Retirement Options Form. Your Personal Details (Compulsory Information) Missing information could result in your payment being delayed

Transcription

1 Retirement Options Form You have a choice of options when converting your pension fund into retirement benefits. Do make sure that you have read the booklet A Guide to Your Retirement Choices before completing this form. Options available are colour coded in the booklet to match this form. BEFORE MAKING ANY DECISIONS REGARDING YOUR POLICY, WE RECOMMEND YOU SEEK INDEPENDENT FINANCIAL ADVICE. A FINANCIAL ADVISER WILL INFORM YOU OF THE FEE THAT THEY CHARGE FOR THIS SERVICE Your Personal Details (Compulsory Information) Missing information could result in your payment being delayed Title and Full Forenames Surname Policy Number National Insurance Number Date of Birth / / Nationality Country of Residence Date of Leaving scheme/service of the employer (if applicable) Telephone Number (in case we need to contact you) address (if you are happy for us to contact you by ) When do you intend to take your pension benefits? Immediately OR / / Later date (Kindly specify a date) If you would like to take pension benefits as soon as possible, tick 'immediately'. With-Profits benefits only On taking retirement benefits the value is normally calculated on guaranteed terms. That means we compare the Policy Value plus any enhancement for capital distribution with the guaranteed minimum benefit and pay the higher amount. In the following circumstances the guaranteed terms do not apply and we will pay the Policy Value plus any capital distribution, reduced by any financial adjustment applicable at the time. This value may be significantly less than your guaranteed benefits. With- Profits guaranteed terms do not apply if your Policy: is an Individual Pension Plan (IPP) or Free Standing AVC (FSAVC); you have yet to reach your normal retirement date and you are still in the service of the employer to which the policy relates. has protected rights benefits and you are under age 60.

2 Options Tick one of the following options from A to F to confirm you have completed the relevant sections A1: Small Funds and/or A2: Triviality If you would like us to establish if you are entitled to take the whole fund as a cash lump sum Go to Section A Small Funds and/or Triviality B: Open Market Option. If you would like to buy your annuity from another provider, Equitable Life will pay any Pension Commencement Lump Sum (PCLS) direct to you and pay the balance of your fund to your chosen provider. (If you would like your benefits to be paid to a drawdown policy, refer to Section D) Go to Section B Open Market Option with another Provider C: Open Market Option with Canada Life. If you decide you would like one of the illustrated Canada Life annuities to be paid to you or you require further annuity illustrations from Canada Life to consider different types of annuity. Go to Section C Open Market Option with Canada Life D: Transfer to another Provider. If you choose to transfer to another provider. (If you would like your benefits to be paid to a drawdown policy with another provider, you must select this option) Go to Section D Transfer E: Ill Health/Serious Ill Health. Go to Section E F: Leaving your funds invested with us. If you wish to leave your funds invested with Equitable Life until a later date, complete this section. Go to Section F Benefit and Payment Details Tick to confirm you have completed the relevant sections G: Other Pension Benefits. Complete this section if requested to in sections A, B or C. Go to Section G Payment Details. We require your payment details if you have selected Options A, B, C or D. Go to Payment Details Declaration. Go to Declaration MISSING INFORMATION COULD RESULT IN YOUR PAYMENT BEING DELAYED 2

3 Section A1: Small Funds If you would like us to check if you can take the whole fund under small fund or triviality rules kindly complete the relevant part of this section. Refer to section A of A Guide to Your Retirement Choices booklet for further information. If you complete either of the Small Funds sections (A1.1 or A1.2) and also the Triviality section (Section A2), we will first check if you can take cash under the small fund rules and if this is not possible, then we will check if you can have cash under the triviality rules. A1. Small Funds A1.1: Small Funds (for Personal Pension Plans, Retirement Annuity, Managed Pension Policies and Section 32 Policies (without protected Pension Commencement Lump Sum (PCLS) only). For other policies, refer to Section A1.2 or A1.3 You may be able to take your entire pension fund as a lump sum if: You have reached age 60 and The value of your fund is 10,000 or less and You have taken a maximum of two small fund payments before. Small Funds and/or Triviality continues over the page 3

4 If you believe you are entitled to a small fund payment under Section A1.1, kindly: A. Sign the small fund payment declaration below B. Complete the Payment Details section I declare that: 1. To the best of my knowledge and belief all the statements made in connection with this election are true and complete. 2. I understand that if any further tax becomes payable because the information I have provided in this form proves to be incorrect then I understand that I will be wholly and personally liable for the tax charge due and any resultant penalty as may be imposed by HMRC. 3. I elect for the payment of the funds under the Policy specified at the beginning of this form (the Policy ). 4. I agree to indemnify and hold harmless Equitable Life against all demands, losses, liabilities, damages, costs and expenses (including legal fees) which may arise from Equitable Life acting on my payment instructions, including any claim from a third party in relation to the payment. 5. I have not received more than two other authorised payment of 10,000 or less from a pension fund with Equitable Life or elsewhere before. 6. I am eligible to apply for the payment of the funds as a cash lump sum in accordance with HMRC rules. 7. I the claimant am the legal owner of the Policy and I hereby irrevocably and unconditionally authorise and request you pay the lump sum available under the Policy, in accordance with the payment instructions I have given in this form. 8. I do not plan to use any of the monies that I receive as a tax free cash payment (also known as a Pension Commencement Lump Sum) directly or indirectly to fund the contribution, or to increase the level of contribution, to any registered pension scheme in which I participate. Moreover, I have neither contributed to nor significantly increased contributions to any registered pension scheme in anticipation of receiving this cash amount. 9. I agree that full payment of the lump sum available under the Policy in accordance with its terms by you shall constitute a discharge of your obligation to make payments under the Policy. For the avoidance of doubt, this release shall not act so as to prohibit me from bringing any claim for any act or omission by you. 10. I understand that if the terms and conditions of my contract with you did not provide for payment of benefits in lump sum form I request that you amend those terms and conditions so that I can receive the benefits in lump sum form, in accordance with current tax laws. Explanation of declaration 8: HMRC regulations strongly discourage tax free cash "recycling". Tax free cash recycling occurs where, because an individual has received or will receive a tax free cash sum, the amount of contributions paid by or for him or her into a registered pension scheme is significantly greater than it otherwise would be. Where tax free cash recycling occurs, a substantial tax penalty may be payable. For further guidance, consult your financial adviser, or the HMRC website at Signature (Sign and print your name) Date 4

5 Section A1.2: Small Funds (for Individual Pension Plan (assigned to the employee) and Free Standing AVC) This option may be available if you are age 60 or over and your fund is 10,000 or less. Kindly complete the following information in order that we can establish if you can have the payment as a lump sum. A1.2.1 Are you a controlling director 1 or connected 2 to a controlling director of the company sponsoring the pension scheme or, if your pension benefits were transferred into this Equitable Life policy, the sponsor of the pension scheme from which the benefits were originally transferred? 1 2 you are a controlling director if you control directly or indirectly at least 20% of the ordinary share capital connected means you are a spouse, civil partner or relative of a controlling director or in any way related to a controlling director s spouse/civil partner Has a transfer value been paid from this policy or any other pension scheme of the sponsoring employer for you in the last 3 years? A1.2.2 Have you other pension benefits either in payment or not yet in payment? (You can ignore any widow's/widower's/dependant's benefits you are receiving and any state pension benefits due or in payment) If : Fully complete the Other Pension Benefits Section G Sign and date the small fund payment declaration on page 6 Complete the Payment Details section If : Sign and date the small fund payment declaration on page 6 Complete the Payment Details section Section A1.3: Small Funds (for Individual Pension Plans (assigned to the employee) and Section 32 Policies with protected Pension Commencement Lump Sum (PCLS)) If you are entitled to take a PCLS in excess of the standard 25%, you may be able to take the remaining fund as a cash lump sum if you meet the following criteria (income tax will be payable on all of the remaining fund): You are 60 or over and the fund value under the pension scheme remaining after taking the maximum PCLS is 10,000 or less, and All or part of your standard lifetime allowance, as set by HMRC, is available at the time the payment is made. Small Funds and/or Triviality continues over the page 5

6 If you believe you are entitled to a small fund payment under Section A1.2 or A1.3, kindly: A. Sign the small fund payment declaration below B. Complete the Payment Details section 1. To the best of my knowledge and belief all the statements made in connection with this election are true and complete. 2. I understand that if any further tax becomes payable because the information I have provided in this form proves to be incorrect then I understand that I will be wholly and personally liable for the tax charge due and any resultant penalty as may be imposed by HMRC. 3. In particular, I understand that if my existing benefits and benefits from the Policy exceed the Lifetime Allowance and I have no transitional protection certificate, a Lifetime Allowance charge will be paid from my benefits and they will reduce accordingly. 4. I elect for the payment of the funds under the Policy specified at the beginning of this form (the Policy ). 5. I agree to indemnify and hold harmless Equitable Life against all demands, losses, liabilities, damages, costs and expenses (including legal fees) which may arise from Equitable Life acting on my payment instructions, including any claim from a third party in relation to the payment. 6. I do not plan to use any of the monies that I receive as a tax free cash payment (also known as a Pension Commencement Lump Sum) directly or indirectly to fund the contribution, or to increase the level of contribution, to any registered pension scheme in which I participate. Moreover, I have neither contributed to nor significantly increased contributions to any registered pension scheme in anticipation of receiving this cash amount. 7. I am eligible to apply for the payment of the funds as a cash lump sum in accordance with HMRC rules. 8. I the claimant am the legal owner of the Policy and I hereby irrevocably and unconditionally authorise and request you pay the lump sum available under the Policy, in accordance with the payment instructions I have given in this form. 9. I agree that full payment of the lump sum available under the Policy in accordance with its terms by you shall constitute a discharge of your obligation to make payments under the Policy. For the avoidance of doubt, this release shall not act so as to prohibit me from bringing any claim for any act or omission by you. 10. I understand that if the terms and conditions of my contract with you did not provide for payment of benefits in lump sum form, I request that you amend those terms and conditions so that I can receive the benefits in lump sum form, in accordance with current tax laws. Explanation of declaration 6: HMRC regulations strongly discourage tax free cash "recycling". Tax free cash recycling occurs where, because an individual has received or will receive a tax free cash sum, the amount of contributions paid by or for him or her into a registered pension scheme is significantly greater than it otherwise would be. Where tax free cash recycling occurs, a substantial tax penalty may be payable. For further guidance, consult your financial adviser, or the HMRC website at Signature (Sign and print your name) Date Small Funds and/or Triviality continues over the page 6

7 A2. Triviality (all pension types) Section A2: Triviality You may be able to take your entire pension fund as a lump sum if: 1. You have reached age 60 and 2. The value of all of your pension funds is 30,000 or less. This is known as triviality. Triviality: Where the value of all your pension funds is 30,000 or less. For pensions in payment (including drawdown), the value used when assessing triviality is not the actual value of the fund. Do contact us if you require further details. You need to inform us if any of your Schemes are being paid by the Financial Assistance Scheme A2.1 If you believe your fund qualifies for Triviality, kindly complete this section mination date*: / / *You must nominate a date on which all of your benefits are valued (this will include pensions already in payment). This date may have already been set if you have previously taken a triviality payment. This value is used to ensure the total benefits are 30,000 or less. You have up to 3 months from the nomination date to receive your first trivial lump sum. This date cannot be earlier than 3 months before your 60 th birthday. If you wish to take other benefits as a trivial lump sum, you must do so within 12 months of the first triviality payment being made. A2.2 Have you other pension benefits either in payment or not yet in payment? (You can ignore any widow's/widower's/dependant's benefits you are receiving and any state pension benefits due or in payment) If : Fully complete the Other Pension Benefits Section G Complete the Payment Details section Sign and date the Declaration on page 18 If : Complete the Payment Details section Sign and date the Declaration on page 18 Failure to complete these sections could result in any payment being delayed. 7

8 Section B: Open Market Option with another provider Complete this section if you have selected option B Open Market Option (OMO) Refer to Section B of A Guide to Your Retirement Choices booklet for further information. If you have a Free Standing AVC, any life cover under the Scheme will cease if you select this option. Insert the name of the Receiving Provider: (This is the name of the company you are buying the annuity from) B1. Select the amount of Pension Commencement Lump Sum (PCLS) that you wish to take, either: Nil Maximum % or Specify the amount or % (this Tick this box if Tick box if you would like 25% of may be restricted by HMRC limits): PCLS required the fund (or as specified in the Illustration) We will pay you the PCLS, if applicable. This will be subject to HMRC limits. It is important to note a PCLS cannot be taken from an Equitable Managed Pension Policy or by a policyholder who attained age 75 prior to 6 April B2. Complete the Payment Details section of this form. B3. Complete the Other Pension Benefits section on the next page (and section G if applicable). (You are not required to complete Section G if you only have an Equitable Managed Pension Policy, a State pension, or a widow's/widower's dependant's benefits ) B4. Sign and date the Declaration. B5. Kindly return this form and written confirmation from the receiving arrangement that they will accept these benefits. Written confirmation to follow: Written confirmation enclosed: Payment cannot be made until confirmation from your receiving provider has been received OMO with another provider continues over the page 8

9 Section B: Open Market Option with another Provider continued B6. Other Pension Benefits Information Kindly read the questions below and select '' or '' as appropriate. You can ignore any widow's/widower's/dependant's benefits you are receiving and any state pension benefits due or in payment. If you ONLY have an Equitable Managed Pension Policy, you do not need to complete this Section. B6.1 Is the total of pensions currently in payment, plus your Equitable Life fund from this arrangement and any other pensions you are starting at the same time, less than 15,000 per annum? B6.2 Is the total of any tax free cash sums you have received from pension schemes, plus the PCLS you intend to take from this arrangement and any others you are taking at the same time, less than 250,000? B6.3 Protection Only complete if you have applied for and been granted transitional protection of your pension rights certified by HMRC. Indicate the transitional protection granted by ticking one of the following boxes: Enhanced Primary Fixed Has HMRC agreed a special enhanced lifetime allowance (e.g. where a divorce credit or overseas pension transfer has been received)? We will need to see certified copies of all HMRC Certificates evidencing the above protection granted and/or enhancement before we can make payment. If you have answered '' to both questions B6.1 & B6.2 or you only have a Managed Pension Policy, you do not need to complete Section G: Other Pension Benefits. You should complete the Payment Details section and also read and sign the Declaration Section at the back of this form. If you have answered '' to either question B6.1 or B6.2 we are required by HMRC to obtain further information, therefore kindly complete Section G - Other Pension Benefits of this form. Check that all required sections have been fully completed. Missing information could result in your payment being delayed. If this happens, annuity rates may change, which could mean lower pension payments. Payment cannot be made until confirmation from your chosen provider has been received. 9

10 Section C: Open Market Option with Canada Life Complete this section if you have selected option C Open Market Option (OMO) with Canada Life. It is important to note this is a two stage process. Refer to section C of A Guide to Your Retirement Choices booklet for further information. Select option C1 or C2 C1. You wish to accept the illustration provided Kindly provide the following information: C1.1 Personal Example Reference from the Canada Life illustration or Comparative Annuity Quotation. Return this form along with the Comparative Annuity Quotation illustration or sheet. C1.2 Select the amount of Pension Commencement Lump Sum (PCLS) you wish to take, either: Nil Maximum % or Specify the amount (this may Tick this box if Tick box if you would like 25% of be restricted by HMRC limits): PCLS required the fund or as specified in the Illustration We will pay you the Pension Commencement Lump Sum (PCLS), if applicable. This may be subject to HM Revenue & Customs (HMRC) limits. It is important to note a PCLS can not be taken from a Managed Pension Policy or by a policyholder who reached age 75 before 6 April C1.3 Complete the Other Pension Benefits information in Section C4 (You are not required to complete Section G if you only have an Equitable Managed Pension, a State pension, or a widow's/widower's dependant's benefits ) C1.4 Complete the Payment Details Section of this form for the PCLS. C1.5 Sign and date the Declaration Section of this form. C1.6 Confirm your Post Code. C1.7 Confirm Spouse's/Civil Partner's Name and Date of Birth (if you have selected a joint life annuity). Enhanced annuities Refer to the enclosed leaflet describing Canada Life's enhanced annuity. Alternative options may be available from other providers. OMO with Canada Life continues over the page 10

11 Section C: Open Market Option with Canada Life continued C2. Further illustrations required. Kindly indicate the required options on Section C3 or the Comparative Annuity Quotations sheet C2.1 Select the amount of Pension Commencement Lump Sum (PCLS) that you require illustrating, either: Nil Maximum % or Specify the amount or % (this Tick this box if Tick box if you would like 25% of may be restricted by HMRC limits): PCLS required the fund (or as specified in the Illustration) We will pay you the PCLS, if applicable. This will be subject to HMRC limits. It is important to note a PCLS cannot be taken from an Equitable Managed Pension Policy or by a policyholder who attained age 75 prior to 6 April C2.2 Complete the 'Other Pension Benefits Information' in Section C4 of this form. (You are not required to complete this Section if you only have an Equitable Managed Pension) C2.3 Sign and date the Declaration section and return this form along with the Comparative Annuity Quotation sheet (if completed). C2.4 Confirm your Post Code. C2.5 Confirm Spouse's/Civil Partner's Name and Date of Birth (if you have selected a joint life annuity). C3. Requote options for Canada Life Kindly choose the required option if you would like an illustration or further illustrations from Canada Life Pension increase/variation Level / RPI / LPI / 3% / 5% /other Guarantee Period (in years) 0 / 5 / 10 / other (max 10) Payment Frequency Monthly/Quarterly/Half yearly/annually Paid in advance/arrears Life Basis: Single/Joint Spouse/Civil Partner Information (if you require a joint annuity) If joint life, select the pension you would like your Spouse/Civil Partner to receive on your death Spouse/Civil Partner Name Spouse/Civil Partner Gender: 50% / 67% / 100% / Other (max 100%) Spouse/Civil Partner Date of Birth: Partner Relationship: Spouse/Civil Partner (delete as appropriate) For further information on the various annuities Canada Life offer, do contact Canada Life OMO with Canada Life continues over the page 11

12 Section C: Open Market Option with Canada Life continued C4 Other Pension Benefits Information Kindly read the questions below and select '' or '' as appropriate. You can ignore any widow's/widower's/dependant's benefits you are receiving and any state pension benefits due or in payment. If you ONLY have an Equitable Managed Pension Policy, you do not need to complete this Section. C4.1 Is the total of pensions currently in payment, plus your Equitable Life fund from this arrangement and any other pensions you are starting at the same time, less than 15,000 per annum? C4.2 Is the total of any tax free cash sums you have received from pension schemes, plus the PCLS you intend to take from this arrangement and any others you are taking at the same time, less than 250,000? C4.3 Protection Only complete if you have applied for and been granted transitional protection of your pension rights certified by HMRC. Indicate the transitional protection granted by ticking one of the following boxes: Enhanced Primary Fixed Has HMRC agreed a special enhanced lifetime allowance (e.g. where a divorce credit or overseas pension transfer has been received)? We will need to see certified copies of all HMRC Certificates evidencing the above protection granted and/or enhancement before we can make payment. If you have answered '' to both questions C4.1 & C4.2 or you only have an Equitable Managed Pension Policy, you do not need to complete Section G: Other Pension Benefits. You should complete the Payment Details section and also read and sign the Declaration Section at the back of this form. If you have answered '' to either question C4.1 or C4.2 we are required by HMRC to obtain further information, therefore complete Section G: Other Pension Benefits. If you have a Free Standing AVC, any life cover under the Scheme will cease if you select this option. Check that all required sections have been fully completed. Missing information could result in your payment being delayed. If this happens, annuity rates may change, which could mean lower pension payments. Payment cannot be made until confirmation from your chosen provider has been received. 12

13 Section D: Transfer to another Provider If you are transferring to purchase an annuity or going into drawdown the Pension Commencement Lump Sum (PCLS) will be paid by the receiving arrangement, if applicable. If you have a Free Standing AVC, any life cover will cease if you select this option. If you have an entitlement to a PCLS of more than 25%, this will be lost on transfer and you will be restricted to 25%. Refer to section D of A Guide to Your Retirement Choices booklet for further information on our requirements. D.1 Are you transferring to another registered Pension Scheme to purchase an annuity? D.2 Are you transferring to a drawdown arrangement? (regardless of whether income is being taken) D.3 Are you transferring to another registered Pension Scheme to leave your benefits invested until a later date? (This is not available if you have a Managed Pension Policy or reached age 75 prior to 6 April 2011) D4. Insert the name of the Pension Scheme you are transferring to below D.4 Kindly return this form and written confirmation from the receiving arrangement that they will accept these benefits. Written confirmation to follow: Written confirmation enclosed: Complete the Payment Details and Declaration sections of this form. Transferring to an overseas Pension Scheme If you are considering transferring to an overseas Pension Scheme, do contact us for further details. Check that all required sections have been fully completed. Missing information could result in your payment being delayed. If this happens, annuity rates may change, which could mean lower pension payments. Payment cannot be made until confirmation from your chosen provider has been received. 13

14 Section E: Ill Health/Serious Ill Health If you are under age 55 (or 60 if you have a Retirement Annuity Contract) and suffering from ill health, then you may be eligible to take benefits early or in the form of a cash lump sum. If you believe that you may be eligible to take these benefits in this way, contact Equitable Life as special considerations apply. Refer to Section E of A Guide to Your Retirement Choices booklet. Section F: Leaving your Pension Fund invested with us If you wish to leave your pension fund invested with Equitable Life until a later date, do complete and return this section. Refer to Section F of A Guide to Your Retirement Choices booklet. Specify a date on which you intend to retire / / If you die after age 75 and you have not taken benefits, any lump sum payable will be subject to a 55% tax charge. If you have a Managed Pension policy, any death lump sum payment, regardless of age, is subject to a 55% tax charge. 14

15 Section G: Other Pension Benefits We are required by HMRC to obtain the following information before we pay your benefits. In addition to your Equitable policy(ies), are the only other pension benefits you hold either a widow's/widower's/dependant's pension or a state pension in payment (or due to be in payment)? If : You do NOT need to complete this Section. Complete the Payment Details section Sign and date the Declaration on page 18 If : Complete this section Complete the Payment Details section Sign and date the Declaration on page 18 G.1 Details of all Pension benefits in payment (excluding Income Drawdown) Kindly complete the table below if you are taking benefits as an Open Market Option (OMO) or as a Small Fund or Triviality payment. For pensions in payment (including drawdown) the value used when assessing triviality is not the actual value of the fund. Do contact us for further details. Where your pension benefits were put into payment prior to 6 April 2006, confirm the amount of pension paid per annum as at 6 April Where your pension was put into payment on or after 6 April 2006, confirm the percentage of Standard Lifetime Allowance (SLA%) used. Name of pension provider and type of pension scheme (for example Equitable Life Personal Pension Plan) The date benefits became payable Pre or Post 6 April 2006 Pre 6 April 2006 The amount of pension per annum at 6 April 2006* ( ) Post 6 April 2006 Percentage of SLA used* (%) Is the pension from an occupational pension scheme of the employer who paid premiums into your Equitable pension scheme policy? Y/N Pre Post Pre Post Pre Post Pre Post * Kindly provide a copy of the statement(s) from your pension provider/pension scheme showing the benefit from each of these arrangements. Other Pension Benefits continues over the page 15

16 G.2 Details of Income Drawdown pension(s) Kindly complete below if you are taking benefits as an Open Market Option (OMO) or as a Triviality payment Where your Income Drawdown was effected prior to 6 April 2006, confirm the maximum amount of income allowable at 6 April Where your Income Drawdown was effected on or after 6 April 2006, confirm the percentage of Standard Lifetime Allowance (SLA%) used. Name of pension provider and type of pension scheme (for example Equitable Life Personal Pension Plan) The date benefits went into drawdown Pre or Post 6 April 2006 Pre Post Pre 6 April 2006 Maximum amount of income allowable at 6 April 2006* ( ) Post 6 April 2006 Percentage of SLA used* (%) Is the pension from an occupational pension scheme of the employer who paid premiums into your Equitable pension scheme policy? Y/N Pre Post * Kindly provide a copy of the statement(s) from your pension provider/pension scheme showing the benefit from each of these arrangements. The Lifetime Allowance If the total of your pension savings being paid are worth more than your lifetime allowance when you take your benefits, you will have to pay tax. The standard lifetime allowance, which will be used for most people, is as follows: Tax Year Standard lifetime allowance 2014/2015 1,250, /2016 1,250, /2017 1,250, /2018 1,250, Other Pension Benefits continues over the page 16

17 Section G: Other Pension Benefits continued G.3 Details of all Money Purchase & Defined Benefit arrangements which are still in force Do also complete below if you are taking benefits in the form of a Small Fund or Triviality payment OR As an Open Market Option (OMO) where you are taking benefits from more than one pension arrangement at the same time (known as Multiple Crystallisation) You must detail below all other pension policies that you hold where you have yet to take benefits or plan to take benefits at the same time. Pension policies include: Money purchase arrangements which is any defined contribution (DC) pension plan you hold. A DC is where contributions are invested in the plan and the fund value is determined on the value of that investment. For example, a Personal Pension Plan or an employer's Money Purchase Pension Scheme. Defined benefit (DB) arrangement (also known as Final Salary) is a pension scheme set up by an employer that provides benefits at retirement based on service and salary. If you are taking other benefits at the same time, list in order of when you intend to take them. We may require confirmation of the SLA% from you if you are due to take benefits before you take them from our scheme. We will notify you if this is required once this form has been completed and returned to us. Name of pension provider or pension scheme Type of arrangement Defined Benefit (DB) or Defined Contribution (DC) DC DB Value/ Benefit at the nomination date (for triviality)* ( ) Value/Benefit at current date (For OMO or Small Fund Payment)* ( ) Tick if you are taking these benefits at the same time as your Equitable Life policy Is the pension from an occupational pension scheme of the employer who paid premiums into your Equitable pension scheme policy? Y/N DC DB DC DB *Kindly provide a copy statement from the scheme showing the value of each of these arrangements dated within the last 3 months. We are required by HMRC to obtain this information, therefore failure to complete these sections could result in your payment being delayed. 17

18 Payment Details A. Your Payment Details PCLS or Triviality/Small Funds The payment is to be made to: Bank/Building Society name and address including post code Account Number Must be 8 digits including any leading zeros Roll Number (for Building Society accounts) Account holder's name (You must be the sole or joint account holder) Sort code - - B. Receiving arrangement details For Open Market Option with another provider or for Transfer Receiving scheme details: Name & address The payment is to be made to: Bank/Building Society name Account Number Must be 8 digits including any leading zeros Account in the name of Sort code Reference Number Written confirmation from the receiving arrangement that they will accept the Equitable Life benefits must be obtained and provided to Equitable Life before we can release payment of an OMO or Transfer. 18

19 Declaration Kindly complete when directed under the relevant sections Do sign and date the form I declare that: 1. To the best of my knowledge and belief all the statements made in connection with this form are true and complete. 2. I understand that if any further tax becomes payable because the information I have provided in this form proves to be incorrect then I understand that I will be wholly and personally liable for the tax charge due and any resultant penalty as may be imposed by HMRC. 3. In particular, I understand that if my existing benefits and benefits from the Policy exceed the Lifetime Allowance and I have no transitional protection certificate, a Lifetime Allowance charge will be paid from my benefits and they will reduce accordingly. 4. I elect for the payment of the funds under the Policy specified at the beginning of this form ( the Policy ) in accordance with the foregoing statements. 5. I agree to indemnify and hold harmless Equitable Life against all demands, losses, liabilities, damages, costs and expenses (including legal fees) which may arise from Equitable Life acting on my payment instructions, including any claim from a third party in relation to the payment. 6. I do not plan to use any of the monies that I receive as a tax free cash payment (also known as a Pension Commencement Lump Sum) directly or indirectly to fund the contribution, or to increase the level of contribution, to any registered pension scheme in which I participate. Moreover, I have neither contributed to nor significantly increased contributions to any registered pension scheme in anticipation of receiving this cash amount. 7. I, the claimant, hereby declare that I am the legal owner of the policy and I hereby irrevocably and unconditionally authorise and request you pay the lump sum available under the Policy, in accordance with the payment instructions I have given in this form. 8. I agree that full payment of the lump sum available under the Policy in accordance with its terms by you shall constitute a discharge of your obligation to make payments under the Policy. For the avoidance of doubt, this release shall not act so as to prohibit me from bringing any claim for any act or omission by you. 9. I understand that if the terms and conditions of my contract with you did not provide for payment of benefits in lump sum form, I request that you amend those terms and conditions so that I can receive the benefits in lump sum form, in accordance with current tax laws. Explanation of declaration 6: HMRC regulations strongly discourage tax free cash "recycling". Tax free cash recycling occurs where, because an individual has received or will receive a tax free cash sum, the amount of contributions paid by or for him or her into a registered pension scheme is significantly greater than it otherwise would be. Where tax free cash recycling occurs, a substantial tax penalty may be payable. For further guidance, consult your financial adviser, or the HMRC website at Signature (sign and print your name) Date 45H For security purposes and training purposes, telephone calls may be recorded. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. The Equitable Life Assurance Society is a mutual society registered in England Registered Office: Bedford Row, London WC1R 4JS, United Kingdom.