ƉƉůŝĐĂƟŽŶ&Žƌŵ. Transfer In

Transcription

1 ƉƉůŝĐĂƟŽŶ&Žƌŵ Transfer In

2 You need to complete this form if you want to transfer benefits from another pension arrangement to a Pointon York SIPP. If you are transferring benefits already in payment through income drawdown then you should complete form TVID ( Income Drawdown Transfer Plan ). You should NOT complete this form. ͻdśŝɛĩžƌŵőŝǀ ĞƐƚŚĞdƌƵƐƚĞĞƐŽƌĚŵŝŶŝƐƚƌĂƚŽƌŽĨLJŽƵƌĞdžŝƐƟŶŐƉĞŶƐŝŽŶĂƌƌĂŶŐĞŵĞŶƚƚŚĞĂƵƚŚŽƌŝƚLJƚŽƉƌŽǀ ŝěğƶƌɵɛăŷŭɛ ǁ ŝƚśƚśğƌğůğǀ ĂŶƚŝŶĨŽƌŵĂƟŽŶĂďŽƵƚLJŽƵƌĞdžŝƐƟŶŐƉĞŶƐŝŽŶĂƌƌĂŶŐĞŵĞŶƚ t Ğǁ ŝůůǁ ƌŝƚğƚžƚśğdƌƶɛƚğğɛžƌěŵŝŷŝɛƚƌăƚžƌƚž ŽďƚĂŝŶƚŚĞĚĞƚĂŝůƐƌĞƋƵŝƌĞĚ t Ğǁ ŝůůŭğğɖljžƶŝŷĩžƌŵğěžĩƚśğɖžɛŝɵžŷăɛƚśğƚƌăŷɛĩğƌɖƌžőƌğɛɛğɛ ͻzžƶǁ ŝůůŷğğěƚžđžŵɖůğƚğžŷğĩžƌŵĩžƌğăđśƚƌăŷɛĩğƌljžƶǁ ĂŶƚƚŽŵĂŬĞ /ĨLJŽƵŶĞĞĚĂĚĚŝƟŽŶĂůĨŽƌŵƐƉůĞĂƐĞĐŽŶƚĂĐƚƵƐŽƌ your adviser. You need to complete Part 1 of the form and sign the form in the two places provided on page 4. dśğƚƌăŷɛĩğƌŵăljƚăŭğăĩğǁ ǁ ĞĞŬƐƚŽĐŽŵƉůĞƚĞ zžƶƌăɖɖůŝđăɵžŷƚžũžŝŷăwžŝŷƚžŷzžƌŭ^/wwǁ ŝůůɖƌžđğğěɛğɖăƌăƚğůlj The benefits that will be transferred will be received by your Pointon York SIPP which is a Registered Pension Scheme for the purposes of Part 4 of Finance Act ƵƌƟƐĂŶŬƐ>ƚĚ ĂƌĞƚŚĞƐĐŚĞŵĞĂĚŵŝŶŝƐƚƌĂƚŽƌ ĂŶĚĂƌĞĂƵƚŚŽƌŝƐĞĚĂŶĚƌĞŐƵůĂƚĞĚďLJƚŚĞ&ŝŶĂŶĐŝĂůŽŶĚƵĐƚƵƚŚŽƌŝƚLJ /ĨĂŶLJŽĨƚŚĞƚƌĂŶƐĨĞƌǀ ĂůƵĞƌĞůĂƚĞƐƚŽĐƌLJƐƚĂůůŝƐĞĚƌŝŐŚƚƐLJŽƵǁ ŝůůŷğğěƚžđžŵɖůğƚğƚśğdƌăŷɛĩğƌŝŷ ƌăǁ ĚŽǁ ŶĂƉƉůŝĐĂƟŽŶĨŽƌŵ instead of this one Member Details Title Forename(s) Surname Date of Birth E ĂƟŽŶĂů/ŶƐƵƌĂŶĐĞE ƵŵďĞƌ Residency Full Name of transferring scheme Trustee/Administrator s address Your Scheme or Policy number (if applicable) /ƐƚŚĞƚƌĂŶƐĨĞƌŝŶŐƐĐŚĞŵĞĂŶŽĐĐƵƉĂƟŽŶĂůƉĞŶƐŝŽŶƐĐŚĞŵĞ If yes, is the scheme a defined benefit scheme? (If you have safeguarded benefits, normally the case if the scheme is a final salary or defined benefit scheme, ǁ Ğǁ ŝůůƌğƌƶŝƌğăŷăěěŝɵžŷăůdϭĩžƌŵƚžďğđžŵɖůğƚğě Is this transfer a transfer of assets in specie? /ĨLJĞƐ ƉůĞĂƐĞĚĞƚĂŝůƵŶĚĞƌ ƐƐĞƚƐƚŽďĞdƌĂŶƐĨĞƌƌĞĚ ƐĞĐƟŽŶŽŶƉĂŐĞϯ Are you subject to the Money Purchase Annual Allowance (MPAA)? If yes, please confirm the date the MPAA first applied. Date: 2 V0.6 05/17

3 Benefits to be Transferred Approximate fund value to be paid to your Pointon York SIPP Does this represent the full value of your ceding provider plan? List of Assets to be Transferred from: Scheme ƐƐĞƚWƌŽǀ ŝěğƌăŷě ĞƐĐƌŝƉƟŽŶ Reference ĂƚĞŽĨ>ĂƐƚs ĂůƵĂƟŽŶ Value Right to Withdraw from Transfer You have the right to withdraw from the transfer within 30 days of the date we inform you that we have received your transfer ƌğƌƶğɛƚ zžƶŵăljěžƚśŝɛďljǁ ƌŝɵŷőƚžƶƌɵɛăŷŭɛăƚƚśğĩžůůžǁ ŝŷőăěěƌğɛɛ ƵƌƟƐĂŶŬƐ WŽŝŶƚŽŶzŽƌŬ, ŽƵƐĞ t ĞůůĂŶĚƵƐŝŶĞƐƐ Park, Valley Way, Market Harborough, Leicestershire, LE16 7PS. t Ğǁ ŝůůǁ ƌŝƚğƚžljžƶůğƫŷőljžƶŭŷžǁ ǁ ŚĞŶƚŚŝƐƌŝŐŚƚƚŽǁ ŝƚśěƌăǁ ĞdžƉŝƌĞƐ This right to withdraw is separate from any right you may have to cancel membership of your Pointon York SIPP on the establishment of your SIPP, and unlike this right, you cannot waive this right to withdraw from the transfer. If you exercise this right to withdraw from the transfer we will endeavour to return any funds already transferred back to the original transferring pension scheme. You should be aware, however, that the transferring scheme is not obliged to take the transfer back, and this may therefore not be possible. In this circumstance we would transfer your SIPP funds or assets to another registered pension scheme of your choice. We will not charge you for doing the above, although any fees outstanding following ƚśğğɛƚăďůŝɛśŵğŷƚžĩljžƶƌ^/wwǁ ŝůůɛɵůůďğěƶğ Where the transfer includes the transfer in-specie of property, then we will not instruct solicitors within the above 30-day period. If you intend using the transferred funds to finance a property purchase, then we will only instruct solicitors within the above ϯ ϬͲĚĂLJƉĞƌŝŽĚŝĨƚŚĞƌĞĂƌĞĂůƌĞĂĚLJƐƵĸĐŝĞŶƚĨƵŶĚƐŝŶLJŽƵƌ^/WWƵŶƌĞůĂƚĞĚƚŽƚŚĞƚƌĂŶƐĨĞƌƚŽŵĞĞƚƚŚĞĂŶƟĐŝƉĂƚĞĚůĞŐĂůĂŶĚƌĞůĂƚĞĚ costs Crescent Trustees Limited will accrue. V0.6 05/17 3

4 I understand that on receipt in my Pointon York SIPP, the transfer value will be divided amongst the 1000 separate Segments forming my account. If I have taken benefits from any pension arrangement, with the current or any other pension provider, in a way which means I am subject to the Money Purchase Annual Allowance (MPAA), I have supplied Pointon York with the date the MPAA first applied to me. I understand that: - if I exercise my right to withdraw from the above transfer it may not be possible for the transfer to go back to the transferring scheme, - if I exercise my right to withdraw from the above transfer any legal and related costs borne by Crescent Trustees Limited in D ĞŵďĞƌĞĐůĂƌĂƟŽŶ ƌğůăɵžŷƚžăŷljŝŷǀ ĞƐƚŵĞŶƚŝŶƐƚƌƵĐƟŽŶĂůƌĞĂĚLJĐĂƌƌŝĞĚŽƵƚǁ ŝůůďğɖăŝěĩƌžŵĩƶŷěɛŝŷŵlj^/wwŷžƚăʃƌŝďƶƚăďůğƚžƚśğƚƌăŷɛĩğƌ ĂŶĚ Ͳ/ǁ ŝůůůžɛğƚśŝɛƌŝőśƚƚžǁ ŝƚśěƌăǁ ĂŌĞƌƚŚĞĚĂƚĞƵƌƟƐĂŶŬƐŝŶĨŽƌŵŵĞŵLJϯ ϬͲĚĂLJƌŝŐŚƚƚŽǁ ŝƚśěƌăǁ expires and that if I subsequently wish to transfer to another pension scheme I will be charged for doing this. Request for transfer /ĂƵƚŚŽƌŝƐĞĂŶĚŝŶƐƚƌƵĐƚLJŽƵƚŽƚƌĂŶƐĨĞƌĨƵŶĚƐĨƌŽŵƚŚĞƉůĂŶ;ƐĂƐůŝƐƚĞĚŝŶƚŚŝƐĨŽƌŵĚŝƌĞĐƚůLJƚŽƵƌƟƐĂŶŬƐŝŶƚŚĞĨŽƌŵŽĨ 1. A cash payment made by cheque made payable to Crescent Trustees Limited, or such other method agreed with ƵƌƟƐĂŶŬƐ Žƌ Ϯ ĚŝƌĞĐƚƚƌĂŶƐĨĞƌŽĨĂƐƐĞƚƐŚĞůĚŽŶŵLJďĞŚĂůĨ;ĂŌĞƌĚĞĚƵĐƟŽŶŽĨĂŶLJŽƵƚƐƚĂŶĚŝŶŐůŝĂďŝůŝƟĞƐŽƌĐŚĂƌŐĞƐ t ŚĞƌĞ ĂƉƉƌŽƉƌŝĂƚĞƵƌƟƐĂŶŬƐǁ ŝůůăěǀ ŝɛğěğƚăŝůɛžĩƚśğŷžŵŝŷğğ ƉĂƌƟĞƐƚŽǁ ŚŽŵĂƐƐĞƚƐŵƵƐƚďĞƚƌĂŶƐĨĞƌƌĞĚ / ƵŶĚĞƌƐƚĂŶĚƚŚĂƚƚŚĞĞdžŝƐƟŶŐŝŶǀ ĞƐƚŵĞŶƚŵĂŶĂŐĞƌŽƌĂĚŵŝŶŝƐƚƌĂƚŽƌŽĨƚŚĞƚƌĂŶƐĨĞƌƌŝŶŐƐĐŚĞŵĞŝƐƌĞƐƉŽŶƐŝďůĞĨŽƌ ĐŽůůĞĐƟŶŐĚŝǀ ŝěğŷěɛăŷěƚădžƌğđůăŝŵɛ ĂŶĚƌĞĂůŝƐŝŶŐĂůůƌŝŐŚƚƐĂŶĚĞŶƟƚůĞŵĞŶƚƐŝŶƌĞƐƉĞĐƚŽĨƚŚĞĂƐƐĞƚƐƚƌĂŶƐĨĞƌƌĞĚĂŶĚ for passing them to the receiving scheme. 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 ĐŽŶƐŝĚĞƌƚŽďĞƚŚĞƉƌŽďĂďůĞƌĞƐƵůƚ ŽĨĂŶLJƵŶƚƌƵĞ ŵŝɛůğăěŝŷőžƌŝŷăđđƶƌăƚğŝŷĩžƌŵăɵžŷěğůŝďğƌăƚğůljžƌđăƌğůğɛɛůljőŝǀ ĞŶďLJŵĞ Žƌ on my behalf, either in this form or with respect to benefits from the plan. /ĂƵƚŚŽƌŝƐĞLJŽƵƚŽƌĞůĞĂƐĞĂůůŶĞĐĞƐƐĂƌLJŝŶĨŽƌŵĂƟŽŶƚŽƌĞƐĐĞŶƚdƌƵƐƚĞĞƐ>ŝŵŝƚĞĚŽƌƵƌƟƐĂŶŬƐƚŽĞŶĂďůĞƚŚĞƚƌĂŶƐĨĞƌŽĨĨƵŶĚƐƚŽ ƵƌƟƐĂŶŬƐ /ĂŐƌĞĞƚŚĂƚĂĐŽƉLJŽĨƚŚŝƐĂƵƚŚŽƌŝƚLJƐŚŽƵůĚŚĂǀ ĞƚŚĞǀ ĂůŝĚŝƚLJŽĨƚŚĞŽƌŝŐŝŶĂů /ĂƵƚŚŽƌŝƐĞLJŽƵƚŽŽďƚĂŝŶĨƌŽŵĂŶĚƌĞůĞĂƐĞƚŽĂŶLJĮŶĂŶĐŝĂůŝŶƚĞƌŵĞĚŝĂƌLJŶĂŵĞĚŝŶƚŚŝƐĂƉƉůŝĐĂƟŽŶĂŶLJĂĚĚŝƟŽŶĂůŝŶĨŽƌŵĂƟŽŶƚŚĂƚ may be required to enable the transfer of funds. /ĨĂŶĞŵƉůŽLJĞƌŝƐƉĂLJŝŶŐĐŽŶƚƌŝďƵƟŽŶƐƚŽĂŶLJŽĨƚŚĞƉůĂŶƐĂƐůŝƐƚĞĚŝŶƚŚŝƐĨŽƌŵ /ĂƵƚŚŽƌŝƐĞLJŽƵƚŽƌĞůĞĂƐĞƚŽƚŚĂƚĞŵƉůŽLJĞƌĂŶLJ ƌğůğǀ ĂŶƚŝŶĨŽƌŵĂƟŽŶŝŶĐŽŶŶĞĐƟŽŶǁ ŝƚśƚśğƚƌăŷɛĩğƌžĩĩƶŷěɛĩƌžŵƚśğƌğůğǀ ĂŶƚƉůĂŶ;Ɛ hŷɵůƚśŝɛăɖɖůŝđăɵžŷŝɛăđđğɖƚğěăŷěđžŵɖůğƚğ ƵƌƟƐĂŶŬƐƌĞƐƉŽŶƐŝďŝůŝƚLJŝƐůŝŵŝƚĞĚƚŽƚŚĞƌĞƚƵƌŶŽĨƚŚĞƚŽƚĂůƉĂLJŵĞŶƚ;ƐƚŽƚŚĞ ceding provider(s). t ŚĞƌĞƚŚĞƉĂLJŵĞŶƚ;ƐŵĂĚĞƚŽƵƌƟƐĂŶŬƐƌĞƉƌĞƐĞŶƚ;ƐĂůůŽĨƚŚĞĨƵŶĚƐƵŶĚĞƌƚŚĞƉůĂŶ;ƐůŝƐƚĞĚŝŶƚŚŝƐĨŽƌŵ ƚśğŷɖăljŵğŷƚ ŵăěğăɛŝŷɛƚƌƶđƚğěǁ ŝůůŵğăŷƚśăƚ/ɛśăůůŷžůžŷőğƌďğğŷɵƚůğěƚžƌğđğŝǀ ĞƉĞŶƐŝŽŶŽƌŽƚŚĞƌďĞŶĞĮƚƐĨƌŽŵƚŚĞƉůĂŶ;ƐůŝƐƚĞĚ t ŚĞƌĞƚŚĞƉĂLJŵĞŶƚ;ƐŵĂĚĞƚŽƵƌƟƐĂŶŬƐƌĞƉƌĞƐĞŶƚ;ƐƉĂƌƚŽĨƚŚĞĨƵŶĚƐƵŶĚĞƌƚŚĞƉůĂŶ;ƐůŝƐƚĞĚŝŶƚŚŝƐĨŽƌŵ ƚśğŷƚśğɖăljŵğŷƚ ŵăěğăɛŝŷɛƚƌƶđƚğěǁ ŝůůŵğăŷƚśăƚ/ɛśăůůŷžůžŷőğƌďğğŷɵƚůğěƚžƌğđğŝǀ ĞƉĞŶƐŝŽŶŽƌŽƚŚĞƌďĞŶĞĮƚƐĨƌŽŵƚŚĂƚƉĂƌƚŽĨƚŚĞƉůĂŶ;Ɛ represented by the payment(s). /ƉƌŽŵŝƐĞƚŽĂĐĐĞƉƚƌĞƐƉŽŶƐŝďŝůŝƚLJŝŶƌĞƐƉĞĐƚŽĨĂŶLJĐůĂŝŵƐ ůžɛɛğɛăŷěğdžɖğŷɛğɛƚśăƚƌğɛđğŷƚdƌƶɛƚğğɛ>ŝŵŝƚğěžƌƶƌɵɛăŷŭɛăŷě ƚśğđğěŝŷőɖƌžǀ ŝěğƌ;ɛŵăljŝŷđƶƌăɛăƌğɛƶůƚžĩăŷljŝŷđžƌƌğđƚŝŷĩžƌŵăɵžŷɖƌžǀ ŝěğěďljŵğŝŷƚśŝɛăɖɖůŝđăɵžŷžƌžĩăŷljĩăŝůƶƌğžŷŵlj ƉĂƌƚƚŽĐŽŵƉůLJǁ ŝƚśăŷljăɛɖğđƚžĩƚśŝɛăɖɖůŝđăɵžŷ I apply to the scheme administrator of the receiving scheme to accept the transfer from the transferring scheme and to pay it ŝŷƚžŵlj^/ww /ĐŽŶĮƌŵƚŚĂƚƚŚĞŝŶĨŽƌŵĂƟŽŶƉƌŽǀ ŝěğěƌğůğǀ ĂŶƚƚŽŵLJĂƉƉůŝĐĂƟŽŶƚŽƚƌĂŶƐĨĞƌďĞŶĞĮƚƐŝŶƚŽŵLJ^/WWŝƐĐŽƌƌĞĐƚĂŶĚ complete, to the best of my knowledge and belief. /ĐŽŶĮƌŵƚŚĂƚĂĚǀ ŝɛğƌƌğŵƶŷğƌăɵžŷŵƶɛƚďğɖăŝěŝŷăđđžƌěăŷđğǁ ŝƚśƚśğăěǀ ŝɛğƌƌğŵƶŷğƌăɵžŷžɖɵžŷɛğůğđƚğěɖƌğǀ ŝžƶɛůlj /ĐŽŶĮƌŵƚŚĂƚ/ŚĂǀ ĞŶŽƚƌĞĐĞŝǀ ĞĚĂŶLJĂĚǀ ŝđğžƌƌğđžŵŵğŷěăɵžŷŝŷƌğůăɵžŷƚžƚśğƚƌăŷɛĩğƌĩƌžŵăƌğɖƌğɛğŷƚăɵǀ ĞŽĨƌĞƐĐĞŶƚ dƌƶɛƚğğɛ>ŝŵŝƚğěžƌƶƌɵɛăŷŭɛ Member Signature Trustee Signature Date Date 4 V0.6 05/17

5 Transfer Details From the Administrator of the Transferring Scheme Full Title of the Transferring Scheme Pension Scheme Tax Reference Is the Transferring Scheme a recognised overseas pension scheme for the purpose of Part 4 of the Finance Act 2004? /ƐƚŚĞƌĞĂŶĞĂƌŵĂƌŬŝŶŐŽƌĚĞƌŝŶĨŽƌĐĞŝŶƌĞůĂƟŽŶƚŽƚŚĞĨƵŶĚƐ ƌŝőśƚɛďğŝŷő transferred? /Ĩ zğɛ ƉůĞĂƐĞĂƩĂĐŚĐŽƉLJŽĨŽƌĚĞƌ Details of the Transfer Value TOTAL TRANSFER VALUE Does any of the transfer value relate to GMPs accured for employment before 6 April 1997? Do any of the transferred rights represent disqualifying pension credits or Safeguarded Rights? If, please provide details ƉĞŶƐŝŽŶĐƌĞĚŝƚ ŝɛƚśğđžƌƌğɛɖžŷěŝŷőăŵžƶŷƚďljǁ ŚŝĐŚĂŶĞdžͲƐƉŽƵƐĞ ƐƉĞŶƐŝŽŶƌŝŐŚƚƐĂƌĞŝŶĐƌĞĂƐĞĚĨŽůůŽǁ ŝŷőƚśğăɖɖůŝđăɵžŷžĩăɖğŷɛŝžŷɛśăƌŝŷőžƌěğƌĩžůůžǁ ŝŷő ƚśğŝƌěŝǀ ŽƌĐĞ ƉĞŶƐŝŽŶĐƌĞĚŝƚ ŝɛ ĚŝƐƋƵĂůŝĨLJŝŶŐ ŝĩƚśğɖğŷɛŝžŷđƌğěŝƚŝɛěğƌŝǀ ĞĚĨƌŽŵĂƉĞŶƐŝŽŶŝŶƉĂLJŵĞŶƚďĞĐĂƵƐĞĂƚƚŚĞƟŵĞƚŚĞŵĞŵďĞƌďĞĐĂŵĞĞŶƟƚůĞĚƚŽƚŚĞ pension credit, the ex-spouse s pension that was being shared with the member was actually in payment. If the pension credit arose from an ex-spouse s benefit ƚśăƚśăěŷžƚljğƚđžŵğŝŷƚžɖăljŵğŷƚăƚƚśăƚɵŵğŝƚŝɛŷžƚ ĚŝƐƋƵĂůŝĨLJŝŶŐ Is this transfer part of a block transfer within the meaning of schedule 36 of Finance Act 2004? If, please confirm: the name of one or other members whose benefits are ďğŝŷőƚƌăŷɛĩğƌƌğěăɛɖăƌƚžĩƚśğɛăŵğƚƌăŷɛĩğƌƚƌăŷɛăđɵžŷ that all of the member s pension rights under the transferring scheme are being ƚƌăŷɛĩğƌƌğěăɛɖăƌƚžĩƚśŝɛƚƌăŷɛăđɵžŷ WůĞĂƐĞƚŚĞŶĂŶƐǁ ĞƌƚŚĞĨŽůůŽǁ ŝŷőƌƶğɛɵžŷɛ /ƐƚŚĞŵĞŵďĞƌĞŶƟƚůĞĚƚŽĂƉƌŽƚĞĐƚĞĚƉĞŶƐŝŽŶĐŽŵŵĞŶĐĞŵĞŶƚůƵŵƉƐƵŵŽĨ more than 25% of the transferred funds under paragraphs 31 to 34 of Schedule of Finance Act 2004? (If, please go to Warranty overleaf) V0.6 05/17 5

6 If, please confirm: the amount of the member s protected lump sum under your scheme as at 5 April 2006, and ƚśğǀ ĂůƵĞŽĨƚŚĞŵĞŵďĞƌ ƐĞŶƟƌĞƵŶĐƌLJƐƚĂůůŝƐĞĚƉĞŶƐŝŽŶƌŝŐŚƚƐƵŶĚĞƌLJŽƵƌ scheme as at 5 April 2006 /ƐƚŚĞŵĞŵďĞƌĞŶƟƚůĞĚƚŽĂƉƌŽƚĞĐƚĞĚŵŝŶŝŵƵŵƉĞŶƐŝŽŶĂŐĞ;ďĞůŽǁ ϱϭƶŷěğƌƚśğ transferring scheme under paragraphs 31 to 34 of Schedule of Finance Act 2004? If yes, please confirm the earliest age at which the member may draw benefits Please confirm that no part of the transfer value shown overleaf represents rights that ŚĂǀ ĞĂůƌĞĂĚLJ ĐƌLJƐƚĂůůŝƐĞĚ ƵŶĚĞƌLJŽƵƌƐĐŚĞŵĞĨŽƌ>ŝĨĞƟŵĞůůŽǁ ĂŶĐĞƉƵƌƉŽƐĞƐ;WůĞĂƐĞƟĐŬďŽdž Scheme Administrator s Warranty - Transferring Scheme Administrator /ĐĞƌƟĨLJŽŶďĞŚĂůĨŽĨƚŚĞƚƌĂŶƐĨĞƌƌŝŶŐƐĐŚĞŵĞƚŚĂƚƚŚĞĚĞƚĂŝůĐŽŶƚĂŝŶĞĚǁ ŝƚśŝŷƚśŝɛƚƌăŷɛĩğƌăɖɖůŝđăɵžŷŝɛđžƌƌğđƚ /ĂůƐŽĐĞƌƟĨLJƚŚĂƚ ŶŽŶĞŽĨƚŚŝƐƚƌĂŶƐĨĞƌƉĂLJŵĞŶƚƌĞƉƌĞƐĞŶƚƐƌŝŐŚƚƐƵŶĚĞƌŽƵƌ^ĐŚĞŵĞƚŚĂƚŚĂǀ ĞĂůƌĞĂĚLJĐŽŵĞŝŶƚŽƉĂLJŵĞŶƚ;Žƌ ĐƌLJƐƚĂůůŝƐĞĚ ĨŽƌ>ŝĨĞƟŵĞ Allowance purposes). I will arrange payment of the transfer value, or transfer of assets in specie, to Crescent Trustees Limited. dśŝɛđğƌɵįđăɵžŷŝɛŵăěğŝŷůŝŷğǁ ŝƚśƚśğůğőŝɛůăɵžŷđƶƌƌğŷƚůljŝŷĩžƌđğĩžƌƚƌăŷɛĩğƌɛƚžƌğőŝɛƚğƌğěɖğŷɛŝžŷɛđśğŵğɛ Signature Date WŽƐŝƟŽŶ 6 V0.6 05/17

7 Flexibility, Choice, Independence Administering SIPPs Since 1990