Section Do I need to complete this section? Page. 1. About your Financial Adviser Yes. 2

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1 Form Beacon House, 27 Clarendon Road, Belfast BT1 3BG You re on your way to a more certain retirement with the. It s important you complete all relevant sections of this form to apply. The checklist on this page will help guide you through the sections you need to complete. You should take time to answer the questions fully, clearly and accurately to prevent any delay to your application. If you are unsure about anything, your Financial Adviser is there to help you. The detail in this application must match your selected illustration. Please provide the MetLife illustration reference number which this application form relates to: How to complete this form Section Do I need to complete this section? Page 1. About your Financial Adviser Yes Your contributions Only if you or anyone else will be making contributions to your policy Transferring benefits Only if you are transferring any existing pension funds into your Retirement Portfolio Your investments Yes Taking retirement benefits 6. Money purchase annual allowance and lifetime allowance Only if you want to take any retirement benefits when your plan is set up. Yes Your beneficiary/beneficiaries Yes Adviser charging You must complete and sign this section if you want MetLife to make any payments to your Financial Adviser for advice they have given you Verifying your identity No - your Financial Adviser must complete and sign this section Declarations - Financial Adviser No - your Financial Adviser must complete this section Declaration - Policyholder Yes, you must read this section and sign page 24. If a Power of Attorney is signing on your behalf they must complete their details and sign in section What to do next Yes - you must complete the attachment checklist. 26 Important note for US citizens and residents Unfortunately this product isn t available to US Citizens and US residents. Please speak to your Financial Adviser for other options. If you become a US Citizen or a US resident after completing this application, you must let us know immediately. Page 1 of 28

2 1 About you and your Financial Adviser Applicant details Title Mr Mrs Miss Ms Other - please specify First name(s) Surname Date of birth Sex National Insurance Number Nationality D D M M Y Y Y Y Male Female Marital Status Single Married Civil Partnership Widowed Divorced Dissolved Civil Partnership Permanent residential address Phone number address Employment Status Employed Self-Employed Unemployed Retired Pensioner Caring for a person under the age of 16 Caring for a person over the age of 16 In full time education Current gross annual income Intended retirement age Your intended retirement age does not affect your right to start taking benefits from age 55. If you leave this box blank, and have not started taking benefits before you turn 75, we will write to you shortly before your 75th birthday. If you are 75 or older when you submit your application and have not taken benefits, we will write to you five years after receipt of this application. Financial Adviser details Title Mr Mrs Miss Ms Other - please specify Name(s) Business name Business address Phone number address Page 2 of 28

3 About you and your Financial Adviser - Applicant details continued... FCA Firm Reference Number FCA Individual Reference Number If you are part of a Financial Adviser network, please provide details below. Financial Adviser network FCA Network Firm Reference Number Business address Phone number Page 3 of 28

4 2 Your contributions Will you or anyone else be making contributions to your policy? Yes - please complete the below No - please go to section Single contributions We cannot accept any contributions which are not fully entitled to UK tax relief. You should provide gross figures for all employer contributions. Applicant and 3rd party contributions will be net of basic rate tax. Amount From Payment method Applicant 3rd Party Employer Electronic transfer Cheque Applicant 3rd Party Employer Electronic transfer Cheque Applicant 3rd Party Employer Electronic transfer Cheque 2.2 Regular contributions We cannot accept any contributions which are not fully entitled to UK tax relief. You should provide gross figures for all employer contributions. Applicant and 3rd party contributions will be net of basic rate tax. Amount Frequency Date How much would you like to invest each time? Applicant (net) Monthly Every 4 months Annually Quarterly Every 6 months 1st 7th 14th 21st M M Y Y Y Y Employer (gross) Monthly Every 4 months Annually Quarterly Every 6 months 1st 7th 14th 21st M M Y Y Y Y Third party (net) Monthly Every 4 months Annually Quarterly Every 6 months 1st 7th 14th 21st M M Y Y Y Y If contributions are being paid by, or via your employer, your employer must complete an employer contribution schedule and send it with this application form. Your Financial Adviser will be able to provide you with this document. We will not start to collect regular contributions until we have received a transfer or single contribution. If your contribution date falls on a non-working day, it will be collected on the next working day. Regular contributions must be paid by Direct Debit. You will need to complete a separate Direct Debit form for each payment source. Direct Debit information can be found at the back of this form. Page 4 of 28

5 Your contributions continued Payer information You should complete this section if contributions are being made by someone other than yourself. If you have more than one employer or third party wishing to make contributions, please copy this page and make note of the amount each party will be contributing. If your employer is not a limited company, we will need documentary evidence of the existence of the employer and the permanent address for anti-money laundering purposes (please see section 9.2 for more details). Employer contributions Employer name Payer occupation/type of business Employer address Third party contributions Third party contributions will be treated as your contributions for tax purposes. Title Mr Mrs Miss Ms Other - please specify First name(s) Surname Address Relationship to applicant National Insurance Number Nationality Approximate annual earnings OR Organisation name Payer occupation/type of business Address Relationship to applicant Page 5 of 28

6 3 Transferring benefits Are you transferring any existing pension funds into your? Yes - please complete below No - please go to section 4 Please provide details below of the pension scheme you want to transfer benefits from. We will notify you when each transfer is complete, or if you need to do anything else. We require funds and information from the transferring scheme, therefore the process may take several weeks. If you need to provide details of more than two transfers, please copy this page. Please read the transferring benefits declarations in section 11.4 and sign this application. 3.1 About the transferring scheme Transfer Scheme Details of Transferring scheme name Policy number Contact name Contact number Transferring scheme address Postcode Is this an Occupational Pension Scheme? Yes No If Yes is it a Defined Benefit Scheme, or a Section 32 Buy Out that originated from a Defined Benefit Scheme? Yes No Transfer value Full transfer Partial transfer Is this transfer in drawdown? Capped drawdown Flexi-access drawdown No Does any part of the fund you are transferring relate to the pension benefits you have received from an ex-spouse or civil partner on divorce or dissolution of the partnership? Yes No If Yes, was any part of your ex-spouse s or civil partner s pension already being paid? Yes No Is there an Earmarking order? We require certified copies of Earmarking orders. Yes - please provide a copy No Declaration If I have provided details of more than one transfer of (an) existing pension fund(s) that I wish to transfer into the MetLife Retirement Portfolio, I acknowledge that by signing the declaration on page 24 of this application form, such declaration applies to each individual transfer. Page 6 of 28

7 Transferring benefits continued... Please read the transferring benefits declarations in section 11.4 and sign this application. Transfer Scheme Details of Transferring scheme name Policy number Contact name Contact number Transferring scheme address Postcode Is this an Occupational Pension Scheme? Yes No If Yes is it a Defined Benefit Scheme, or a Section 32 Buy Out that originated from a Defined Benefit Scheme? Yes No Transfer value Full transfer Partial transfer Is this transfer in drawdown? Capped drawdown Flexi-access drawdown No Does any part of the fund you are transferring relate to the pension benefits you have received from an ex-spouse or civil partner on divorce or dissolution of the partnership? Yes No If Yes, was any part of your ex-spouse s or civil partner s pension already being paid? Yes No Is there an Earmarking order? We require certified copies of Earmarking orders. Yes - please provide a copy No Declaration If I have provided details of more than one transfer of (an) existing pension fund(s) that I wish to transfer into the MetLife Retirement Portfolio, I acknowledge that by signing the declaration on page 24 of this application form, such declaration applies to each individual transfer. Page 7 of 28

8 4 Your investments Please indicate below the investments you have selected for your Retirement Portfolio. All investments must be in whole percentages. If you have selected the Secure Capital Option (SCO) or Secure Income Option (SIO) the minimum investment is 5,000 per portfolio. If selecting the Secure Income Option or the Secure Capital Option, all contributions and transfers received within 10 weeks of receipt of your application will have the same review dates (being a year after the first transfer or single contribution is received). Regular contributions cannot be invested in the Secure Capital Option. Please give alternative instructions. If you do not, we will invest them in the same portfolio but without the guarantee. Guaranteed investments Guaranteed Portfolio - Secure Capital Option Date/Term Singles/Transfers MetLife Managed Wealth Portfolio - Foundation MetLife Managed Wealth Portfolio - Min MetLife Managed Wealth Portfolio - Mid MetLife Managed Wealth Portfolio - Max % % % % Guaranteed Portfolios - Secure Income Option Regulars Singles/Transfers MetLife Managed Wealth Portfolio - Foundation % % MetLife Managed Wealth Portfolio - Min % % Other investments Protected Growth Funds Regulars Singles/Transfers MetLife Protected Growth Fund 90% % % MetLife Protected Growth Fund 80% % % MetLife Protected Growth Fund 70% % % Other Portfolios (non guaranteed) Regulars Singles/Transfers MetLife Managed Wealth Portfolio - Foundation % % MetLife Managed Wealth Portfolio - Min % % MetLife Managed Wealth Portfolio - Mid % % MetLife Managed Wealth Portfolio - Max % % MetLife Defensive Managed Portfolio % % MetLife Conservative Managed Portfolio % % MetLife Cautious Managed Portfolio % % MetLife Balanced Managed Portfolio % % MetLife Aggressive Managed Portfolio % % MetLife Defensive Index Portfolio % % MetLife Conservative Index Portfolio % % MetLife Cautious Index Portfolio % % MetLife Balanced Index Portfolio % % MetLife Aggressive Index Portfolio % % MetLife Fidelity Cash Fund % % TOTAL (Must add up to 100%) 100% 100% Page 8 of 28

9 Your investments continued Secure Income Option If you have chosen the Secure Income Option would you like it on a single or joint life basis? Not applicable - please go to section 5 Single life - please go to section 5 Joint life - please complete the below By selecting joint life, the Secure Income Option will continue for your nominated joint life following your death. Once this decision has been made it cannot be changed. This applies to all investments into the Secure Income Option funds detailed in this application form. Title Mr Mrs Miss Ms Other - please specify First name(s) Surname Date of birth Sex National Insurance Number D D M M Y Y Y Y Male Female Permanent residential address Relationship to you Spouse Civil Partnership Partner Other Page 9 of 28

10 5 Taking retirement benefits 5.1 Do you want to take any retirement benefits when your plan is set up? Yes - please complete below No - please go to section How do you want to take your retirement benefits? Flexi-access drawdown - please go to section 5.3 and complete sections 5.4 and 5.5 if applicable Capped drawdown (only if already in capped drawdown) - please go to section 5.5 Uncrystallised Funds Pension Lump Sum - please go to section 5.6 Phased drawdown - please go to section 5.7 We can only pay benefits upon receipt of sufficient cleared funds. If your requested date cannot be met, for example if it falls on a weekend, we will aim to pay you on the nearest working day prior to that date. These instructions will apply to any options you have selected in this section. 5.3 Would you like a full or partial drawdown? Full drawdown Partial drawdown A percentage An amount % From All funds SIO funds SCO funds Non SIO or SCO funds Specific funds If you select an amount, we may not be able to pay your benefits until all transfers have been received. 5.4 Would you like to take a Pension Commencement Lump Sum? PCLS Pension Commencement Lump Sum (PCLS) Maximum PCLS A percentage % Payment will be based on the specified percentage for each transfer going into drawdown. From All funds SIO funds SCO funds Non SIO or SCO funds Specific funds An amount If you select this option, we may not be able to facilitate payment until all transfers have been received. Page 10 of 28

11 Taking retirement benefits continued Do you want to take an income? How much? Which are invested in Frequency INCOME or or % of guaranteed income pa Max GAD (if capped drawdown) If you are currently in capped drawdown and request an income higher than your GAD maximum, you will convert to flexi-access drawdown and will be subject to the money purchase annual allowance. All funds SIO funds SCO Non SIO or SCO funds A specific fund or drawdown arrangement - please outline below and include any reference date for a capped drawdown arrangements Monthly Quarterly Termly Half yearly Annually Unless you specify a date in the future below, we will pay the income into your account as soon as it is available. D D M M Y Y Y Y We ll deduct the money from your policy up to four days before this. 5.6 Do you want to take an Uncrystallised Funds Pension Lump Sum? If you would like to take part of your fund as a UFPLS, a minimum of 5,000 must be left in the policy. How much? Which are invested in Frequency UFPLS This should be the target amount before tax of the Fund Value % or All funds SIO funds SCO Non SIO or SCO funds A specific fund or drawdown arrangement - please outline below and include any reference date for a capped drawdown arrangements One off payment Regular annual payment D D M M 5.7 Do you want to take phased drawdown? You have the option to use your pension fund to provide a target income by crystallising some of your fund each year. Your phased drawdown instruction will only be established once we have received all contributions and/or transfers. If the contributions and/or transfers are not received within 10 weeks of your application we will contact you again for further instructions. Your instruction will only apply to contributions and transfers shown on this form that are not already in drawdown. Page 11 of 28

12 Taking retirement benefits continued... PHASED PCLS/INCOME How much? (This should be the annual target amount before any tax) pa Taken from: PCLS only PCLS and the maximum guaranteed income PCLS and income Which are invested in All funds SIO funds SCO Non SIO or SCO funds A specific fund or drawdown arrangement - please outline below and include any reference date for a capped drawdown arrangements I would like the payment to arrive annually in my account on: D D M M We ll deduct the money from your policy up to four days before this. 5.8 Payment details To allow us to pay your income and/or lump sum, please complete the below. Name of bank or building society Address Name(s) of account holder(s) Sort code Account number Building Society roll number (if applicable) Page 12 of 28

13 6 Money purchase annual allowance and lifetime allowance 6.1 Your money purchase annual allowance Are you subject to the money purchase annual allowance? Yes No If yes, please specify the date this was triggered. 6.2 Your lifetime allowance Are you starting to take benefits from any part of your fund for the first time? Yes - please complete the rest of section 6 No - please go to section 7 If, when I take my benefits, the value of my pension fund exceeds my remaining lifetime allowance entitlement, I want the excess fund: Paid to me as a lump sum, less the appropriate tax charge To provide me with an income after the appropriate tax charge has been deducted. 6.3 Protection Please check with your Financial Adviser before you fill in this section. If you have registered for protection, please enclose a copy of the certificate you received from HMRC. Have you registered for protection with HMRC? No - go to section 6.4 Yes - please tick the appropriate box below Primary Protection Any other Lifetime Allowance Enhancement Factor Enhanced Protection Individual Protection Fixed Protection Can you confirm that your Enhanced/Fixed Protection is still valid? Yes No If you have Primary Protection, has any Pension Commencement Lump Sums (PCLS) been paid to you since 6 April 2006? Yes - Please complete details below No - Go to section 6.4 Date of PCLS payment Amount of PCLS payment D D M M Y Y Y Y Date of PCLS payment Amount of PCLS payment D D M M Y Y Y Y Date of PCLS payment Amount of PCLS payment D D M M Y Y Y Y Page 13 of 28

14 Money purchase annual allowance and lifetime allowance continued Use of your lifetime allowance Did you take any pension benefits (excluding State pensions) before 6 April 2006? Yes No Is this the first time you are taking pension benefits (excluding State pensions) since 5 April 2006? Yes No - how much of your lifetime allowance have you used? % You would have been advised of this when your benefits came into payment. If you answered Yes to both questions please fill in the details below so we can work out what percentage of the lifetime allowance you have used. The current yearly amount before tax of all the pensions you receive (excluding State pensions) The current yearly income limit for any drawdown pension from all of your pension schemes. We need to know the maximum amount you could take rather than the amount you actually take. The information you give us in this section will help us establish if you will pay a lifetime allowance charge when we pay your benefits. We will notify you of the amount of lifetime allowance you use. If you are aged 75 or over we may need to contact your Financial Adviser for additional information. 6.5 If, when I take my benefits, the value of my pension fund exceeds my remaining lifetime allowance entitlement, I want the excess fund Paid to me as a lump sum, minus the appropriate tax charge To provide me with an income after the appropriate tax charge has been deducted Page 14 of 28

15 7 Your beneficiary/beneficiaries Please fill in this section to let us know who you would like us to pay benefits to upon your death. If you would like to nominate more than two beneficiaries please provide details on a separate sheet. Total percentage of each beneficiaries share must equal 100% in total for all the pages you supply. First beneficiary Title Mr Mrs Miss Ms Other - please specify First name(s) Surname Date of birth Sex National Insurance Number D D M M Y Y Y Y Male Female Permanent residential address Relationship to you Percentage share % Second beneficiary Title Mr Mrs Miss Ms Other - please specify First name(s) Surname Date of birth Sex National Insurance Number D D M M Y Y Y Y Male Female Permanent residential address Relationship to you Percentage share % Changing your Beneficiaries The payment of any death benefit is at the complete discretion of the Scheme Trustee. The Scheme Trustee will refer to your latest nominations and keep your wishes in mind when they are notified of your death. We recommend you review your beneficiaries from time to time, especially if your circumstances change. You can let us know about any changes to your chosen beneficiaries by writing to us or completing a Beneficiary Nomination form. Page 15 of 28

16 8 Adviser Charging Do you want MetLife to make any payments to your Financial Adviser for advice they have given to you in relation to this application? Yes - please read the important information in section 8.1, complete section 8.2 and sign the confirmation in section 8.3 No - please proceed to section Important information about Adviser Charging MetLife will facilitate Adviser Charges on your behalf in accordance with its terms and conditions, details of which can be found in our current Charges Booklet copies of which are available from MetLife using the contact details on the back page of this form. MetLife monitors the level of Adviser Charges paid from its policies, and reserves the right not to facilitate an Adviser Charge if it considers that the payment requested would have a detrimental effect upon your investment, such that the MetLife product that you are invested in would no longer perform in accordance with its design. The amounts in section 8.2 below must match the selected illustration indicated on the front page of this application form. 8.2 Adviser Charging If you do not provide full details here, MetLife will not be able to make any payments to your Financial Adviser. Please note that MetLife cannot take payment details from your illustration. Initial Adviser Charge or % of single contributions and transfers only (after deduction of any PCLS or UFPLS). If you are using this application form to make more than one investment from different sources into your MetLife Retirement Portfolio (whether by way of multiple transfers or a combination of a single contribution and a transfer), MetLife will facilitate the relevant amount of Initial Adviser Charge for each investment received at the time such monies are received by MetLife. If you choose a monetary amount for an Initial Adviser Charge, MetLife will split such amounts proportionately by value across the different investments listed in this form (using the transfer values indicated by you in section 3.1). This means that if a contribution or transfer listed in this form does not arrive, the amount of Initial Adviser Charge facilitated will not match your requested amount. If you do not complete the estimated amounts in section 3.1, this will delay the facilitation of Adviser Charges. Ongoing Adviser Charge Please indicate the amount of the payment you wish us to make, how often you would like us to make this payment and from which investments you would like the payment to be made. % or of full fund value, to be taken: Monthly Quarterly 4 Mths 6 Mths Annually from the following investments: One option must be ticked If you don t tick an option we ll assume you are going with option A and want to pay adviser charges from all investments A. Please pay ongoing adviser charges from all investments. This will include any new funds invested into my Retirement Portfolio in future. Payments from Secure Income or Secure Capital Investments will proportionately reduce the guaranteed benefits. B. Please pay ongoing adviser charges from my Protected Growth Funds and Non-Guaranteed Investments. If there is not enough money in these funds, or I have initially decided not to invest in them, the payments will be made from my Secure Income and/or Secure Capital Investments proportionately reducing the guaranteed benefits they provide, until additional monies are paid into the Protected Growth Funds and/or Non-Guaranteed Investments. Page 16 of 28

17 Adviser charging - Initial adviser charge continued Confirmation Please sign below to confirm you have read and understood the important information in this section 8, agreed the amounts stated in section 8.2 with your Financial Adviser and to confirm your instruction to MetLife to facilitate such amounts on your behalf. By signing below you also agree that: a. MetLife may set off any Adviser Charges that instruct MetLife to facilitate against any amount that your Financial Adviser owes to MetLife provided that your Financial Adviser has agreed that you will no longer be obliged to pay the amount of Adviser Charges set-off; and b. Unless you instruct MetLife in writing to the contrary, if your Financial Adviser transfers some or all of its business to another Financial Adviser (the New Adviser), including the business it does with you, MetLife will pay any facilitated Adviser Charges to the New Adviser. Applicant signature The applicant must sign here Date D D M M Y Y Y Y All alterations must be made by crossing out the part you want to change, writing your amend and signing against it. Page 17 of 28

18 9 Verifying your identity - To be completed by Financial Adviser This section must be completed by the Financial Adviser to confirm they have verified the identity of the private individual. 9.1 Private individual Introduction by an FCA regulated firm A separate confirmation must be completed for each contributor. Where a third party is involved, e.g. a payer of contributions who is different from the customer, the identity of that person must also be verified, and a confirmation provided. Please photocopy this section if you need to verify the identity of more than one individual. This form cannot be used to verify the identity of any customer that falls into one of these categories: those who are exempt from verification as being an existing client of the introducing firm prior to the introduction of the requirement for such verification; those whose identity has not been verified by virtue of the application of a permitted exemption under the Money Laundering Regulations; or those whose identity has been verified using the source of funds as evidence. This confirmation must carry an original signature, or an electronic equivalent. Details Title Mr Mrs Miss Ms Other - please specify First name(s) Surname Date of birth Sex D D M M Y Y Y Y Male Female Current address Previous address (only complete if the applicant has changed address in the last three years) Confirmation I have verified the customer s date of birth No Yes Their confirmed age is I used the following document to verify their date of birth You do not need to provide a copy of the document, but you should take one for your own records. Page 18 of 28

19 Verifying your Identity continued... I confirm that: the information in section 9.1 was obtained by me in relation to the customer; the evidence I have obtained to verify the identity of the customer; Meets the standard evidence set out within the guidance for the UK Financial Sector issued by JMLSG; OR Exceeds the standard evidence (written details of the further verification evidence taken are attached to this confirmation) Full name of regulated firm (or Financial Adviser) FCA Firm Reference Number Full name of Financial Adviser FCA reference number (Financial Adviser) Name Position Financial Adviser signature The Financial Adviser must sign here Date D D M M Y Y Y Y 9.2 Corporate and other non-personal entities - Introduction by an FCA regulated firm If the applicant is receiving contributions from an employer, a corporate or a non-person entity this section needs to be completed to verify their identity. Non-personal entities includes sole traders, Partnerships, LLPs, trusts, charities, organisation etc. Relevant company registry includes other registers, such as those maintained by charity commissions (or equivalent) or chambers of commerce. This form cannot be used to verify the identity of any customer that falls into one of the following categories: those who are exempt from verification as being an existing client of the introducing firm prior to the introduction of the requirement for such verification; those whose identity has not been verified by virtue of the application of a permitted exemption under the Money Laundering Regulations; or those whose identity has been verified using the source of funds as evidence. This confirmation must carry an original signature, or an electronic equivalent. Page 19 of 28

20 Verifying identity - Corporate and other non-personal entities continued... Details of customer Full name of customer Type of entity (e.g. Corporation or Trust) Location of business (full operating address) Previous address (only complete if the applicant has changed address in the last three years) Registered office in country of incorporation Registered number (if any or appropriate) Relevant company registry or regulated market listing authority Names of all directors (or equivalent, e.g. partners) Names of principal beneficial owners (Over 25%) Confirmation I confirm that: the information in section 9.2 was obtained by me in relation to the customer; the evidence I have obtained to verify the identity of the customer; Meets the standard evidence set out within the guidance for the UK Financial Sector issued by JMLSG; or Exceeds the standard evidence (written details of the further verification evidence taken are attached to this application). Financial Adviser signature The Financial Adviser must sign here Date D D M M Y Y Y Y Page 20 of 28

21 10 Declarations - Financial Adviser 10.1 Financial Adviser s declaration I confirm that I have provided advice in relation to this application and that I will act as the adviser to this Plan. I confirm that where the application includes a transfer of benefits from an Occupational Scheme the suitability of the advice provided has been reviewed by an appropriately qualified individual, certified by us. During my time as an adviser to this Plan I will remain authorised and comply with the rules of the appropriate regulatory bodies and act in accordance with the Terms of Business which exists between myself and MetLife Europe Limited. I will notify MetLife Europe Limited immediately if there are any changes to my authorisation, including any disciplinary action that may be taken against me. I confirm all the information in this application is accurate and complete. Financial Adviser name Financial Adviser signature Date D D M M Y Y Y Y The Financial Adviser must sign here 11 Declarations - Policyholder The following sections must be read and signed by the applicant. If you do not understand any of the terms in this declaration, please ask for more information Policyholder declarations a. I apply for the on the basis of this application form and the Member Terms and Conditions that have been made available to me. I understand that, subject to approval of this application by MetLife and all requirements being met, the Policy will take effect on the date on which MetLife accept this application and MetLife will confirm this by issuing and posting my policy documents to me within five days after that date. b. On MetLife s acceptance of my offer, I will become a member of the MetLife Personal Pension Scheme. c. I understand that my Policy is set up on MetLife s acceptance of the first transfer or single contribution. Any additional transfers and/or contributions received within 10 weeks of receiving my application form will be added to the same Policy. Any transfers or contributions received after 10 weeks of receiving my application form will be treated as a separate investment and different terms and conditions may apply. d. I accept that if MetLife has not received any transfers or contributions from me within 10 weeks of receiving my application form MetLife reserves the right to request that I reapply before my Policy can be set up. e. I am permanently resident in the United Kingdom. I will notify MetLife in writing, if I move permanently outside of the United Kingdom. f. I understand that if the information I provide MetLife in my application form or any additional documentation is incomplete or incorrect, MetLife may need to amend my Policy accordingly based on the correct information and where necessary refuse to issue a Policy. Page 21 of 28

22 Declarations continued Scheme declarations a. I have read the Member Terms and Conditions and agree to be bound by them at all times. b. I understand that if there is any conflict or discrepancy between the information contained in this application form and the Member Terms and Conditions, the provisions of the Member Terms and Conditions will prevail. c. I understand that, the Trust Deed and Rules of the Scheme and the Member Terms and Conditions may be modified from time to time in accordance with the provisions of those documents. d. I understand that on satisfactory evidence of my death any death benefit payable (subject to any relevant taxes) in respect of my Retirement Portfolio will be paid in accordance with the Member Terms and Conditions. I also understand that the Trustee of the Scheme has absolute discretion to distribute the death benefit in accordance with the Rules of the Scheme, where permitted by pensions legislation. However, I request that the Trustee considers making any such payments in accordance with the latest written Beneficiary Nomination Statement that I may provide to MetLife. e. I confirm that I have not received, in the past 12 months, a cumulative amount of 7,500 and intentionally used this, either directly or indirectly, to obtain further UK income tax relief by recycling, that is by using the PCLS to significantly increase the contribution into this Scheme or any other. I also confirm that I will not recycle any PCLS received under this Scheme. f. If I have Enhanced, Individual or Fixed Protection under the relevant Finance Acts, I have taken all advice I consider necessary regarding the effect of any transfer or contribution to the Scheme, in respect of that protection. g. If I have any entitlement to either a protected pension age or a scheme specific PCLS within the transferring scheme, I understand that I may lose any entitlement on transferring to the Scheme. h. If I am taking immediate Drawdown with MetLife, I confirm that I do not intend to crystallise any further pension funds between the date of completing my application form and the date MetLife confirm my pension fund has been crystallised. If I do, I undertake to notify MetLife in writing immediately. I understand that if I do not notify MetLife, I may be subject to additional tax and/or HMRC charges. i. If I have taken benefits from any pension arrangement, with the transferring or any other pension provider, in a way which means I am subject to the Money Purchase Annual Allowance (MPAA), I have supplied the date the MPAA first applied to me in section 6 of this application. j. I understand that where I trigger the Money Purchase Annual Allowance, my contribution allowance will reduce. I also understand that it is my responsibility to keep a record of the contributions made by me or in respect of me to the Scheme and to any other Registered Pension Scheme, so that I know if the Annual Allowance or Money Purchase Annual Allowance is exceeded. MetLife will not be held responsible where the acceptance of a contribution results in me becoming liable to an Annual Allowance charge. k. If I am transferring a capped drawdown arrangement(s) to a Flexi-Access drawdown arrangement(s), I will be subject to the Money Purchase Annual Allowance (MPAA) from the date of my first Flexi-Access income payment. l. If I am applying to make regular or single contributions I declare that the total payments to any registered pension scheme, in respect of which I am entitled to relief under section 188 of the Finance Act 2004, will not exceed the higher of the basic amount or my relevant UK earnings within the meaning of section 189 of that Act, for that tax year. I declare that I will tell MetLife if an event occurs which results in me no longer being entitled to relief for my payments under section 188 of the Finance Act I will do so before the end of the tax year in which the event occurs, or within 30 days of the event if this is later. I understand that it is a serious offence to make false statements in order to gain tax relief and the penalties for doing so are severe and could include prosecution. Page 22 of 28

23 Declarations continued Use of your information and data protection a. I understand that MetLife values my privacy and complies with its privacy policy to hold in confidence information about me and my. However, in certain circumstances, MetLife may disclose or transfer this information, for example: i. If permitted by the Terms and Conditions of this Form and my ; ii. iii. iv. If required to do so by law or if necessary to comply with the rules of any regulatory body whose rules or provisions apply to MetLife, such as the Financial Conduct Authority; To countries inside and outside the European Economic Area to administer and service my. I understand that data protection laws may not be as comprehensive in other countries as in the European Union. However, where such a disclosure takes place MetLife will ensure that a contract is in place to ensure the level of protection for my data is maintained; or If it is in my own interests. b. MetLife may transfer my Personal Data and Sensitive Personal Data (as defined by the Data Protection Act 1988) to its parent company, MetLife Inc. (or any other parent as a result of merger or amalgamation or corporate restructure), any other organisation with the MetLife Group or to third party service providers, inside or outside the European Economic Area, for processing for the purposes of providing MetLife services to me and for their confidential and internal use. c. MetLife may also disclose such details to other third parties where it is reasonably necessary to do so for their or MetLife s business analysis purposes or to administer and invest in the assets of my or to enable them to provide services to me. d. MetLife, other companies within its Group and other reputable organisations chosen by MetLife will use, analyse and assess my information to maintain and develop MetLife s and their relationships with me. The types of activity that this will include are: i. Administering and investing in the assets of my and to deal with my enquiries; ii. Operating and administering the product and services MetLife and/or they supply; iii. Servicing my relationship with other companies within the MetLife Group and other organisations; iv. Helping MetLife and them to identify products and services which may be of interest to me (unless I have asked MetLife not to); and v. Helping MetLife and them to understand and develop MetLife and their businesses, including new and innovative products and services. e. For operational reasons in order to carry out the activities listed above, MetLife may: i. Link information MetLife holds in relation to my and other products and services I maintain with MetLife and other companies within its Group; and ii. Link or use information MetLife receive from third parties about me; iii. Link information held in relation to resulting from the same block transfer. In relation to my, this will mean that my name and number may be stored on the records of another resulting from or to which a transfer was made as part of the same block transfer. f. I understand that it is important that I give you accurate information. g. I understand that I have the legal right to make certain requests in respect of the information that MetLife holds about me: i. To stop MetLife from contacting me by post, fax, , SMS (text) messaging, or giving my details to others for these purposes I can send a written request to this effect to the Data Protection Officer, MetLife, One Canada Square, London E14 5AA. ii. To receive a copy of the information that MetLife holds about me, I can apply in writing to the Data Protection Officer, MetLife, One Canada Square, London E14 5AA. h. If my is terminated for any reason MetLife will hold my personal information about me and my for no longer than is absolutely necessary. i. I declare that I have checked the details which I have provided in this Form. Page 23 of 28

24 Declarations continued Transferring benefits - declaration (these apply if you are making a transfer) I make declarations (a) to (h) inclusive below for the benefit of MetLife and the transferring scheme(s). References to you in declarations (a) to (h) inclusive mean the transferring scheme(s). a. I wish to transfer my existing pension benefits from the previous scheme(s)/arrangement(s) listed in section 3 of this application into the. I authorise you to transfer funds from the plan(s) listed above directly to MetLife. Where you have asked me to provide any original policy document(s) in return for the transfer of funds 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 made the transfer(s) listed in section 3 of this application. b. I authorise you to release all necessary information to the MetLife to enable the transfer of funds to MetLife. c. I authorise you to obtain from and release to the Financial Adviser named in this application any additional information that may be required to enable the transfer of funds. d. If an employer is paying contributions to any of the plans as listed in section 3 of this application, I authorise you to release to that employer any relevant information in connection with the transfer of funds from the relevant plan(s). Until this application is accepted and complete, MetLife s responsibility is limited to the return of the total payment(s) to the current provider listed in section 3 of this application. e. Where the payment(s) made to MetLife represent(s) all of the funds under the plan(s) listed in section 3 of this application then payment made as requested will discharge the current provider of all claims and responsibilities in respect of the plan(s) listed. f. Where the payment(s) made to MetLife represent(s) part of the funds under the plan(s) listed in section 3 of this application, then the current provider will be discharged of all claims and responsibilities only in respect of the part of the plan(s) represented by the payment(s). g. I promise to accept responsibility in respect of any claims, losses and expenses that MetLife and the current provider may incur as a result of any incorrect information provided by me in this application or of any failure on my part to comply with any aspect of this application. h. I understand that my personal data will be used in accordance with the declaration and consent in my completed MetLife Retirement Portfolio application My offer to contract Please note, making false statements can be a serious offence and carries severe penalties, including criminal prosecution. I declare to the best of my knowledge and belief, all of the information provided on or with this form is accurate and complete. If I discover that any of the details are incorrect or incomplete, I will write to MetLife within 30 days with the correct information. I am making an offer to MetLife to contract on the terms described in this application form. Applicant name Applicant signature Date D D M M Y Y Y Y The applicant must sign here Page 24 of 28

25 Declarations continued... If you have signed as a person with Power of Attorney for the applicant, please fill in your details below Power of Attorney details Title Mr Mrs Miss Ms Other - please specify First name(s) Surname Address Capacity Please provide documentary evidence that you possess a Power of Attorney for the applicant as appropriate. MetLife Pension Trustees Limited, as Scheme Administrator, undertakes to administer your MetLife Personal Pension in accordance with the provisions of the Trust Deed and Rules of the Scheme. A copy of this completed Form, the Trust Deed and Rules of the Scheme are available on request from MetLife. The MetLife Personal Pension Scheme is a registered pension scheme. MetLife Pension Trustees Limited is both the Scheme Administrator and Trustee. Page 25 of 28

26 12 What to do next 12.1 Payment information Cheque Please make cheques payable to MetLife and send them with this form. Bank or Building Society drafts and non-personal cheques must be marked with the applicant s name either on the payee line or reverse of the cheque. s may be delayed if payments are not made out correctly. Electronic transfer These details are for single contributions only:, Bank name and address: HSBC, Canary Wharf, London Account name: MetLife Europe Limited, Sort code: , Account number: Attachment checklist Please tick which of these attachments apply to you and send them with your form. For the applicant Any extra sheets you used to fill in the form, correctly labelled. Power of Attorney Court order (including Pension Sharing court orders) Protection Certificate(s) Cheques Direct Debit instruction (for a Regular contribution). Contribution Schedule (for payments coming from your employer s account). For the Financial Adviser Written details of your extra verification evidence of the customer s identity Where to send this application form Once you have checked the Form and the supporting documents, please send it with your attachments to: MetLife, Beacon House, 27 Clarendon Road, Belfast BT1 3BG. Page 26 of 28

27 Direct Debit instruction to you bank or building society - Retirement Portfolio Please complete this form using a ballpoint pen and send it to: MetLife Europe Limited, Beacon House, 27 Clarendon Road, Belfast, BT1 3BG. To the Manager Name of bank or building society Address Name(s) of account holder(s) Originator s Identification number Reference number (for office use only) Sort code Account number Building Society roll number (if applicable) Instructions to your bank or building society Please pay MetLife Europe Limited Direct Debits from the account above under the Direct Debit Guarantee. I understand that this instruction may remain with MetLife Europe Limited and, if so, that they will pass my details to my bank or building society electronically. Account holder signature Joint account holder signature Please ensure the account holders sign here Please ensure the account holders sign here Date D D M M Y Y Y Y Date D D M M Y Y Y Y Some banks and building societies may not accept Direct Debit instructions for some types of account. The Direct Debit Guarantee This guarantee should be detached and retained by the Payer. This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits. If there are any changes to the amount, date or frequency of your Direct Debit, MetLife Europe Limited will notify you five working days in advance of your account being debited or as otherwise agreed. If you request MetLife to collect a payment, confirmation of the amount and date will be given to you at the time of the request. If an error is made in the payment of your Direct Debit by MetLife or your bank or building society you are entitled to a full and immediate refund of the amount paid from your bank or building society. If you receive a refund you are not entitled to, you must pay it back when MetLife asks you to. You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

28 This address will show in the window of an A4 envelope MetLife Beacon House 27 Clarendon Road Belfast BT1 3BG MetLife Sales Desk (Pre-sale information for Financial Advisers) One Canada Square, London E14 5AA Tel: Fax: MetLife Customer Service Centre (Post-sale information for Financial Advisers and policy holders). Beacon House, 27 Clarendon Road, Belfast BT1 3BG Tel: Fax: Products and services are offered by MetLife Europe Limited which is an affiliate of MetLife, Inc. and operates under the MetLife brand. MetLife Europe Limited is authorised by the Central Bank of Ireland and subject to limited regulation by the Financial Conduct Authority. Details about the extent of our regulation by the Financial Conduct Authority are available from us on request. Registered address: 20 on Hatch, Lower Hatch Street, Dublin 2, Ireland. Registration number UK branch address: One Canada Square, Canary Wharf, London E14 5AA. Branch registration number BR WM l MAR 2015 l MAR 2015

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