INDIVIDUAL STAKEHOLDER PENSION PLAN APPLICATION FORM ON BEHALF OF A MINOR FOR OFFICE USE ONLY. Referral Type. Agency Number

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1 INDIVIDUAL STAKEHOLDER PENSION PLAN APPLICATION FORM ON BEHALF OF A MINOR FOR OFFICE USE ONLY Agency Number Referral Type Vantive Lead ID Introducer Code if different from above) Campaign Code Branch Sort Code SB Code S B

2 Plan Number (Internal use only) This form should only be completed on behalf of a person who is under the age of 16, or under 18 years of age and not in employment. Such a person is referred to on this form as a minor. 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. A. ELIGIBILITY NOTES (1) Habitually resident means the minor s permanent residential address. To be eligible for this plan, the following condition must apply. The minor is habitually resident in the United Kingdom. (see note 1) If you have not been able to tick the box above, it will not be possible to take out a Stakeholder Pension with Scottish Widows on behalf of the minor. B. MINOR S DETAILS (SEE NOTE 2) 1. Minor s surname (2) As the person for whom the plan is being arranged is under 16 years of age, or under 18 years of age and not in employment, the legal guardian (e.g. a parent) should complete the application. However, the details should be those for the person who will ultimately receive the pension, i.e. the minor. The contract will be in the name of the legal guardian for the benefit of the minor. 2. Minor s first name(s) 3. Minor s Address (see note 3) Postcode Country *Please ensure you complete the above if your address is outside England/Scotland/Wales and Northern Ireland (3) This should be the minor s permanent residential address. We will send all correspondence to this address or to the address of the legal guardian if different. Please ensure the postcode is provided. (4) Please write in the most appropriate of the following: caring for one or more children aged under 16 caring for a person aged 16 or over unemployed other. (5) National Insurance Numbers are issued shortly before a child s 16th birthday. Please tick the box if the minor is too young to have received a National Insurance Number. If you are unable to tick this box and the minor has a National Insurance Number, it is essential that you provide it. A National Insurance Number can be found on a payslip or a P60. Where the minor has a National Insurance Number and this is not provided, we are unable to accept contributions and cannot process the application. If you cannot find their National Insurance Number please phone the HM Revenue & Customs General Enquiries helpline (6) This is the age from which the minor wants their pension to become payable. This must be between the ages of 55 and Contact name and phone number 5. Minor s date of birth (DD MM YYYY) 6. Is the minor Male Female 7. Minor s nationality For example British, French, Irish 8. If over 16, minor s Single marital status Married/in a registered civil partnership Other 9. Is the minor In full-time education Other 10. Please provide the minor s National Insurance Number (see note 5) If the minor does not have, or has never been given, a National Insurance Number, please tick this box 11. Selected Pension Age (see note 6) C. MINOR S CONTRIBUTIONS (please specify, see note 4) The total contributions into the plan can be up to 3,600 gross, or 100% of the minor s relevant UK earnings each tax year. 2

3 D. HOW MUCH IS TO BE PAID? NOTES (CONT D) (7) Currently, tax relief is available on payments of up to 3,600 gross in each tax year. If the minor has relevant UK earnings that exceed 3,600, tax relief will be available in payments up to 100% of the minor s relevant UK earnings, in each tax year. A tax year runs from 6 April in one year to 5 April in the next year. If the minor is a Scottish taxpayer, the tax relief they will be entitled to will be at the Scottish Rate of income tax, which may be different from the rest of the UK in the future. (8) The minimum monthly payment is 20 net. Please choose a payment date up to the 28th of the month. (9) When selecting a payment start date, please allow at least 14 days for the Direct Debit Instruction to be processed. If any payments are due to be collected before the Direct Debit Instruction is processed, we will collect these payments on the first payment date falling after the date the Direct Debit Instruction is processed. In certain circumstances, this may mean that we will deduct more than one payment from the designated account on the same payment date. (10) The minimum single payment is 20 net. The single payment must be paid by cheque, payable to Scottish Widows. When writing a cheque, it will help to prevent fraud if you include additional information on the Payee Line, especially if you are not personally paying the cheque in, for example you may be sending the cheque by post. When writing a cheque to Scottish Widows you should include your name and policy number on the Payee Line. For example Scottish Widows re: your name, your reference policy number xxxyyz. Remember to draw a line through unused space on the cheque so extra numbers or names cannot be added. Who is to make payments? Minor Legal Guardian Other If Other, please provide the following: Name Address Postcode Country Nationality Relationship to minor Regular Payments When are the regular payments to start? (DD MM YYYY) (see notes 8 & 9) If the start date of the plan is less than 21 days after the date we receive the application, we may collect both the first and second premiums on the due date of the second premium. By Minor net (see notes 7 & 8) By Legal Guardian net (see notes 7 & 8) By Other net (see notes 7 & 8) Single Payment Minor Legal Guardian Other E. INVESTMENT OF CONTRIBUTIONS net (see notes 7 & 10) Fund selection is a very important decision. Please refer to our Stakeholder Pension Funds Guide for full details of the funds and any risks associated with them. 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 which apply. You can select one of the following options You can choose one of three Growth Portfolio Funds (complete section (a)) or You can choose your own selection of funds (complete section (b)) or You can choose one of nine Pension Investment Approaches (complete section (c)). If a Growth Portfolio Fund or Pension Investment Approach is selected, it will apply to the whole plan i.e. for all types of payment and all future contributions. If you do not make a selection in sections (a), (b) or (c) below, the payments will be invested in our default fund (the Consensus Fund). We will also automatically switch the plan value approximately 75% into the Pension Protector Fund and 25% into the Cash Fund over the five years before the selected pension date. Please tick this box if you do not want the investment to be switched approximately 75% into the Pension Protector Fund and 25% into the Cash Fund over the five years before the selected pension date. 3

4 E. INVESTMENT OF CONTRIBUTIONS (CONT D) (a) Scottish Widows Growth Portfolio Fund selection To be completed ONLY if you wish to select a Scottish Widows Growth Portfolio Fund. Please select one of the following funds: Please tick as appropriate Each payment invested Balanced Growth Portfolio Fund 100% Strategic Growth Portfolio Fund 100% Stockmarket Growth Portfolio Fund 100% Lifestyle Switching You can select the following lifestyle switching option to accompany the Growth Portfolio Fund. There are two stages: 1. Initially 100% of each payment will be invested into the selected Growth Portfolio Fund. 2. From the date 5 years before the selected pension date until the selected pension date we will: invest approximately 75% of each payment into the Pension Protector Fund and 25% into the Cash Fund; switch a proportion of the value of the 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. Please tick this box if you do not want the investment to be switched automatically. The final fund split may not exactly be 75% Pension Protector Fund and 25% Cash Fund due to stockmarket movements. (b) Fund selection (If not choosing a Growth Portfolio Fund under (a) or a Pension Investment Approach under (c)) You can select up to 10 funds at any one time but there may be restrictions on the amount you can invest in certain funds. Please contact us for further details of any restrictions that may apply. Please indicate which fund(s) you wish to select in the table below: Fund % split for transfer Total 100% 4

5 E. INVESTMENT OF CONTRIBUTIONS (CONT D) We will also automatically switch the investment approximately 75% into the Pension Protector Fund and 25% into the Cash Fund over the five years before the selected pension date. Please tick this box if you do not want the investment to be switched approximately 75% into the Pension Protector Fund and 25% into the Cash Fund over the five years before the selected pension date. The final fund split may not exactly be 75% Pension Protector Fund and 25% Cash Fund due to stockmarket movements. (c) Pension Investment Approaches (If not choosing a Growth Portfolio Fund under (a) or other funds under (b)) 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 (Targeting Encashment) Adventurous (Targeting Flexible Access) Balanced (Targeting Annuity) Balanced (Targeting Encashment) Balanced (Targeting Flexible Access) Cautious (Targeting Annuity) Cautious (Targeting Encashment) Cautious (Targeting Flexible Access) F. MARKETING OPT-OUT Our policy on Data Protection is included in the additional sheet Important Notes for Applications. If you would prefer not to receive details of other products and services please tick this box. Other Lloyds Banking Group companies will not make marketing approaches to you unless you already have a relationship with them. 5

6 G. DECLARATION LEGAL GUARDIAN S DECLARATION IMPORTANT Please complete SCOTTISH WIDOWS STAKEHOLDER PENSION SCHEME (the Scheme) Scottish Widows has set up the above Scheme by Deed Poll. As the administrator of the Scheme, Scottish Widows agrees to run the Scheme according to the Rules of the Scheme. Each policy will consist of one or more Arrangements made for providing benefits under the Rules of the Scheme. I apply on behalf of a minor, who is under the age of 16 or under 18 years of age and not in employment, to become a member of the Scheme: I am legal guardian for the minor and; a) I understand that Scottish Widows will administer my policy according to the Deed Poll, which established the Scheme; the Rules of the Scheme; and the Policy Provisions. b) I declare that: (i) the minor is eligible to join the scheme because they are resident in the UK; (ii) the proposed contributions to this Scheme, and any other payments by or on behalf of, or intended to be paid by or on behalf of the minor to any other registered pension schemes, in respect of which minor is entitled to receive tax relief, will not in any tax year, exceed the higher of the basic amount (currently 3,600 gross), or 100% of minor s relevant UK earnings; (iii) contributions paid net of basic rate tax will change if the basic rate of tax changes, to maintain the then total contribution to this Arrangement by the payer and Her Majesty s Revenue and Customs (HMRC); (iv) to the best of my knowledge and belief all the statements I have made, whether in my own handwriting or not, are true. (v) I will tell Scottish Widows as the Scheme Administrator within 30 days if: the minor stops residing in the United Kingdom. (vi) I will inform Scottish Widows if the minor is no longer entitled to receive tax relief. I will do so by the later of: 5 April in the tax year in which the minor ceased to be entitled to tax relief; and 30 days after the date the minor ceased to be entitled to tax relief. c) 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. d) I will be responsible for the contract as if it were my own until the minor reaches 18 years of age. e) I authorise any agent of the minor acting in connection with the policy, to pass to Scottish Widows, any information concerning the minor that Scottish Widows may require to process the application made on the minor s behalf. Your signature as Legal Guardian Date (DD MM YYYY) Your full name Your permanent residential address Postcode Country A copy of the completed application, Scheme Rules and Policy Provisions is available from Scottish Widows. I understand that the contributions made to the scheme may only be returned to the member in the form of benefits payable under the rules of the scheme (i.e. after the member attains the age of 55 except in the case of earlier incapacity). Your signature as Legal Guardian Date (DD MM YYYY) 6

7 DIRECT DEBIT INSTRUCTION Instruction to your Bank or Building Society to pay by Direct Debit Please complete to instruct your bank/building society to make payments directly from your account. When completed please return the form to: Scottish Widows 15 Dalkeith Road Edinburgh EH16 5BU Names(s) of Account Holder(s) Originator s Identification Number Reference Number (for office use only) Account Number Sort Code Name and full postal address of your Bank or Building Society To the Manager INSTRUCTION TO YOUR BANK OR BUILDING SOCIETY Please pay Scottish Widows Limited Direct Debits from the account detailed in this instruction, subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Scottish Widows Limited and, if so, details will be passed electronically to my Bank/Building Society. Address Signature(s) Postcode Date (DD MM YYYY) Banks and Building Societies may not accept instructions for some types of account. This guarantee should be detached and retained by the Payer THE DIRECT DEBIT GUARANTEE This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits. If there are any changes to the amount, date or frequency of your Direct Debit Scottish Widows Limited will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Scottish Widows Limited to collect a payment, confirmation of the amount and date will be given to you at the time of the request. If an error is made in the payment of your Direct Debit by Scottish Widows Limited or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society. If you receive a refund you are not entitled to, you must pay it back when Scottish Widows Limited asks you to. You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

8 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 MA 04/17