The Xafinity SIPP and SimplySIPP application form for transferring into an existing SIPP
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1 The Xafinity SIPP and SimplySIPP application form for transferring into an existing SIPP If you require this document in another format for ease of reading, please let us know. Making Sense of Pensions
2 Important Please read the Terms and Conditions as they are an important part of your agreement with us. Text in this colour refers to the SimplySIPP. Information you give in this Application Form is required for income tax purposes. Providing false information is a serious offence and could lead to prosecution and severe penalties. Information in this Application Form is subject to current legislation and may change without prior notice. About you Title ( ) Mr Mrs Miss Ms Other Full Forenames Surname Sex Date of birth DD/MM/YYYY House number/name Street Town City Postcode Xafinity SIPP reference number Are you subject to a Bankruptcy order? Yes No Financial advice Important note: The law around pension transfers is complex. We strongly recommend that you get advice before transferring funds into a SIPP. We can t provide any advice on transfers into your SIPP and the flowchart overleaf explains when it s mandatory for you to take advice from a suitably qualified financial adviser. If you re not sure about where to obtain advice, we suggest you contact Unbiased Ltd, which is an industry body responsible for promoting independent financial advice in the UK. They will be able to give you details of a financial adviser in your area and whether they have specialist pensions qualifications. Their contact details are (see We also recommend that you check to see the adviser you select is properly authorised by the Financial Conduct Authority (FCA) and this information can be checked on their website Making Sense of Pensions 2
3 Transferring into your SIPP The law around pension transfers is complex. We strongly recommend that you get advice before transferring funds into a SIPP. The flowchart below explains whether it s mandatory for you to obtain advice from a suitably authorised financial adviser about the scheme you re transferring from. Notes for all transfers: 1. This does not include a guaranteed lump sum death benefit or a guaranteed investment return whilst uncrystallised, but does include: Guaranteed pensions (e.g. defined benefits / final salary, Guaranteed Minimum Pension) Guaranteed Annuity Rates ( GAR ) Please check your policy documents carefully as your transfer could be delayed if these are identified later on. 2. If you have Automatic Tax Free Cash Protection this could be lost on transfer if it is not classed as a block transfer. Please discuss this with your financial adviser prior to completing the transfer. 3. If you are transferring from a scheme which offers certain guarantees, your financial adviser will need to complete the section overleaf. Making Sense of Pensions 3
4 Transfers from schemes offering guarantees NOTE: This section is for transfers from schemes offering certain guarantees but excludes those with guaranteed annuity rates (see next section). For completion by the Pension Transfer Specialist Except for Guaranteed Annuity Rates, where a transfer is being paid from a scheme offering guarantees (also called safeguarded benefits) the Pension Transfer Specialist should complete and sign the section below in all cases. Pension Transfer Specialist Name FCA Individual Reg No 4. Did you recommend the safeguarded transfer(s) detailed in this form? Yes No 5. If no to 1. above, have you advised against the transfer in writing (including having carried out a full analysis as required by the FCA Rules) and have you recorded this as an insistent customer? Yes No Pension Transfer Specialist signature Date Declaration for completion by the SIPP member NOTE: We will not accept transfers from schemes offering guarantees unless you have received appropriate independent financial advice. You must therefore complete the declaration below. I confirm that I was advised by the above adviser on transfer(s) from the following pension(s) (please list): I confirm that I have accepted that advice. Yes No If no, I confirm that I am acting against specialist advice to transfer and that I am responsible for any losses that may result from my decision. I confirm that I do not hold Xafinity liable in any way for my decision. Yes N/A Member s signature Date Making Sense of Pensions 4
5 Transfers from other schemes This section is for: transfers from schemes only offering Guaranteed Annuity Rates; and any other schemes not offering guarantees. For completion by the adviser Adviser Name FCA Individual Reg No Did you recommend the transfer(s) detailed in this form? Yes No If no to 1. above, have you advised against the transfer in writing and have you recorded this as an insistent customer? Yes No Adviser signature Date Declaration for completion by the SIPP member NOTE: We will not accept transfers from occupational pension schemes or any scheme which offers Guaranteed Annuity Rates unless you have received appropriate independent financial advice. You must therefore complete the declaration below if the transfer is from one of these schemes. If the transfer is from a personal pension only and you do not wish to take advice, please tick here. In all other cases, please complete the declaration below. I confirm that I was advised by the above adviser on transfer(s) from the following pension(s) (please list): I confirm that I have accepted that advice. Yes No If no, I confirm that I am acting against advice to transfer and that I am responsible for any losses that may result from my decision. I confirm that I do not hold Xafinity liable in any way for my decision. Yes N/A Member s signature Date Making Sense of Pensions 5
6 Pension transfers from uncrystallised* schemes Please copy this form to add more transfers Provider name Address Scheme 1 Scheme 2 Type of scheme (please tick) Occupational pensions are: Defined benefit/final salary Defined contribution Section 32 Personal pensions are: Section 226/Retirement annuity PPP / GPP Stakeholder FSAVC Policy / reference number Full Scheme Name (if known) Defined benefit/final salary Defined benefit/final salary Defined contribution Defined contribution Section 32 Section 32 Personal pension / GPPP Personal pension / GPPP Section 226 Section 226 Other (please detail below) Other (please detail below) Amount of cash transfer Amount of any in specie transfer Does this transfer represent the full value of the plan? Details of in specie assets (if multiple, please provide full breakdown) Details of any guarantees (if none, please confirm) This includes guaranteed: Pensions (e.g. defined benefits / final salary, GMP) Annuity Rates ( GAR ) Is this transfer part of a block transfer? Yes / No Yes / No *Uncrystallised means you ve not taken any benefits. If you have partially crystallised you must complete both forms (crystallised and uncrystallised). Please check your policy documents carefully for the above information as your transfer could be delayed if these are identified later on. Making Sense of Pensions 6
7 Pension transfers from crystallised* schemes Please note: If any benefits (e.g. lump sum or drawdown) have been taken from the scheme these can only be used for drawdown in your Xafinity SIPP and all crystallised funds must be transferred. Please copy this form to add more transfers. Provider name Address Type of scheme Full Scheme Name (if known) Policy / reference number Type of drawdown Capped drawdown / Flexi-access drawdown Amount of cash transfer Amount of any in specie transfer Does this transfer represent the full value of the plan? Details of in specie assets (if multiple, please provide full breakdown) For capped drawdown only please also complete the following: GAD maximum allowable pension (p.a.) Date of last GAD review DD/MM/YYYY Amount of pension taken in current pension year Next drawdown review (reference) date DD/MM/YYYY Is this transfer from a dependant s drawdown pension fund or dependant s/nominee's/successor's flexi-access drawdown fund? Yes No Would you like to take income from your Xafinity SIPP? Yes No If you would like to take income from your Xafinity SIPP please complete a Drawdown Payment Request form, which can be found on our website ( or from our New Business Team ( ). We also need a copy of your most recent P45/P46. Is it enclosed? Yes *Crystallised means you ve taken some benefits Making Sense of Pensions 7
8 Xafinity: Administrator certificate 1. We confirm that the Xafinity SIPP incorporating the SimplySIPP: is a Personal Pension Plan registered in accordance with Part 4 of the Finance Act 2004, and Xafinity Pension Scheme Tax Reference is RF. 2. the Xafinity SIPP, incorporating the SimplySIPP, is a registered pension scheme and as such can accept transfers into the scheme from other registered pension schemes in accordance with the Finance Act Your declaration to the Trustees/Administrators of the scheme: 1. I request that you make a transfer to the Xafinity SIPP/SimplySIPP, representing the benefits which have accrued to or in respect of me under the ceding scheme. 2. I hereby consent to Xafinity obtaining details from the Administrator/Trustee or insurance company or other pension provider of the transferring scheme, arrangement or contract of which I am or have been a member and authorise the giving of any such details to Xafinity. 3. I authorise and instruct you to transfer funds from the plan(s) as listed in this application directly to Xafinity. Where you have asked me to give you any original policy document(s) in return for the transfer of funds and I am unable to do so, I promise that I will be responsible for any losses and/or expenses which are the result, and which a reasonable person would consider to be the probable result, of any untrue, misleading or inaccurate information deliberately or carelessly given by me, or on my behalf, either in this form or with respect to benefits from the plan. 4. I authorise you to release all necessary information to Xafinity to enable the transfer of funds to Xafinity. 5. I authorise you to obtain from and release to any financial adviser named in this application any additional information that may be required to enable the transfer of funds. 6. If an employer is paying contributions to any of the plans as listed in this application, I authorise you release to that employer any relevant information in connection with the transfer of funds from the relevant plan(s). 7. Until this application is accepted and complete, Xafinity s responsibility is limited to the return of the total payment(s) to the transferring scheme(s). 8. Where the payment(s) made to the Xafinity represent(s) all of the funds under the plan(s) listed in this application, then payment made as instructed will mean that I shall no longer be entitled to receive pension or other benefits from the plan(s) listed. 9. Where the payment(s) made to Xafinity represent(s) part of the funds under the plan(s) listed in this application, then payment made as instructed will mean that I shall no longer be entitled to receive pension or other benefits from that part of the plan(s) represented by the payment(s). 10. I promise to accept responsibility in respect of any claims, losses and expenses that Xafinity and the transferring provider(s) 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. 11. For cash transfer payments, please make the transfer cheque payable to Xafinity Pension Trustees Ltd and send it to us at Scotia House, Castle Business Park, Stirling, FK9 4TZ. Upon making the transfer payment to Xafinity Pension Trustees Ltd, the Trustees/Administrators will be discharged from any liability under the ceding scheme to provide benefits for and in respect of me from the assets / cash equivalent so transferred. Making Sense of Pensions 8
9 Your transfer cancellation rights This section applies to any applications you make to transfer funds from another pension into your SIPP. By completing this application form you have asked us to start processing a transfer from a former scheme. We ll now start processing your application. We ll only ask for the transfer money from your existing pension once a period of 30 days has elapsed. If you do change your mind, send us the form on the back page of this form. Alternatively write to, or e- mail, us at the address on this form and tell us that you want to cancel your transfer. Do you understand what a transfer-in to your SIPP will do for you? You should have received a number of documents which should explain this, including an application form, Key Features document and a personal illustration. If anything is still unclear, please contact us or speak to your financial adviser. If you want to proceed with the transfer-in what should you do? Ignore this notice and do nothing with the Cancellation Form. If you want to cancel the transfer-in, what should you do? Send the Cancellation Form (see back page) to us as soon as possible, so that we can stop the process. In any event, you must post it on or before the 30th day after the date you sign this application form. We won t request transfer monies until the 30 days have elapsed. What happens after the transfer payment has been made? Once a transfer has been paid your former pension scheme is unlikely to allow you reverse the transfer. That s why we won't request the transfer monies until the 30 days have elapsed. Even if your former scheme will allow the transfer to be reversed, you could lose money, particularly if there s been any movement in the fund prices. If you ve used the transferred funds to purchase other investments, those investments will also have to be cancelled and you may lose money as a result of the change in value of those investments. You will also be responsible for recovering any payments that have been made to your financial adviser in connection with the transfer. If you decide to cancel the transfer after your transfer cancellation rights have elapsed, the transfer funds will need to be transferred to another pension arrangement. Transfer proceeds cannot be refunded. If you want to waive your cancellation rights, what should you do? We won t process a transfer until 30 days from the date you sign this application form. But, in some cases, you might want to proceed with an investment as a matter of urgency. If you wish to waive these important rights, you can do so by completing this section. This means you won t be able to change your mind about transferring. Please tell us why you want to waive your transfer cancellation rights. Making Sense of Pensions 9
10 Your investments Once the transfer is received, we ll arrange for all funds to be banked in the SIPP bank account awaiting your investment instructions. We ll follow instructions from you, from your financial adviser, or from any appointed stockbroker or investment manager. If you wish to appoint a stockbroker or investment manager please provide us with their contact details so we can arrange the appointment. You are solely responsible for your own, or your financial adviser s, appointed stockbroker s or investment manager s investment decisions. We can t advise you on investment decisions. We reserve the right (as Scheme Administrator) to exercise the power of veto for any investments that we believe may jeopardise the registered position of your pension. What are you going to invest in? To allow us to provide you with an illustration, please also indicate in the table below what your investment intentions are. If no information is provided we will assume, for illustration purpose only, that the transfer will be invested in cash. This won t affect or restrict your actual investment choices. Type of investment (e.g. cash, shares, unitised funds, property etc) Is this a new investment or in specie? Estimated value Type of investment (e.g. cash, shares, unitised funds, property etc) Is this a new investment or in specie? Estimated value Making Sense of Pensions 10
11 Financial adviser remuneration agreement If you don t complete this section, we ll continue to pay your adviser using the existing instructions we have for your SIPP. Any regular, fund-based, payments will also continue. We will stop making payments to any financial adviser who ceases to be authorised by, or hold, appropriate permissions from, the Financial Conduct Authority or other recognised professional body. All remuneration will be based on the transfer payment received and will not be paid in advance of receipt. Remuneration payments explained Every time a transfer is received we can arrange for payments to be sent to your financial adviser. By completing and signing this application form, you are agreeing to these payments being made. Scope of payments Please note that remuneration can only be paid to your adviser for advice about your SIPP. It can t be used to pay for any other advice. If the payment is for something else HMRC will apply tax penalties. We may refuse to facilitate payment if we believe the amounts are an unauthorised payment. For the transfers shown in this application, you instruct us to pay one of the following: A fixed amount of: OR A proportion of the transfer: % Should VAT be added to the above? Yes No Making Sense of Pensions 11
12 Your declaration For your own benefit and protection, before signing this Declaration, make sure you ve read: 1. This Application Form; 2. The Terms and Conditions for the Xafinity SIPP, incorporating the SimplySIPP. We ll rely on the Terms and Conditions in providing the SIPP to you so it is important that you read these very carefully. If you don t understand any point please refer to your financial adviser. By signing below I confirm that: I have previously received a copy of the Terms and Conditions. I understand that Xafinity will rely on these documents in transferring benefits into my SIPP. The Financial Adviser, whose details have been provided in this form, provided advice to me on this transfer and I confirm that I wish to have remuneration, as set out in this form, paid to this Adviser Firm; To the best of my knowledge and belief, the information given in this Application Form, whether in my handwriting or not, is correct and complete; and I confirm and agree the consents and statements in this form. I confirm and accept that (for transfers from which I am taking drawdown): the amount of income can be changed. If I choose to do so an extra charge may be taken from the fund to meet the additional costs; and (for transfers from which I am taking capped drawdown) if, at any time, the amount of income selected is above the upper limit, I understand that I will automatically be moved to flexi-access drawdown and be subject to the Money Purchase Annual Allowance Rules. Applicant s signature Applicant s name Date of signing DD/MM/YYYY If the applicant is under 18, please also complete the following Legal guardian s signature Legal guardian s full name Date of signing DD/MM/YYYY Adviser declaration I confirm that I have advised this client to transfer the funds noted, with the recommended investments, as set out in this application form. Adviser signature FCA Individual Reg No Making Sense of Pensions 12
13 SIPP trustee Xafinity Pension Trustees Ltd SIPP administrator Xafinity SIPP Services Ltd Phone: SIPP Department Xafinity SIPP Services Ltd Scotia House Castle Business Park Stirling FK9 4TZ Xafinity SIPP Services Ltd is authorised and regulated by the Financial Conduct Authority. Our FCA Registration Number is You can check this on the FCA s website at Xafinity Pension Trustees Ltd ( ) is registered in England at Phoenix House, 1 Station Hill, Reading, RG1 1NB. Xafinity SIPP Services Ltd is registered in Scotland (No 69096) and its registered office is at Scotia House, Castle Business Park, Stirling FK9 4TZ. 145XSP(o) (02/18) Making Sense of Pensions 13
14 Transfer cancellation form! Please detach this before returning your completed application form to Xafinity (ONLY complete this if you wish to cancel the transfer-in(s) to your SIPP) To: SIPP Department Xafinity SIPP Services Ltd Scotia House Castle Business Park Stirling FK9 4TZ I hereby give notice that I have decided not to proceed with the transfer from: (Name of provider / scheme) (Name of provider / scheme) (Name of provider / scheme) (Name of provider / scheme) (Name of provider / scheme) To my Self Invested Personal Pension number Please enter your name and address below: Name: Address : Signed: Date: Please always remember to include your SIPP number on any communication you send to us. Making Sense of Pensions
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