is greater, (both these figures include tax relief) into registered pension schemes and receive tax relief. These payments are called relievable contributions. We can only accept relievable contributions into this plan. Please note: HM Treasury sets an annual allowance on the amount that can be paid into all your registered pension schemes without incurring a tax charge. It applies to all contributions you pay (or that are paid on your behalf, e.g. employer contributions and death-in-service premiums) except transfers, unrelievable contributions and pension credits following a divorce or dissolution of a civil partnership, to all registered pension schemes of which you are a member. (If you are a member of a defined benefit scheme, such as a final salary scheme, the value of the increase in your pension entitlement during the year will be counted against your annual allowance rather than the contributions you have made to that scheme.) If the total contributions to all your registered pension schemes are more than the annual allowance, you may incur a tax charge on the gross excess contribution. Higher earners will have a lower annual allowance limit, called the Tapered Annual Allowance. Your annual allowance may also be limited to the Money Purchase Annual Allowance if you have flexibly accessed a pension with another provider. Please speak to your adviser if you are unsure about how much you can pay. The Money Purchase Annual Allowance (MPAA) is currently 4,000. The MPAA applies to you if you have flexibly accessed your pensions from us or any other provider and have received any of the payments listed below from 6 April 2015 onwards: a payment from a flexible access drawdown fund (also known as a flexi-access drawdown fund); a payment from a capped drawdown fund which would exceed existing capped drawdown limits; a pension encashment (also known as an uncrystallised funds pension lump sum); a payment under a flexible annuity contract; a pension payment from a money purchase scheme which has fewer than 11 other pensioner members; a stand-alone lump sum from a money purchase arrangement where you were entitled to primary protection with a right to take a lump sum of greater than 375,000. The MPAA applies to all contributions you pay (or that are paid on your behalf e.g. employer contributions and death-in-service premiums) each year to all money purchase pension schemes of which you are a member. If the MPAA applies to you and your contributions exceed it, you will be liable to pay a tax charge based on your highest rate of income tax. The MPAA does not apply if you have taken only income from a capped drawdown plan; tax-free cash (pension commencement lump sums) when using your plan to purchase an annuity or drawdown plan; or small pots taken as a cash lump sum. In these circumstances, the higher annual allowance applies to you. Have you flexibly accessed any pensions with us or any other provider? Yes No If Yes Date of first payment (DD MM YYYY) 3

4 5. Investment instructions Please indicate your investment choice(s) below. Would you like to invest your transfer value/single contribution into the same funds as your existing policy? Yes No If No, you can choose one of the following options: Choose one Lifestyle Investment Programme, or Choose a fund(s) from our range of performance pension funds, or Choose both one Lifestyle Investment Programme and also a fund(s) from our range of performance pension funds. All instructions should be in whole percentages (minimum of 1% in any chosen fund or option). The sum of all the percentages should equal 100%. Lifestyle Investment Programmes (You can only choose one Lifestyle Investment Programme). If you re already invested in a Lifestyle Investment Programme, you must choose the same Lifestyle Investment Programme for your transfer value/single contribution. Aberdeen Adventurous Option % Balanced Option % Cautious Option % BlackRock Aggressive Lifestyle % Balanced Lifestyle % Cautious Lifestyle % If you enter 100% in one of the above boxes please ignore the rest of this section. If you do not enter anything in the above boxes, or if you enter an amount of less than 100%, please make your investment fund choice(s) below (minimum of 1% in any chosen fund or option). The sum of all the percentages should equal 100%. Investment funds With-Profits Pension Fund (unitised)* % Balanced Fund % Cautious Fund % Adventurous Fund % Non-Equity Fund % International Growth Fund % UK Growth Fund % Ethical Fund % UK Equity Income Fund % Retirement Protection Fund % UK Equity Tracker Fund % European Fund % North American Fund % Japanese Fund % Far Eastern Fund % UK Property Fund % Gilt and Fixed Interest Fund % UK Index-Linked Gilt Fund % Cash Fund % Smaller Companies Fund % Halifax Fund % Global Equity Tracker Fund % *Please note: With-Profits is only available if you are an existing member of, or a new member of, a Group Personal Pension Plan set up before 6 April Fund name Fund name % % % % % % For further information on our performance pension funds or Lifestyle Investment Programmes, please refer to our Investment options for group pensions guide, With-profits summary, or speak to your financial adviser. We may change the range of funds we make available and restrictions may apply. 4

5 6. Additional information (for transfer value only) Full name and address of administrator of transferring scheme or insurer of a Section 32 or Retirement Annuity Contract Name Address Postcode Full title of transferring scheme or contract Policy number Pension Scheme Tax Reference Number* *We don t accept transfers from non-registered schemes. Important: Your financial adviser should allow you a reflection period of 30 days before you send your transfer application to Clerical Medical. When Clerical Medical receives your application it will assume that your reflection period has already expired which means that your decision to transfer is irrevocable. You will not be given a separate notice. Have any benefits come into payment from the transferring scheme? Yes No If Yes, please give details: 5

6 7. Important Notes Please read these important notes before making your decision to apply. Data Protection Act Your information will be held by Clerical Medical which is part of the Lloyds Banking Group. More information on the Lloyds Banking Group can be found at We may ask you to provide physical forms of identity verification when you open your investment or plan. Alternatively, we may search credit reference agency files in assessing your application. The agency also gives us other details and information from the Electoral Register to verify your identity. The agency keeps a record of our search, whether or not your application proceeds. Our search is not seen or used by lenders to assess your ability to obtain credit. We will share your personal information from your application with fraud prevention agencies. If necessary a copy of the application form and any other supporting information may be given to a reassurance company who will share the risk with us. If false or inaccurate information is provided and fraud is identified, details of this fraud will be passed to these agencies to prevent fraud and money laundering. Further details explaining how information held by the fraud prevention agencies may be used can be obtained by reading the privacy notice at If you make a claim, any information you give to us, may be put onto a register of claims and shared with other insurers to prevent fraudulent claims. Your personal information will be shared within the Lloyds Banking Group so that we and any other companies in our Group can look after your relationship with us. By sharing this information it enables us to better understand your needs and provide products in the efficient way that you expect. If you apply to us for insurance, a pension or life insurance, we may ask you for some sensitive details, for example your medical history. We will only use this information to provide the service you require and we will ask for your explicit consent. It is important that you understand how the personal information you give us will be used. Therefore, we strongly advise that you read our Privacy Statement, which you can find at or you can ask us for a copy. By signing this application/declaration you agree to your personal information being used in the ways we describe in our Privacy Statement. Please let us know if you have any questions about the use of your personal information. We may record and monitor telephone calls with you in case we need to check we have carried out your instructions correctly and to help improve our quality of service. Money Laundering Under current regulations we are required to verify the identity of our customers. In order to meet this requirement and for the prevention and detection of fraud, we will access information from a credit reference agency* to confirm your identity. They will authenticate your name and address and date of birth, which involves checking the details you supply against those held on any databases that the company carrying out the checks on our behalf (or any similar company) has access to. This includes information from the Electoral Register. We will use scoring methods to authenticate your identity. Our search will not be used by lenders or insurers when assessing lending or insurance risks. We may also pass information to financial and other organisations involved in money laundering and fraud prevention to protect ourselves and our customers from theft and fraud. If you give us false or inaccurate information and we suspect fraud, we will record this and share this information with other organisations. If you provide us with information about another person, we will treat this as confirmation that they have appointed you to act for them to consent to the processing of their personal data. This means that you have informed them of our identity and the purpose for which their personal data will be processed, namely to verify their name, address and date of birth. Where Clerical Medical receives notification affecting the legal ownership of the plan, or the appointment of an attorney under a Power of Attorney or other circumstances where there are new parties associated with the contract, the same process as set out above will apply. If we cannot confirm your name, address and date of birth by using a credit reference agency we may contact you to ask you to supply certain documents to verify this information. If you ask, we will tell you which credit reference agency we have used so you can get a copy of your details from them. * We only use this agency to verify identity to fulfil anti-money laundering regulations and not to check credit worthiness. 6

7 8. Authorisation For your own benefit and protection you should read the important notes in section 7 before your sign this application. Clerical Medical will rely on these when administering your contract. If you do not understand any point please refer to your financial adviser for further information. If I am making a transfer payment: I understand that once Clerical Medical has received this completed form and the transfer payment, my decision to transfer is irrevocable. In respect of my transfer value, I consent to Clerical Medical seeking information from the administrator of the transferring scheme or the insurer of the Section 32 or Retirement Annuity Contract and to the administrator or insurer providing any such information. I authorise Clerical Medical to apply the transfer value/single contribution (delete as appropriate) in accordance with the terms and conditions of the plan and the instructions given in this notification. Lloyds Banking Group companies may use your information to contact you by mail, telephone, or text message about products and services that may be of interest to you. If you do not wish to receive this information please tick this box. Signature Date (DD MM YYYY) Full name of signatory (CAPITAL LETTERS) To be completed by the adviser Please complete this declaration, so we can release the necessary documentation. Your details Name Adviser company name FCA number Adviser declaration (Please tick the statement that applies to you) I will be advising the above member regarding the transfer of their rights to the Scheme. I will not be advising the above member regarding the transfer of their rights to the Scheme. However I confirm that I will be dealing with the sale on an execution-only basis. I understand that Clerical Medical will accept the transfer on this basis where the transfer is into the Clerical Medical Personal Pension or Stakeholder Pension Scheme and is not from a defined benefit (final salary) scheme. As such I will take full responsibility for the submission of this transfer to you and any subsequent complaint. I understand that Clerical Medical cannot be held responsible for any loss suffered by the member as a consequence of them failing to seek advice. Signature Date (DD MM YYYY) Full name of signatory (CAPITAL LETTERS) Please note: If you do not intend to deal with this case at all, or if the transfer is from a defined benefit scheme transferring into the Clerical Medical Personal Pension or Stakeholder Pension Scheme where you are dealing with the sale on an execution-only basis, please contact us in order that we can deal with the member s request accordingly. 7

8 Clerical Medical is a trading name of Scottish Widows Limited. Scottish Widows Limited is registered in England and Wales No Registered office in the United Kingdom at 25 Gresham Street, London EC2V 7HN. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services Register number G1167/0517

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