BENEFIT DISCHARGE FORM

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1 BENEFIT DISCHARGE FM For provision of flexi-access drawdown from Old Mutual Wealth Heritage pension arrangements For use by financial advisers only Please tick/complete using BLOCK CAPITALS and blue or black ink, initialling any changes you make. WITH THIS FM YOU CAN: take tax-free cash and transfer the remaining value as a flexi-access drawdown plan*. *A flexi-access drawdown plan allows you to take income which is taxed at your marginal rate. This form can be used for the following Old Mutual Wealth products EPP (Executive Pension Plan) EP1-6 (Executive Pension) EPS (Executive Pension Scheme) BB6 (Buyout Bond) DP (Director s Plan) SRP (Self-administered Retirement Plan) SAP (Self-administered Plan) ERA (Executive Retirement Account) EBP (Employee Benefits Plan) BB6 (Buyout Bond) PP1-6 ( Personal Pension) PPS ( Personal Pension) PRA ( Personal Retirement Account) PCO ( Personal Contracted-out Bond FS1-4 ( Free- Standing Pension) ACA ( Free Standing AVC Account AVC(Free Standing additional contribution scheme) NOTE Complete this form using the guidance notes at the end. Some pensions are subject to an early encashment charge and you may not get the full value of your pension. Where this applies to your plan if you are aged 55 or over, the maximum charge early encashment charge will from 1st October 2016 be capped at 1% of the plan value. If you are unsure whether this applies to you, speak to your financial adviser or contact us for more information. Alternatively, you can find out more information in your Member s Guide or policy document.! We recommend that you talk to your financial adviser before completing this form for advice about your options, any risks and tax implications involved. If you don t have an adviser and would like to find one in your area, you can find a range of options by visiting: Alternatively, the Government has set up a free and impartial guidance service called Pension Wise that will offer you: Tailored guidance (online, over the telephone or face to face) to explain what options you have and help you think about how to make the best use of your pension savings; Information about the tax implications of different options and other important things you should think about; and Tips on getting the best deal, including how to shop around. To access Pension Wise, go to Page 1 of 6

2 Please tick/complete this form as applicable using BLOCK CAPITALS and blue or black ink. A FINANCIAL ADVISER STATEMENT this statement must be completed in order for Old Mutual Wealth to carry out the instruction on behalf of the client This is to confirm that I have provided my client with advice and discussed the appropriate risks in relation to this transaction. Adviser name Firm name Signature B YOUR DETAILS Plan number Full name Address uif your address has changed within the last 12 months, we will need proof of the new address, for instance a recent original or certified copy of a bill showing the new address, eg phone, electricity, gas, water etc. but not a mobile phone bill. Contact details u in case of queries Tel no: address: NOTE Evidence of Age As this is the first time money has been taken from this pension, we must have evidence of age. Please refer to guidance notes at the back of this form for more information. Are you are taking benefits before age 55? No Go to section C Yes* What date did you leave the sponsoring employer? (ddmmyyyy) * Please note if you have not left the sponsoring employer, you are not entitled to take benefits until age 55 or until you leave the employer (see the guidance notes for further details) C YOUR INSTRUCTIONS I wish to receive the following amount of tax-free cash: i) Maximum*u the maximum is normally 25% of your pension value, unless you have a protected amount in which case it could be more or less than 25% ii) Other amount (please state): u between nil and the maximum * If you do not take the maximum amount available now, you will lose the right to take further tax-free cash from this fund at a later date. I wish to transfer the value of my pension, after the tax-free cash I have requested, as a flexi-access drawdown arrangement to : A. The Old Mutual Personal Pension Scheme using a Collective Retirement Account B. Another registered pension scheme u provide the other scheme s details in section H of this form Page 2 of 6

3 D AVAILABLE LIFETIME ALLOWANCE Part 1 We cannot process this form if this section is not completed the guidance notes at the end will help you. You must tick/complete ONE of the following: 1a I have not taken pension benefits from any provider, I have only taken pension benefits from my Old Mutual Wealth Collective Retirement Account 1b I have only taken pension benefits that started before 6 April 2006 The current annual pension I am receiving is Where this income is paid by capped income withdrawal, please show the current annual maximum income amount you are allowed to take. If you have converted your capped drawdown to flexi-access then we will need to know the maximum annual drawdown amount applicable in the pension year at the time you converted. 1c I have only taken pension benefits since 5 April 2006 The total percentage of the Standard Lifetime Allowance used up by pension benefits started after 5 April 2006 is 1d I have taken benefits both before and after 5 April 2006 The total percentage of the Standard Lifetime Allowance used up by pension benefits started after 5 April 2006 is % % The first time I took pension benefits after 5 April 2006 was (dd/mm/yyyy) Please tick one of the following: On this date I had already started taking pension benefits, and these are included in the Lifetime Allowance percentage provided above. On this date I was already receiving an annual pension of, which started before 6 April 2006 but is not included in the Lifetime Allowance percentage given above. Only complete the following if you have ever taken a scheme pension from a money purchase scheme and this is not included in any lifetime allowance figure provided above. Your financial adviser will be able to confirm whether this applies to you. Please state: (i) The purchase price of the scheme pension from the money purchase scheme. (ii) The tax-free cash lump sum taken with this. (iii) The date this occurred. Part 2 How do you want the value of any benefits above the Lifetime Allowance to be paid to you? i) as a lump sum u this will be subject to 55% tax ii) as an income uthis will be subject to 25% tax and any income payments from your resultant flexi-access drawdown arrangement will be taxed at your marginal rate u See the guidance notes for more information. Please note that the transfer of the flexi-access drawdown fund will not take place until the appropriate tax charge has been deducted in respect of any Lifetime Allowance excess E PROTECTION BENEFITS If you have registered with HM Revenue and Customs for higher Lifetime Allowance, please provide details in this section so that we can take it into account. If you do not know whether you have such protection, you should ask your financial adviser. Tick to indicate the protection required Enhanced Protection Primary Protection Fixed protection 2016 Please state your HM Revenue & Customs (HMRC) certificate number I confirm that my entitlement to protection indicated above has not been revoked u if you have protected TFC/early retirement age and you partially crystallise your CRA, you will lose the block protection and be entitled to 25% of the uncrystallised value as a tax free lump sum. Primary Protection Tax-free cash received to date Lifetime Allowance Enhancement Factor Fixed protection 2012 Individual Protection 2016 Individual Protection 2014 Fixed Protection 2014 u you must enclose a copy of the certificate if applicable, if this is the first application for protection made on our platform Tax-free cash paid Tax-free cash paid Tax-free cash paid Page 3 of 6

4 F YOUR BANK ACCOUNT DETAILS Please provide details below of the bank account into which you want us to pay your tax-free cash. NOTE The bank account must be a UK account held in your name or jointly with your spouse. We are unable to make payments to any other type of account. We will need to see proof of the bank account ownership. The proof can be a voided cheque or a copy of your bank account statement dated within the last six months (certified as a true copy by your financial adviser). If you have online bank account statements, a printed copy certified by your adviser will suffice. Bank or building society name and address u must be in the UK Bank/Building society account number Name of Bank/ building society account holder Sort code Building society roll number u if applicable G YOUR DECLARATION a) I understand that payment by Old Mutual Wealth of the tax-free cash sum, if any, and the transfer of my flexi-access income withdrawal fund to the scheme stated in this form, will end Old Mutual Wealth Life Assurance Ltd s liability to provide benefits in respect of this plan. b) I understand that where I have sufficient unused Lifetime Allowance to allow the payment of benefits in full, they will be paid without deduction of any Lifetime Allowance tax charge; c) I understand that, where I have insufficient Lifetime Allowance to allow the payment of the benefits in full without deduction of a Lifetime Allowance tax charge, Old Mutual Wealth will deduct the relevant tax charge to any excess benefits prior to the transfer of my flexi-access income withdrawal fund; d) I declare that any tax-free cash sum will not be used to fund further contributions to any registered pension scheme to the extent that either Old Mutual Wealth or I will suffer a tax liability ; e) I understand that I must comply with Old Mutual Wealth s requirements as requested of me before the benefits under the named plan can be provided. Signature Send the completed form to: Old Mutual Wealth Old Mutual House Portland Terrace Southampton SO14 7AY Tel: Page 4 of 6

5 H RECEIVING SCHEME DETAILS This section is for the details of your new pension provider TRANSFER USING OPTIONS Some pension providers use an online system to transfer pensions. This system is called OPTIONS. Tick here if the receiving scheme will carry out your request using OPTIONS u Your financial adviser will need to clarify this with the receiving scheme. Alternatively the receiving scheme can confirm to you if you contact them. If you have ticked above, the rest of section F does not need to be completed. To be completed by the new provider if OPTIONS is not being used. Receiving Scheme Name Address Pension Scheme Tax Reference (PSTR) Your reference Payment to be made by: BACS u Please provide bank details below Bank name and address Bank account holders name Bank account number Sort code By cheque payable to Signed For the Trustee/Administrator of the Receiving Scheme Print name Send the completed form to: Old Mutual Wealth Old Mutual House Portland Terrace Southampton SO14 7AY Tel: Please be aware that calls and electronic communications may be recorded for monitoring, regulatory and training purposes and records are available for at least five years. Old Mutual Wealth Life Assurance Limited is registered in England & Wales under number Registered Office at Old Mutual House, Portland Terrace, Southampton SO14 7EJ, United Kingdom. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services register number VAT number PDF4488/ /March 2018 Page 5 of 6

6 GUIDANCE NOTES A current Valuation Statement should be obtained for your Old Mutual Wealth Heritage pension. (Please note the value on this statement is not guaranteed and is subject to change.) You can only make this withdrawal after reaching your minimum pension age, which is typically 55. Where special circumstances apply, such as ill health or where you have transferred from another scheme with a protected low pension age, you may be able to take benefits before age 55. Section B Personal details Enter your details in this section. We will require proof of your residential address if it is different from the one we have on our records or has changed in the last 12 months, for example an original household bill dated within the last 6 months (mobile phone bills are not acceptable). Evidence of Age If this is the first time you have taken Tax Free Cash from the Collective Retirement Account, we must have evidence of your date of birth. We will require one of the following: your photocard driving licence your passport (Your driving licence or passport must be valid and must not have expired.) your birth certificate (If your name is currently different from your birth certificate, we will require evidence of the change of name for example your marriage certificate or change of name deed) a Confirmation of Verification of Identity (CoVI) from your financial adviser If you are making this application through a financial adviser, there is no need to send your original document to us in the post. You can provide the relevant document to your financial adviser, who can then either: declare that they have seen the appropriate evidence of your age using the option on our online system, or provide us with a certified copy of the document for our files. Section C - Payment instructions Please confirm the amount of money you would like us to deduct from your account. Section D Previous Pension Benefits Taken Only complete section D if you are receiving, or have received in the past, any benefits from any pension arrangements not including any State Pension payments. You will only need to complete one part, 1a, 1b, 1c or 1d as applicable to you. Insufficient Lifetime Allowance The Standard Lifetime Allowance is 1,030, This is the value of tax privileged pension savings each individual is allowed to make in their lifetime. Some individuals have a higher Lifetime Allowance (see Section E Protection Benefits). Any excess funds above the Lifetime Allowance that is paid as a lump sum will be liable for a tax charge of 55%. This will be deducted and paid to HMRC before the balance is paid to you. For example, if your account is valued at 500,000 and you use all of it to provide benefits and your available Lifetime Allowance is 400,000, the excess would be 100,000 and the tax charge would be 55,000. Alternatively the excess can be taken in the form of income through a flexi-access drawdown facility in which case a charge of 25% of the excess will be deducted and paid to HMRC before the flexi-access drawdown transfer can be made. Part 1a I have not taken pension benefits from any provider, or I have only taken pension benefits from my Old Mutual Wealth Collective Retirement Account Select this option if you have never taken pension benefits with any provider all of your crystallised pension savings are held in Collective Retirement Accounts with Old Mutual Wealth. We will then use the information we hold in respect of your Lifetime Allowance usage. Crystallised means that the amount concerned has been set aside to provide pension benefits. Part 1b I have only taken pension benefits that started before 6 April 2006 If you have only taken pension benefits that started before 6 April 2006, and have not taken any other pension benefits since then, please complete part 4b. Complete the total annual pension payable to you currently. If this pension is from a capped income withdrawal arrangement we need to know the maximum annual gross income you are allowed to take each year. If you have converted your capped drawdown to flexi-access then we will need to know the maximum annual drawdown amount applicable in the pension year at the time you converted. If in doubt about this figure check with the pension provider or your financial adviser. Part 1c I have only taken pension benefits since 5 April 2006 If you have taken benefits since 5 April 2006, please complete part 1c. The pension provider will have given you a letter showing you the percentage of the Standard Lifetime Allowance used up when you started to take pension benefits after this date. Please state the total percentage of the Standard Lifetime Allowance used to date in respect of pension benefits started after 5 April 2006 this should be stated to 2 decimal places. Part 1d I have taken benefits both before and after 5 April 2006 Please state the total percentage of the Standard Lifetime Allowance used up when you started to take pension benefits after this date (as outlined above in Part 1c). If you are also receiving a pension that started before 6 April 2006, please tell us how much it was paying you when you first took other pension benefits after 5 April For example, if the first pension benefit you took after 5 April 2006 was on 5 June 2007, and at that date the value of a pension you started to take in 2005 was paying you 10,000 per year, you would enter 5 June 2007 and 10,000. Section E Protection Benefits If you have claimed Lifetime Allowance Protection (ie Enhanced, Primary or Fixed Protection 2012, Fixed Protection 2014, Individual Protection 2014, Fixed Protection 2016, Individual Protection 2016 or a Lifetime Allowance Enhancement Factor.) please complete this section and supply a copy of your Certificate of Lifetime Allowance Protection if applicable provided by HM Revenue & Customs (HMRC) or a certified copy. Section F Bank details We need to know the bank account you want the lump sum to be paid into. We will need to see proof of the bank account ownership. The proof can be a voided cheque or a copy of your bank account statement (certified as a true copy by your financial adviser). If you have online bank account statements, a printed copy certified by your adviser will suffice. Section G Client Declaration This section is for you to sign, declaring that you understand and agree various points. The information given on this form is based on our understanding of pension and taxation legislation. Old Mutual Wealth Life & Pensions Limited does not accept any liability for any loss arising from the misunderstanding of the information provided or omissions therein. All benefits are payable in accordance with the Terms and Conditions of the Collective Retirement Account available from To make a false statement knowingly may be considered tax evasion by HMRC and could result in legal action against you. Please be aware that calls and electronic communications may be recorded for monitoring, regulatory and training purposes and records are available for at least five years. Old Mutual Wealth Life Assurance Limited is registered in England & Wales under number Registered Office at Old Mutual House, Portland Terrace, Southampton SO14 7EJ, United Kingdom. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services register number VAT number PDF4488/ /March 2018 Page 6 of 6

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