Praemium Retirement Account

Transcription

1 Adviser Checklist THIS SECTION MUST BE COMPLETED I have enclosed original documents or certified copies of the following identity verification documentation: Tick One Passport Photocard (new style) Driving Licence EU Member State ID card Northern Ireland Electoral ID card Shotgun / Firearms Licence AND, I have enclosed the following address verification documentation Utility statement (dated within the last three months and not from the Internet) Bank statement (dated within the last three months and not from the Internet) Mortgage statement (dated within the last twelve months and not from the Internet) Council tax statement (dated within the last twelve months) Telephone bill (dated within the last three months) HMRC notification or tax assessment (not P45 or P60 and dated within the last twelve months) Valid (old style) full UK Driving Licence Photocard (new style) Driving Licence (if not already as above) Tick One Please note we will not be able to process the application until we have received one valid item from each section I have enclosed a Transfer Authority (Section F) for each scheme being transferred If immediate access to benefits is required, I have enclosed a completed Benefit Request Form If regular contributions are required from outset, I have enclosed a completed Regular Contributions Mandate to set up a Standing Order The client has signed the application in Section I and Section L. Please note that it is a serious offence to make false statements or false claims in order to obtain a tax advantage - the penalties are severe and could include criminal prosecution. Please return this form and any additional documentation to: Praemium Retirement Account, 12 Market Place, Cockermouth, Cumbria, CA13 9NQ Page 1 of 17

2 Section A: Your Personal Details The information supplied will be held in the strictest confidence and is subject to the provisions of Data Protection legislation. Title * Forename(s)* Surname * Marital Status* Gender* Other Occupation* Annual Earnings Selected Retirement Age* Telephone (Main) * Telephone (Home) Current Residential Address ( PO Box or Care of addresses not acceptable) Mailing Address (if different to above) Address Town/City Country Post code Section B: Your Tax and Residency Status Country of Nationality * Date of Birth * Identifier* The individual doesn t have the identifier: Identifier Dual Nationality? If yes, which Country * Country of Birth * US Person Politically Exposed Person Tax Residence 1 * Tax Identification Number 1* Date from Date to Tax Residence 2 Tax Identification Number 2 Date from Date to Section C: Your Status Please advise which category is applicable to the applicant (if more than one, indicate the category that is most applicable). Employed Self Employed Caring for someone (under 16) Unemployed Pensioner Caring for someone (older than 16) Full time education Other (please specify): Section D: Your Source of Wealth Savings from salary Pension transfer Inheritance Divorce settlement Property sales Sale of Assets Other (please specify): Page 2 of 17

3 Section E: Contributions (the amounts below should be NET of basic rate tax) Personal Contributions Please enter the net contributions you wish to pay Single (net)* Payment Date Regular (net) Commencement Date Frequency Employer Contributions Please enter the net contributions you wish to pay Single (net)* Payment Date Monthly/Quarterly/Semi-annually/Annually Regular (net) Commencement Date Frequency Employer Name Please note, we will ask for further information about the third party or the Employer before accepting any contributions. Benefactor Contributions Please enter the net contributions you wish to pay Single (net)* Payment Date Regular (net) Commencement Date Frequency Third Party Name Please note, we will ask for further information about the third party or the Employer before accepting any contributions. Money Purchase Annual Allowance Have you have taken benefits from any pension arrangement in a way which means you are subject to the reduced Money Purchase Annual Allowance (MPAA) rules? If you answered Yes to the above, what date did you trigger these rules? Regular Contributions to your PRA should be made by Standing Order, using your PRA member number as a reference. Details of your PRA member number and operating bank account will be included within your Welcome Pack. An optional Regular Contributions Mandate is available. Page 3 of 17

4 Section F: Transferring Pension Details You should complete a separate form for each of the schemes that you intend to transfer, if you have more than one, please complete another copy of this section. Scheme Name* Policy Number* Provider Country*/Post code* Scheme Type (please tick one) Occupational Defined Benefit Occupational Defined Contribution Pension with Guaranteed Annuity Rate Section 32 with GMP Section 32 without GMP Personal Pension/Stakeholder/SIPP Other (please specify): Is the transferring pension subject to any existing or proposed trustee in bankruptcy orders, or earmarking or pension sharing orders, or other receiving orders? Estimated Transfer Value The sums/assets being transferred are; already entirely in drawdown OR already partially in drawdown OR not in drawdown Estimated transfer value Full Partial Estimated crystallised value Estimated uncrystallised Safeguarded Benefits (please complete if estimated transfer value is greater than 30,000) Does this proposed transfer include Safeguarded Benefits? Please complete the following if you answered Yes to the above Are you aware of the risks associated with transferring Safeguarded Benefits? Have you received specific pension transfer advice from your Financial Adviser as noted in Section I? Page 4 of 17

5 Section G: Investment Choice Initial funds received should be invested as below. Investment Manager Strategy Name Weighting Helm Godfrey Partners Limited HG PMX Cash Model % % % % Investment Manager Details Investment Manager Helm Godfrey Partners Limited 1a, Lloyd's Avenue London UNITED KINGDOM EC3N 3AA * Regulator number* Investment Manager * Regulator number* Section H: Fees Please pay my Adviser (as noted in Section I) the following fees for initial and on-going advice related to my Praemium Retirement Account (the maximum permitted is 5% of the value of your portfolio) Initial Adviser charge (Lump sums)* or % Initial Adviser charge (Regulars)* or % Ongoing Adviser fee* % In addition to the fees that my Adviser will be paid, I understand that the following fees are also payable Platform Custody & Execution Ongoing fee from at 0.1 % from at 0.08 % from at 0.05 % from at % from at % Investment Management fee * 0.54 % (Fees are always shown inclusive of any VAT which may be applicable) Page 5 of 17

6 Section I: Your Adviser Details This section should be completed by your Financial Adviser. Please note, we only accept applications from individuals who have an appointed Financial Adviser and who have received specific advice on the establishment of a Praemium Retirement Account and any related pension transfers or contributions. Firm Name Helm Godfrey Partners Limited Marlow House, 1a Lloyds Avenue London UNITED KINGDOM EC3N 3AA * joanne.beavis@helmgodfrey.com Firm Regulator Pension transfer advice Are any of the proposed transfers over 30,000? If yes to the above, do those proposed transfers include Safeguarded Benefits? Please complete the following if you answered Yes to both of the above Has your firm provided specific advice in relation to the transfer of Safeguarded Benefits? Does your firm hold pension transfer permissions? Has your pension specialist been involved in the advice relating to this applicant? Has a transfer value analysis been undertaken and discussed with the applicant? Details of Registered Individual signing on behalf of the Firm I hereby confirm the information in this section is correct and complete Name* Regulator number Signature* Date* I/We hereby confirm that the applicant has read all of the relevant supporting literature including but not limited to the Key Features Document, Terms & Conditions and Schedule of Fees & Charges. I/We have obtained and enclosed evidence to verify the identity of my client(s), which meets the standard evidence criteria set out within the guidance for the UK Financial Sector issued by the Joint Money Laundering Steering Group. Appointment of my Financial Adviser (to be signed by the member) I hereby appoint the above named Firm my Financial Adviser Name* Signature* Date* (a) I undertake to inform the Operator immediately if I wish to amend or cancel this appointment. (b) I authorise the Operator and any other firm in the Praemium Group of companies as required from time to time, to act on instructions received from my Financial Adviser and to release any information that they request in relation to my Praemium Retirement Account. (c) I authorise the Operator and any other firm in the Praemium Group of companies as required from time to time, to pay my Financial Adviser the fees set out in section H of this form. I undertake to inform the Operator immediately if I wish to amend or cancel the fees detailed in section H of this form. (d) All information relating to my Praemium Retirement Account will be sent to my Financial Adviser. (If you would like to receive copies of correspondence, please tick here ) (e) I fully understand that the Operator reserves the right in its absolute discretion to reject any appointment or refuse such a request where it is deemed not to be in my best interest or in the best interest of the Operator. Page 6 of 17

7 Section J: Expression of Wish Please provide details of who you would like to benefit in the event of your death. The Expression of Wish allows you to tell us who you would like to receive death benefits without reducing the options of anyone you do not name. You can change this Expression of Wish by writing to us at any time. In the event of my death, my wishes are that you consider allocating any death benefits from my PRA as follows: Beneficiary Name* Relationship Date of Birth* % of benefit* Beneficiary Name* Relationship Date of Birth* % of benefit* Beneficiary Name* Relationship Date of Birth* % of benefit* Beneficiary Name* Relationship Date of Birth* % of benefit* Section K: Cancellation rights You have the right to cancel your application to set up a Praemium Retirement Account at any time within 30 days of the date that we accept your application. After that date, you will be subject to the Terms and Conditions of the Praemium Retirement Account and we will not be able to refund any money or return money to your previous pension scheme. If you wish to cancel, you can do so by writing to us at the address on this form or by sending an to PRA@praemium.com. You can choose to waive your cancellation rights within the 30-day cancellation period. If you would like to waive your cancellation rights, please tick here. You can find full details of your cancellation rights in the Praemium Retirement Account Key Features Document. Page 7 of 17

8 Section L: Declaration 1. MEMBERSHIP 1.1 I declare that to the best of my knowledge and belief all statements made in this (including the contents of this declaration) as at the date of completion (whether in my handwriting or not) are correct and complete. 1.2 I undertake to tell the Operator in writing within 30 days, if there is any change to any of the personal details stated on this including but not limited to, my tax and residency status. 1.3 I understand that it is a serious offence to make false statements or false claims in order to obtain a tax advantage and the penalties for doing so are severe and could include criminal prosecution. 1.4 Before signing this declaration, I have had the opportunity to read the following documents: (a) Praemium Retirement Account Key Features Document (b) Praemium Retirement Account Schedule of Fees and Charges (c) Praemium Platform Key Features Document (d) Cater Allen FSCS Disclosure and Exclusions list (e) Cater Allen Data Protection Statement 1.5 I understand that these documents give important information about my Praemium Retirement Account ( PRA ) and along with this Application Form the Agreement which will be relied upon. 1.6 I have discussed these documents with my Financial Adviser as noted in Section I of this and fully understand the product features and risks. 1.7 I understand that the PRA is a brand style of the Wensley Mackay Personal Pension ( the Scheme ). 1.8 I understand that Wensley Mackay Limited is the Operator ( Operator ) of my PRA and that W M Pension Trustee Services Limited is the Trustee ( Trustee ). 1.9 I declare that I am the person (or the parent or guardian of the person) named in this and apply for Membership of the PRA and agree to be bound by the Trust Deed and Rules and the Terms and Conditions of the Scheme I understand and accept the Terms and Conditions of the Praemium Platform I understand that I am applying to the Operator for Membership of the PRA I understand and agree to pay the Operator all fees and charges in return for the services to be provided as set out in the Schedule of Fees and Charges I understand that fees and charges may be amended from time to time I understand that the Operator will deduct any fees and charges directly from the value of my PRA when they become due I understand that if there are insufficient liquid funds available in my PRA that I will be required to settle any fees and charges personally. 2. CONTRIBUTIONS 2.1 For any contributions I wish to make I am eligible to obtain tax relief on those contributions as a relevant UK individual. 2.2 I understand that tax relief on regular and single contributions is only available to relevant UK individuals. A relevant UK individual is a person who: (a) has relevant UK earnings chargeable to income tax in the current tax year; or (b) is resident in the UK at some time during the current tax year; or (c) was resident in the UK at some time during the 5 tax years immediately before the current tax year in question and also resident in the UK at the time of joining the Scheme; or (d) has, or is the spouse of a person who has, for the current tax year general earnings from overseas Crown employment subject to UK tax 2.3 I understand that I must stop making contributions to the Scheme, if I am no longer a relevant UK individual. 2.4 I understand that it is my responsibility to inform HM Revenue & Customs ( HMRC ) through my Self-Assessment Tax Return of the pension contributions made to any pension scheme, and that contributions in excess of my Annual Allowance and/or Money Purchase Annual Allowance will normally mean I will be subject to a tax charge equivalent to my marginal rate of tax. 2.5 I agree that the total contributions to any Registered Pension Schemes in which I am entitled to tax relief will not exceed the higher of: (a) the basic amount set by the Government (currently 3,600); or (b) my relevant UK earnings in any tax year. 2.6 If an event occurs, as a result of which I am no longer entitled to tax relief on my contributions I undertake to tell the Operator in writing not later than: (a) 5 April in the tax year in which this occurs; or (b) within 30 days of the event. 2.7 I understand that the Operator will only accept third party contributions including employer contributions upon satisfactory completion of any due diligence that the Operator may require. 2.8 I understand that contributions or other payments will not be invested until the Trustee has received cleared funds. 2.9 I understand that I will lose any enhanced or fixed protection upon making any contributions into my PRA. 3. TRANSFERS 3.1 To the transferring provider noted in Section F of this and in any additional transfer requests: (a) I authorise and instruct you to transfer sums and assets from the transferring pension(s) as listed in Section F of this Application Form directly to the Operator and to provide any instructions and/or discharge required by any relevant third party to do so. (b) I authorise the Operator, the transferring provider and any Financial Adviser named in this 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 the Operator. (c) I authorise the Operator, the transferring provider and any employer paying contributions to any of the transferring Page 8 of 17

9 pension(s) as listed in Section F 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 the Operator. (d) Until this Application is accepted and complete, the Operator s responsibility is limited to the return of the total payment(s) to transferring provider(s). (e) When payment is made to the Operator as instructed, this means that I shall no longer be entitled to receive pension benefits from the whole of the transferring pension(s) listed in Section F where the whole of the transferring pension(s) is transferring, or that part of the transferring pension(s) represented by the payment(s) if only part of the transferring pension(s) is transferring. 3.2 To the transferring provider noted in Section F of this application and in any additional transfer requests and to the Operator: (a) I accept responsibility in respect of any claims, losses, expenses, additional tax charges or any penalties that the Operator and the transferring 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. 3.3 I understand that; (a) 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 from the date of my first Flexi-Access payment; or if I am already subject to the Money Purchase Annual Allowance, I have supplied the date the Money Purchase Annual Allowance first applied to me in Section E of this. 4. INVESTMENTS 4.1 I understand that the information disclosed on this will be used to open an operating account for my PRA with Cater Allen Private Bank. 4.2 I understand that the information disclosed on this will be used to open a Praemium Platform Account in the name of my PRA. 4.3 I have read the Terms of the Praemium Platform in conjunction with the Key Features Document and Terms and Conditions of the PRA and have discussed these with my Financial Adviser. 4.4 I understand that the PRA may be opened in any of the DAS, Direct and Select services offered by Praemium. 4.5 I understand that the investments held within my PRA will be selected for me and managed in accordance with the operation of the particular service (DAS, Direct or Select, as the case may be) in which the PRA is opened. 4.6 I declare that the Investment Manager(s) (each an Investment Manager ) named in section G has full authority on my behalf to give instructions and otherwise deal with the investments and assets held under the Investment Mandate(s) offered by them without limitation. 4.7 You are, and at all times will remain, the beneficial owner of the Assets held in your PRA. Investments made by you will be held, on your behalf, in the name of the Trustee. 4.8 I approve the Operator to realise investments under the Scheme attributable to me in order to pay its annual charges and transactions. In particular, I agree that any legal fees incurred by the Trustee or the Operator in relation to any action taken in connection with investments held on my behalf under the Scheme will be paid from my arrangements under the Scheme. 5. BENEFITS 5.1 I accept that the value of my PRA may only be applied to provide benefits at the time I take retirement benefits or upon my death and that Operator will provide the appropriate benefits as required from my Self- Invested Personal Pension (SIPP) funds. 5.2 I understand that benefits under the Scheme may not be surrendered, assigned, commuted or transferred other than in accordance with the Finance Act 2004, or in implementation of a pension sharing order in accordance with the Welfare Reform and Pensions Act I will not attempt to withdraw funds held to provide benefits for me under the Scheme or the income on those funds, other than in accordance with the Rules of the Scheme. In the event that an unauthorised payment is made, I agree to the Scheme Administrator deducting the amount of any Scheme Sanction Charge, or other charges, levied by HMRC on the Scheme Administrator from the Fund held for me under the Scheme. If there are insufficient funds held for me under the Scheme, I agree to pay the Scheme Administrator the amount by which the charge exceeds the value of my fund under the Scheme. 5.4 I understand that where I instruct the Operator to pay any monies (Tax Free Cash and/or income payments) and then subsequently change my mind and cancel the plan (where a cancellation right exists), I will pay back in full any such payments received from the Scheme. In addition, I will also pay the Operator s reasonable administration and/or legal costs in recovering this money. 5.5 I understand that it is my responsibility to disclose details of any enhanced, primary, fixed or individual protection applicable to me at the point of Application. 6. FINANCIAL ADVICE 6.1 I acknowledge and accept the terms of the PRA and I accept that the service provided under it does not extend to financial advice under the terms of the Financial Services and Markets Act I confirm that I have neither sought, received nor relied upon any advice from the Operator, the Trustee, or any Praemium Group Company in relation to my Application to become a Member of the Scheme. 6.3 I understand that I am required to maintain a relationship with a Financial Adviser at all times and have appointed the Financial Adviser in Section I of this. 6.4 I understand that the Operator will correspond with any Financial Adviser (including employees of the Financial Adviser) identified in Section I of this rather than me directly unless I give written instructions to the contrary. 6.5 I understand that it is the responsibility of my Financial Adviser to disclose all fees, charges and commissions earned in respect of my PRA. 6.6 I undertake to notify the Operator immediately if I terminate the relationship with my Financial Adviser and/or appoint a new Financial Adviser. 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10 7. DATA PROTECTION ACT 2018 (e) Prevent and detect crime; and 7.1 I understand that Wensley Mackay Limited is the Operator of the Praemium Retirement Account and is a member of the Praemium Group of companies. 7.2 I understand and accept that the Operator may disclose my personal information to verify my details with a credit reference agency or agencies both during the Application process and during the ongoing administration of my plan. This information will be used to prevent fraud and money laundering and to check my identity. Any checks performed may be recorded on my credit history. 7.3 I understand and accept that the information provided by the Operator to credit reference agencies will be used by other credit grantors to prevent fraud and money laundering, to make credit decisions about me and the people with whom I am financially associated, and occasionally for tracing debtors. 7.4 I understand and accept that the Operator will only disclose my personal information to any legal or regulatory body if required to do so by law. 7.5 I understand and accept that the Operator will never disclose my details to a third party without my consent but will use my personal information, and share it with associated companies in order to: (a) Establish my PRA (b) Open an operating bank account with Cater Allen (c) Provide ongoing administration and communications in relation to my PRA (d) Administer my Praemium Platform Account and the investments held therein (f) Conduct statistical market research. 7.6 I understand and accept that the Operator may be required to collect personal data about me (as described in the Praemium Privacy Policy) to provide its services, and I provide my consent that the Operator may collect and process personal data (including, where relevant, special categories of personal data) as may be required. 7.7 I understand and accept that the Operator may need to transfer my personal information to another country but that in doing so the Operator will ensure the same level of protection as required under the UK Data Protection Act 2018 and the General Data Protection Regulation (EU) 2016/ I understand and accept that I have a right to obtain a copy of the personal information that the Operator holds in relation to me (subject to the payment of a fee) and to have any inaccuracies corrected. 7.9 I understand and accept that the Operator or an associate company, may inform me, from time to time, of other products and services supplied by them or associated companies, which may be of interest to me If you do not wish to receive such information, please tick here. 8. ANTI MONEY LAUNDERING 8.1 I understand and accept that the Operator will request documentation sufficient to prove identity under the Joint Money Laundering Steering Group guidelines. 8.2 I understand that the Operator will conduct online verification using a third party service. I confirm that, to the best of my knowledge and belief, the details given on this are correct and complete. Name*.. Signature* Date* Page 10 of 17

11 Benefit Request Form About this form Please complete this form if you wish to draw Pension Commencement Lump Sum and access your benefits. Please complete all sections. Inaccurate, illegible or incomplete information may delay payment. Please enclose the requested supporting documentation or drawdown may be delayed. We strongly recommend that you speak to a Financial Adviser prior to making your decision. The Praemium Group of companies cannot provide you with any advice. If you are unsure of any of the implications of converting to Flexi-Access Drawdown please speak to your Financial Adviser or Pension Wise. Pension Wise is a free, impartial guidance service backed by the government. It is, however, not intended to replace full, regulated financial advice. Web: Telephone: or face to face via the Citizens Advice Bureau. Member Details Name * Date of Birth* Policy No.* Tax Identification Number* Important Points for Consideration Are you aware that the amount of income available from the fund in your Praemium Retirement Account (PRA) is not guaranteed and may be exhausted depending on the level of withdrawals, investment performance and charges etc? Yes No Are you aware of the amount of tax you will pay when you withdraw money from your PRA? Yes No Do you require a regular guaranteed income to sustain your intended lifestyle through retirement? Yes No Do you have any other pensions or significant savings and investments outside your Praemium Retirement Account upon which you are able to rely in the event your PRA funds are exhausted? Yes No Do you understand that the monies paid as pension income or UFPLS are taxable? Yes No Do you understand that once the money is withdrawn from your PRA it loses a number of significant tax advantages and reduced limits will apply for what you are able to pay back in? Are you aware that drawing pension income may have a detrimental impact on any means-tested benefits to which you otherwise be entitled? Yes Yes No No Are you aware that creditors may have a call on any money drawn from your pension savings? Yes No Have you considered the ongoing charges both for the administration of the pension scheme and pension payments as well as any ongoing investment charges and compared these charges with those applicable from other retirement options? Have you been contacted by someone suggesting you withdraw money from your pension scheme in order to invest it? Do you have any health conditions or lifestyle factors that might mean you are entitled to a better rate on an annuity (an enhanced annuity)? Yes Yes Yes No No No Are you married or do you have other people financially depending on you? Yes No Dependent on your answers to the above points we will write to you with more detail regarding the particular point and asking you to formally re-confirm that you wish to proceed with your chosen course of action. Page 11 of 17

12 Benefit Request Form Advice I have received advice from a regulated Financial Adviser I have received guidance from Pension Wise Adviser Details Name * Firm Name * Helm Godfrey Partners Limited joanne.beavis@helmgodfrey.com Telephone Number* Marlow House, 1a Lloyds Avenue London UNITED KINGDOM EC3N 3AA Lifetime Allowance We are required to test the value of your plan against the Lifetime Allowance (LTA). We will not be able to pay your benefits if this section is not completed. Other benefits taken: I have not taken any retirement benefits from any other pension scheme I took benefits from another pension scheme prior to 6 April 2006 If you have subsequently put another pension scheme into payment (crystallised) on or after 6th April 2006 please confirm the date and deemed Lifetime Allowance usage. If you have not subsequently put another scheme into payment please provide the current maximum gross annual income available from the scheme. I took benefits from another pension scheme after 5 April 2006 Please provide details: Date of Crystallisation Event Protection Scheme Name Lifetime Allowance Used % % % % I do not have any form of HMRC protection regarding Lifetime Allowance or I do have HMRC protection regarding Lifetime Allowance and enclose the certificate(s) (tick relevant boxes below) Please advise which category is applicable to the applicant (if more than one, indicate the category that is most applicable). Primary Protection Enhanced Protection Individual Protection 2014 Individual Protection 2016 Fixed Protection 2012 Fixed Protection 2014 Fixed Protection 2016 If you are crystallising another scheme at the same time please provide us with full details and make that scheme aware of this crystallisation event. If you have transferred to a QROPS since 6th April 2006 please provide details. If you have any other LTA enhancement for instance as a result of a pension credit or an overseas pension transfer please provide details. If there is a liability to the LTA charge we will contact you to discuss how you wish to take benefits from the chargeable amount (a Lifetime Allowance Lump Sum, as Income Drawdown or as a combination of the two). Page 12 of 17

13 Benefit Request Form Drawdown details Please select from the benefit options below and provide additional details: Flexi-Access Drawdown (FAD) I instruct crystallisation of the plan as follows: Pension Commencement Lump Sum (Tax Free Cash) required: Maximum or Income: Nil* Single one-off payment** Gross Income Required Regular Income ** Gross Income Required Frequency (Monthly/Quarterly/Bi-annually/Annually) * Pension Commencement Lump Sum/Tax Free Cash paid with no Taxable Income ** In addition to Pension Commencement Lump Sum/Tax Free Cash Uncrystallised Funds Pension Lump Sum (UFPLS) I instruct crystallisation of the plan as follows: Gross UFPLS Required Additional Fund Designation to existing Capped Drawdown (AFD to CDD) I instruct crystallisation of the plan as follows: Pension Commencement Lump Sum (Tax Free Cash) required: Maximum or Income: Nil* Single one-off payment** Gross Income Required Regular Income ** Gross Income Required Frequency (Monthly/Quarterly/Bi-annually/Annually) * Pension Commencement Lump Sum/Tax Free Cash paid with no Taxable Income ** In addition to Pension Commencement Lump Sum/Tax Free Cash Please note that if the Gross Income Required exceeds the maximum income calculated under Capped Drawdown, the gross income payable will be reduced to the maximum as calculated. If you wish to draw gross income in excess of the maximum calculated then please complete the Flexi-Access Drawdown options above. Annuity Purchase I wish to purchase an annuity the details of which I enclose as provided to Wensley Mackay Ltd by my Financial Adviser. (Additional information is required) Maximum Pension Commencement Lump Sum (Tax Free Cash) Other Pension Commencement Lump Sum (Tax Free Cash) or please give details: Pension Commencement Lump Sum (Tax Free Cash) required Please note that it is your responsibility to ensure adequate funds are available in the Trustees bank account to make Tax Free Cash/PCLS, pension and PAYE payments. Wensley Mackay will not be responsible for any delays caused by your failure to ensure funds are available. Page 13 of 17

14 Benefit Request Form Payment Details Please pay to my account: Account Name* Account No.* Bank Name* Sort Code/Routing Number Declaration I confirm that all details I have supplied are correct. I understand that: it is my responsibility (and not that of the Scheme Administrator) to ensure sufficient funds are available to pay benefits as they fall due and I understand that if sufficient funds are not available my pension may be delayed. the Scheme Administrator will operate a PAYE system and make payments relating to the liabilities to HMRC. the benefits available are limited by legislation and that the Scheme Administrator may make changes to my benefits in order to comply with legislation. I will be subject to the Money Purchase Annual Allowance (MPAA) and that I will no longer be able to carry forward any unused Annual Allowance entitlement from previous tax years if I draw income under Flexi-Access Drawdown or via UFPLS. I have read and understood the above statements and questions and wish to proceed with my application to access benefits. Sufficient information has been provided to me to understand the implications of my request to access benefits and I understand the risks associated with taking benefits. Name*.. Signature* Date* Upon receipt and review of this completed form we will process the benefit request and make arrangements to pay monies to the Account Details stated in this form. Please return this form and any additional documentation to: Praemium Retirement Account, 12 Market Place, Cockermouth, Cumbria, CA13 9NQ Page 14 of 17

15 Regular Contributions Mandate Standing order instruction Section 1 and 2 are to be completed by the contributor with their bank details Section 1 Contributor Bank Account Details Account Name* Bank Name* Account No.* Sort Code/Routing No. * IBAN No. Bic. Number Section 2 Standing order instruction Please pay by Standing Order Regular Payment To be paid until further notice from: Frequency (Monthly/Quarterly/Bi-annually/Annually) Name* Signature* Date* Reference (optional) Section 3 Praemium Bank Account Details Praemium will complete this section and credit your Pension Scheme Account Name* Bank Name* Account No.* Sort Code/Routing No. * IBAN No. Bic. Number This Standing Order Mandate supersedes all previous Standing Orders to this recipient. Please return this form and any additional documentation to: Praemium Retirement Account, 12 Market Place, Cockermouth, Cumbria, CA13 9NQ Page 15 of 17

16 Employer Contribution Form Member Details Name *.. Policy No.* Date of Birth* Tax Identification Number* Employer Details Company Name * Company Type * Company Registration No. * Nature of Activities * The company traded on a recognised Stock Exchange Registered Address Country*/Post Code* Principal Place of Business Address (if different from Registered Address) Address Country/Post Code Main Contact Details Title * Forename(s)* Surname * Telephone (Contact) * Contribution Details Single (net)* Payment Date Regular (net) Commencement Date Frequency Employer signature I confirm that all details I have supplied are correct. Name* Signature* Date* Page 16 of 17

17 Employer Contribution Form Employer Details (continued) Director Details Name(s) * Beneficial Shareholders (>25%) Name(s) * Adviser Details Firm Name * Helm Godfrey Partners Limited joanne.beavis@helmgodfrey.com Telephone Number* Marlow House, 1a Lloyds Avenue London UNITED KINGDOM EC3N 3AA Authorised Signature (must be signed by the Registered Individual) I confirm that all details I have supplied are correct. Name* Signature* Date* Please return this form and any additional documentation to: Praemium Retirement Account, 12 Market Place, Cockermouth, Cumbria, CA13 9NQ Page 17 of 17