INDIVIDUAL STAKEHOLDER PENSION PLAN TRANSFER APPLICATION FORM FOR OFFICE USE ONLY. Campaign Code. Agency Code

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1 INDIVIDUAL STAKEHOLDER PENSION PLAN TRANSFER APPLICATION FORM Campaign Code FOR OFFICE USE ONLY Agency Code

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3 IMPORTANT INFORMATION Warning: You must not make false statements when filling in this application; it is a serious offence. The penalties are severe and you could be prosecuted. Please read the Stakeholder Pension Plan literature including the Key Features before completing this application. Please use BLOCK CAPITALS or tick relevant boxes. You must already have a Stakeholder Pension plan with us, for us to accept a transfer payment. Please tell us the plan number below and we will add the payment to your existing plan. Government rules allow certain individuals to protect entitlements to: tax-free cash which exceeded 25% of the value of that individual s pension fund as at 5 April 2006 and/or a lower or earlier pension age, where a right to take pension benefits at that age existed prior to 6 April This protection will be lost on transfer from one scheme to another unless the transfer is a block transfer. To be a block transfer, two or more members must transfer all sums and assets held within a scheme at the same time to a single receiving scheme. Please note that in any event, you will lose tax-free cash protection/ protected pension age if you have already been a member of the receiving scheme for longer than 12 months before the transfer. (Please ensure you check this with the receiving scheme prior to transfer). For further information, please speak to your financial adviser. In certain circumstances, restrictions may apply to the benefits your plan can provide. Ask us for details. Plan Number 1

4 NOTES TO SECTION A (1) Habitual residence means your permanent residential address. We can only accept applications from a limited number of overseas countries. If you are not resident in the United Kingdom, please speak to your financial adviser or contact us to confirm your eligibility. (2) To be eligible to make personal contributions you must be resident in the United Kingdom or otherwise entitled to tax relief on your payments. A. ELIGIBILITY You must be aged less than 75 to transfer to a Stakeholder Pension Plan and in order to further determine your eligibility, please provide the following information: Country of habitual residence (see note 1) Nationality And, if you are not resident in the United Kingdom: (see note 2) I am a Crown employee, or the husband, wife or registered civil partner of a Crown employee, who has general earnings from overseas Crown employment. (please tick box if applicable) or I have earnings which are chargeable to United Kingdom Income tax. (please tick box if applicable) NOTES TO SECTION B (1) This should be your permanent residential address. We will send all correspondence to this address. Please ensure the postcode is provided. For minors we will send all correspondence to this address or the legal guardian if different. (2) A birth certificate should be sent to us with your application. If you have changed your surname, for example, through marriage or a civil registered partnership, a copy of the appropriate certificate should also be sent. To be eligible for this plan you must be aged less than 75. (3) If you have income from more than one category, the category that is your main source of income will apply. B. POLICYHOLDER DETAILS 1. Title Mr Mrs Miss Ms Other (please specify) 2. Your surname 3. Your first name(s) 4. Your address (see note 1) Postcode 5. Your daytime phone number 6. Your date of birth (see note 2) (DD MM YYYY) 7. Are you Male Female 8. Your marital status Single Married/in a registered civil partnership Separated Divorced/registered civil partnership dissolved Widowed/a surviving registered civil partner 9. Employment status (see note 3) Employed Self-Employed A pensioner Other If Other please indicate which of the following applies to you: Are you: Caring for one or more children under 16 Caring for a person aged 16 or over In full time education Unemployed 2

5 NOTES TO SECTION B (CONT D) (4) Your National Insurance Number can be found on a payslip or a P60, or on a tax return. Without a National Insurance Number, we are unable to accept contributions and cannot process your application. If you cannot find your National Insurance Number please phone the HM Revenue & Customs General Enquiries (5) This is the age from which you want your pension to be payable. This must normally be between the ages of 55 and 75. You may be able to choose an earlier age, if your type of work has a lower retirement age approved by HM Revenue & Customs. B. POLICYHOLDER DETAILS (CONTINUED) 10. If you are employed, please give your employer s name and address Postcode 11. Please tick this box if you are eligible now or at the end of a specified waiting period to join your employer s pension scheme, but have declined to do so, or will decline to do so at the end of the specified waiting period. Please also tick this box if you have left your employer s pension scheme to take out this pension plan. 12. Your National Insurance Number (see note 4) 13. Selected Pension Age (see note 5) C. YOUR PENSION CONTRIBUTION TRANSFER PAYMENTS Total amount of expected transfer payment Please complete section E for each transfer payment. Actual transfer payment(s) processed by Scottish Widows will depend on the final value(s) paid by the transferring scheme(s). Warning: Deciding whether or not to transfer can be complicated. Therefore, before you sign your application you should satisfy yourself that transferring your pension fund is right for you. It is important that you are sure about the suitability of transferring, and that you understand the risks by seeking advice from your financial adviser. Your financial adviser may charge you a fee for this. Further information on pension transfers can be viewed at: 3

6 D. YOUR CHOICE OF FUNDS If a Lifestyle switching or Pension Investment Approach has already been selected for other types of payments, then these options will apply to this transfer payment. In this case, do not complete any of these sections. You can select one of the following options You can choose one of three Growth Portfolio Options (complete section 1.) or You can choose your own selection of funds (complete section 2.) or You can choose one of nine Pension Investment Approaches (complete section 3.). If you don t complete one of these sections your payments will automatically be invested in our Consensus Fund with your investments automatically switched over the five years before your selected pension age, with the aim that your plan is invested approximately 75% in the Pension Protector Fund, and 25% in the Cash Fund at your selected pension age. Full detail of all available funds can be found in our Pension Funds Investors Guide. We can change the selection of funds that we make available. There may be restrictions on the amount you can invest in certain funds. Please contact us for details of any restrictions that apply. Important Note Due to fluctuations in stockmarkets, there s no guarantee that the percentage splits between the fund shown in each of the Lifestyle Switching and the Automatic Switching option will be achieved. 1. Scottish Widows Growth Portfolio Only complete this section if you wish to select a Scottish Widows Growth Portfolio Fund. If you complete this section don t complete 2. or 3. on the next page. If you complete this section, please select only one option. Balanced Growth Portfolio Fund Strategic Growth Portfolio Fund Stockmarket Growth Portfolio Fund Please tick one as appropriate Lifestyle Switching If you have more than five years to selected pension age you can select the following lifestyle switching option to accompany your Growth Portfolio Fund. There are two stages: (i) (ii) Initially 100% of your payment will be invested into your selected Growth Portfolio Fund. From the date five years before your selected pension age until your selected pension age we will switch a proportion of the value of your plan each month and invest the amount switched 75% into the Pension Protector Fund and 25% into the Cash Fund. The proportion in the first month is 1/60th, the proportion in the second month is 1/59th, and so on. You can elect for this NOT to happen by ticking this box. The final fund split may not be exactly 75% Pension Protector Fund and 25% Cash Fund due to stockmarket movements. If you select a Growth Portfolio or Lifestyle switching it will apply to the whole plan i.e. to the existing plan value and for all future contributions. 4

7 D. YOUR CHOICE OF FUNDS (CONTINUED) 2. Choice of funds You can only complete this section if you have not completed 1. or 3. You can invest in up to 10 funds at any one time. Your investments will be automatically switched over the five years before your selected pension age, with the aim that your plan is invested approximately 75% in the Pension Protector Fund, and 25% in the Cash Fund at your selected pension age. Please read the Important Note. You can elect for this NOT to happen by ticking this box. Fund % split for transfer TOTAL 100% 3. Pension Investment Approaches (If you complete this section don t complete 1. or 2.) Please tick one of the following boxes if you wish to select a Pension Investment Approach. If you select one of these options it will apply to the whole plan i.e. to the existing plan value and for all future contributions. Please see Pension Investment Approaches Guide (reference 45770IG) for full details of these options. Please tick one box. ADVENTUROUS RISK CATEGORY BALANCED RISK CATEGORY CAUTIOUS RISK CATEGORY Adventurous (Targeting Annuity) Adventurous 2 (Targeting Encashment) Adventurous 3 (Targeting Flexible Access) Balanced (Targeting Annuity) Balanced 2 (Targeting Encashment) Balanced 3 (Targeting Flexible Access) Cautious (Targeting Annuity) Cautious 2 (Targeting Encashment) Cautious 3 (Targeting Flexible Access) 5

8 If there is more than one transferring scheme, please photocopy this section and complete a copy for each scheme. NOTES TO SECTION E (1) The Financial Conduct Authority (FCA) requires that certain transactions are reported by authorised persons. These include certain pension transfers, specifically those from A relevant statutory scheme; An occupational pension scheme; or An individual pension contract or buy out plan (e.g. Section 32 plan) which provides guaranteed or fixed benefits. E. TRANSFERRING SCHEME S DETAILS Is the transfer coming from a: (a) Registered Pension Scheme (as defined in part 4 of the Finance Act 2004) (b) Recognised Overseas Pension Scheme (as defined in part 4 of the Finance Act 2004) (c) Overseas Pension Scheme (as defined in Part 4 of the Finance Act 2004) (d) Employer-Financed Retirement Benefits Scheme (As defined in Income Tax (Earnings and Pensions) Act 2003) Details of the transferring scheme Type of Scheme Full name of the scheme of scheme administrator or provider Address Postcode HM Revenue & Customs pension scheme tax reference number Policy number (transferring plan) For transfers from an occupational pension scheme, please indicate if the transferring scheme is: (see note 1) A money purchase scheme If so, please confirm if the scheme is: an Executive Pension Plan or a Small Self-Administered Scheme A defined benefits scheme Has the transferring member flexibly accessed any pension benefits? Yes No If Yes Date of first payment (DD MM YYYY) 6

9 F. NOMINATION FORM This form supersedes any earlier form completed in respect of this plan number. I wish to nominate the person/people listed below to receive any death benefits which become payable under my plan. I understand that, in exercising discretion in applying the benefits, Scottish Widows as Scheme Administrator will not be bound by this expression of my wishes. Please consider the following person/people to receive death benefits in the percentages shown. Full name Relationship (if any) Percentage of benefits If your circumstances change after submitting this form and you would like to change the nominated beneficiaries please send a new form, which is available from us on request. 7

10 G. DECLARATION IMPORTANT PLEASE COMPLETE SCOTTISH WIDOWS STAKEHOLDER PENSION SCHEME (THE SCHEME ) Declaration to Scottish Widows Scottish Widows has set up the above Scheme by Deed Poll. I apply to join the Scottish Widows Stakeholder Pension Scheme. On acceptance of my application, I understand a policy will be issued in my name. I agree that the information detailed on this application is correct and complete and that it forms part of my contract with Scottish Widows, along with the Rules of the Scheme, the policy provisions, the policy schedule and any document amending the policy schedule. Copies of these are available from Scottish Widows. I agree that all payments will be invested in one Arrangement. I agree that my appointed financial adviser and Scottish Widows may exchange such information concerning me as is necessary to effect and administer the policy. Where necessary, I consent to Scottish Widows seeking further information from other pension arrangements. If I am transferring benefits currently held as GMP or section 9(2B) rights in the transferring scheme, I confirm that I have acknowledged in writing to the transferring scheme that: I have received a statement from Scottish Widows showing the benefits to be awarded in respect of the transfer payment I accept that the benefits to be provided by Scottish Widows may be in a different form and of a different amount to those which would have been payable by the transferring scheme and I accept that there is no statutory requirement on Scottish Widows to provide for survivor s benefits out of the transfer payment. I also acknowledge that Scottish Widows is not accepting liability to provide benefits in the form of GMP or section 9(2B) rights. I promise to accept responsibility in respect of any claims, losses and expenses that Scottish Widows 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. I have received and read the Key Features of the Stakeholder Pension Plan. I have received the Important Notes for Applications document. For your own benefit and protection, please read each of the statements in that document before you sign this application. Scottish Widows will rely on them when administering your contract. If you do not understand any point, please let us know. 8

11 G. DECLARATION IMPORTANT PLEASE COMPLETE (CONTINUED) Declaration to the provider/administrator of the transferring scheme named in Section E. I authorise and instruct you to transfer sums and assets from the plan(s) as listed in Section E directly to Scottish Widows and to provide any instructions and/or discharge required by any relevant third party to do so. I authorise Scottish Widows, the current provider and any financial adviser named in this application to obtain from each other, and release to each other, any information that may be required to enable the transfer of sums and assets to Scottish Widows. Until this application is accepted and complete, Scottish Widow s responsibility is limited to the return of the total payment(s) to the current provider(s). When payment is made to Scottish Widows as instructed, this means that I shall no longer be entitled to receive pension benefits from the whole of the plan(s) listed in Section E where the whole of the plan(s) is transferring, or that part of the plan(s) represented by the payment(s) if only part of the plan(s) is transferring. I accept responsibility in respect of any claims, losses, expenses, additional tax charges or any penalties that Scottish Widows and the current provider may incur as a result of any incorrect, untrue, or misleading information in this application or given by me, or on my behalf, or of any failure on my part to comply with any aspect of this application. This includes where I have been asked to provide any original policy document(s) in return for the transfer of funds and I am unable to do so. Your signature Date (DD MM YYYY) A copy of the completed application, Scheme Rules and Policy Provisions is available from Scottish Widows. MARKETING CHOICES Our policy on Data Privacy is included in the additional sheet Important notes for applications. We would like to keep you up to date on products and offers that may be of interest to you. Please select how you would like to hear from us below. These choices won t affect any necessary information we need to send you such as statements and, don t worry, you can change your mind and update your preferences at any time. SCOTTISH WIDOWS WEBSITES You may see relevant messages when you log in to our online services. If you choose no, you may still see messages, but they will not be tailored to you. Yes No Yes No POST Yes No DEVICE NOTIFICATIONS As we develop mobile applications you ll receive relevant notifications to your mobile device Yes No TEXT MESSAGES Yes No PHONE Yes No By saying yes, you are giving consent for Scottish Widows to use your personal information to send you relevant offers and information about our products. Scottish Widows includes the following legal entities: Scottish Widows Ltd, Scottish Widows Unit Trust Managers Limited, Scottish Widows Administration Services Limited and HBOS Investment Fund Managers Limited. Occasionally we will send you selected offers from other companies within Lloyds Banking Group that may be relevant to you. 9

12 Scottish Widows Limited. Registered in England and Wales No Registered office in the United Kingdom at 25 Gresham Street, London EC2V 7HN. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services Register number /18