Group Personal Pension plan application form (UNI) You should not complete this form if: 1. you re aged 75 or over 2. you re a Crown Servant or spouse of a Crown Servant 3. you re not resident in the UK If points (2) or (3) apply then speak to a inancial adviser for further information and/or to get the appropriate application form. You should refer to the Group pension application form notes (ref: GPPAN4) when you re completing this application form. For words in bold see the Deinitions section of the notes. This application and the answers you give will form the basis of a contract of insurance, which may be invalid in the event of a claim arising if you ve failed to disclose any material fact (that s any fact which would be likely to inluence the assessment and acceptance of this application) that this form asks for. If you ve any doubt as to the signiicance of any fact then you should disclose it. This form is submitted as part of your application for a Group Personal Pension plan from Aegon (a brand name of Scottish Equitable plc). You should check that the application form is fully completed and the information in it is accurate and complete. This is extremely important, as this document forms the basis of a contract between you and Aegon. If any details are incorrect or incomplete, amend the details, initialling any changes. If you require further details, speak to a inancial adviser. You should complete the Lump sum death beneit, expression of wish section, if required, and remember to sign and date the Declaration. What you must do if you are subject to the money purchase annual allowance provisions If you have flexibly accessed your pension rights and so are subject to the money purchase annual allowance provisions, you must tell us within 91 days of joining this plan. You can be ined by HMRC if you don t tell us within this timescale. You will have flexibly accessed your pension rights if: a you had a flexible drawdown plan at any time before 6 April 2015; or b you take, or have already taken, certain types of pension beneit from a registered pension scheme on or after 6 April 2015 for example, an uncrystallised funds pension lump sum or income from a flexi-access drawdown plan. If you have flexibly accessed your pension rights because you had a flexible drawdown plan before 6 April 2015, you must tell us that you became subject to the money purchase annual allowance provisions on 6 April 2015. Otherwise, you must pass on the information given to you in the statement from your scheme administrator telling you that you have flexibly accessed your pension rights (you can do this by sending us a copy of the statement).
1 Personal details Title Full forename(s) Surname Date of birth National Insurance (NI) number Gender M F Permanent home address Telephone number(s) Postcode Home Work, if applicable To become a member of the Group Personal Pension plan, you should conirm you re Yes No a relevant UK individual in the tax year in which the irst contribution is to be paid. If you ve answered No, don t complete this form, and speak to a inancial adviser. Status: Employed Self-employed Full name and address of employer (if employed) Postcode 2 Contributions Will contributions be paid in accordance with a tiered contribution facility (TCF) as notiied to Aegon by your employer? Yes No If Yes, refer to your information pack for details of the contributions you and your employer will make. If No, complete the contributions you and your employer want to make below. If you want to pay additional personal contributions over and above any tiered contributions, enter the additional amount you want to pay in the Gross personal contributions section below. Gross personal contributions Gross employer contributions Regular Single Regular Single and/or * % of earnings and/or * % of earnings *delete as appropriate Regular contributions will be payable (for example monthly) The expected date of payment of irst instalment of regular contribution is Chosen retirement age Where contributions above are expressed as a percentage of earnings, the earnings on which these are to be based will be ixed between you and your employer. In the year in which the irst contribution is to be paid, these are
3 Investment choice If you don t choose a fund, all contributions to your plan will be invested as detailed in the Investment fund allocation procedure. Enter the fund(s) required and percentage split in the tables below: Regular contributions % Single contributions % Total 100% Total 100%
4 Waiver of contribution Do you want to apply for waiver of contribution? No go to section 5 Yes how do you want waiver to apply? Regular contributions Employer s regular contributions Single contributions* *If you ve selected cover for single contributions, what single contributions are covered depends on what s selected for your and your employer s regular contributions. Please make sure that you ve read the notes on waiver of contribution. Who pays for waiver of contribution for regular contributions? Only tick one box. You Your employer Both you and your employer How s the cost of cover for regular contributions to apply? Only tick one box, this will apply to all regular contribution types. Included in the speciied contributions or In addition to the speciied contributions The cost of waiver of contribution for any single contributions will always be included in the single contribution Please tell us the industry you work in and your job title: 5 Lump sum death beneit, expression of wish I note that this expression of wish applies to any lump sum death beneit that becomes payable from the plan. I would like the scheme administrator to pay any such lump sum death beneit to the beneiciaries named below, and in the proportions indicated by the percentage of beneits. I note that the scheme administrator isn t bound by my wishes and has discretion as to whom any such beneit is paid and in what proportions. Full name Relationship (if any) Percentage of beneits (%)
6 How we treat your personal information Here at Aegon, we re committed to protecting and respecting your privacy. We collect your personal information so that we can verify your identity, set up your plan and provide ongoing administration. We need this information to carry out our obligations and to provide you with the products and services under the terms of your contract with us. Without it, we wouldn t be able to provide you with a plan. As part of our administration process, we work with carefully selected service providers (in other words suppliers) that carry out certain functions on our behalf. We only share the appropriate level of personal information necessary to enable our suppliers to carry out their services and they need to keep the information safe and protected at all times. Our suppliers must only act on our instructions and can t use your personal information for their own purposes. The personal information we collect may be transferred to, and stored at a destination outside the European Economic Area (EEA). This could be to other companies within the Aegon Group or to our service providers. Where any such processing takes place, appropriate controls are in place to make sure your information is protected. We may disclose your information to licensed credit reference and/or fraud prevention agencies to help make inancial or insurance proposals and claims decisions (this will be during the application or enrolment process and on an ongoing basis), for you and anyone you re linked with inancially or other members of your household. Our enquiries or searches may be recorded. You can ind more information on how we use and share your personal information, including how long we keep it and details of your rights at www.aegon.co.uk/protectinginformation or by contacting us to request a copy. We d like to keep you up-to-date with information about our news, products and services. If you d like to hear more from us, please tick the relevant box(es) below. Mail Phone SMS Email By ticking the box(es), you re consenting to receiving marketing messages in this way from us. You can change your mind and unsubscribe at any time simply by contacting us. For more information on how to do this go to www.aegon.co.uk/protectinginformation We won t pass your information to other companies outside of the Aegon Group for marketing purposes.
7 Declaration In this declaration, I means the person applying for the plan and you means Aegon. (a) (i) I apply to become a member of the Scottish Equitable Personal Pension Scheme (the Scheme ) in respect of any payments made to the plan either now or in the future. (ii) Where I ve applied for waiver of contribution beneit, I apply for a contract with you for the provision of waiver of contribution cover. Accordingly, I apply for the issue of a plan or plans to be issued on your standard provisions and incorporating any special terms or provisions appropriate to the plan or plans, or any part of them, which may be applicable. These special terms or provisions shall be in your current form or, where you don t have one, as you think reasonable to relect the special terms or provisions. (b) I agree to be bound by the documents and rules of the Scheme. (c) I agree that the amount of contributions speciied in the arrangements will be paid by me or, with my knowledge, on my behalf. I conirm that, where I m employed: (i) my employer shall pay the amount of employer contributions set out in this application; and (ii) where my contributions are to be deducted directly from my earnings and paid to you, I authorise my employer to make these deductions. (iii) where my contributions are to be deducted from my earnings on a weekly basis, I agree that my employer may remit these contributions to you on a monthly basis. (d) I agree that you shall decide what funds are available under my policy. This includes changing what funds are available from time to time. I agree that the powers in the policy may be used to do this. I note that the funds available will relect the views of an adviser that you deem is (or was) involved with the Group Personal Pension plan for me. Where the funds available change, this may involve a switch of funds (for example I m invested in a fund that s no longer to be available). I agree that any such switch will count as a switch for the purposes of the policy, and I undertake to take all reasonable steps to enable the switch to be made. Going forward, the situation may change and I note the following will take place. (i) Where you wind up an investment fund, existing Units will be surrendered and dealt with as set out in the policy conditions (for example either I instruct a switch or the investment is moved to the Cash fund or the default investment fund). The timing will be chosen reasonably by you. For further contributions that would have gone to the fund winding up, either I shall instruct a switch, or they ll be dealt with in accordance with your Investment fund allocation procedure. (ii) Where you close an investment fund, existing Units will be left in that fund unless I instruct a switch. For further contributions that would have gone to the closed fund, either I shall instruct a switch, or they ll be dealt with in accordance with your Investment fund allocation procedure. (iii) Where the adviser removes an investment fund or funds, I agree that there will be no change to where my contributions are invested unless I instruct a switch. If I leave the employment to which the Group Personal Pension plan relates, then the funds available position set out above continues to apply (subject to you and I agreeing to something diferent). I note that details of what funds apply for my policy from time to time will be available from you. You don t have to contact me when the funds available change, and it s up to me to check the information available. (e) I agree as follows: (i) Any contributions to the plan will be allocated to investment funds in accordance with my instructions to you (which includes any set out in the Investment choice section of this application). Where an investment choice hasn t been speciied, I agree to you investing all contributions in the Cash fund or the default investment fund (the Investment fund allocation procedure explains whether it s the Cash fund or the default investment fund for my plan both don t apply for one plan).
7 Declaration continued I agree that you can change your default investment fund in the future, and in the event of such a change you can: 1. at your discretion, invest any contributions paid to my plan after the date of change into the new default investment fund(s), and/or 2. at your discretion switch the funds held in the old default investment fund(s) into the new default investment fund(s). I note that if you don t receive any clear and complete investment instructions, either from me or an authorised person acting on my behalf, you ll invest the contributions in line with the Investment fund allocation procedure. (ii) If a tiered contribution facility (TCF) is to apply to my plan, I agree that this facility is as advised to you by my employer. My employer can change the TCF from time to time. If I don t want a TCF to apply to my plan, I ll notify you in writing. (iii) I m aware that you have an Investment fund allocation procedure, and this procedure may be changed from time to time. (iv) That procedure will be part of the plan I m applying for. (v) Whenever a contribution is given to you to apply under the plan, and you don t have clear and complete instructions from me as to which investments funds that contribution is to be applied, then you ll apply the contribution to investment funds chosen in accordance with the said procedure. (f) I conirm that I shall take all steps required to avoid any tax charge arising in relation to the plan in respect of recycling lump sum beneit. (g) I undertake to immediately inform the scheme administrator whenever my status (as set out in the Personal details section) changes. (h) I consent to the scheme administrator or its representative obtaining from me or any other person or body to whom a duly authorised payment under the provisions of the Scheme is to be made such evidence and information as it may need for the purpose. (i) I note that if there s any failure to provide information needed by the scheme administrator in order to administer my beneits in an accurate manner, the scheme administrator has the right to make further charges. (j) I declare that the total contributions in a tax year, to any and all registered pension schemes to which I m entitled to tax relief under Section 188 of the Finance Act 2004, won t exceed the higher of the basic amount and my relevant UK earnings in that tax year. (k) I declare that the declaration given in clause (i) of this declaration is, to the best of my knowledge and belief, correct and complete. (l) I declare that the particulars given in the Personal details section of this application form and the information given in this application form, whether in handwriting or not, are, to the best of my knowledge, correct and complete. (m) I undertake to give notice to the scheme administrator if an event occurs which results in me no longer being entitled to tax relief on my contributions under Section 188 of the Finance Act 2004. I ll give the notice required to the scheme administrator by the later of 5 April in the tax year in which the event occurs and 30 days after the event occurs. (n) I agree that this application and every answer or statement (if any) made, or to be made, by me to you or to a medical oicer acting for you (in conjunction with the information given in this application) shall be the basis of contracts between me and you consisting in arrangements under the Scheme. (o) I agree that you or your representatives may get from the scheme administrator or the provider of any other registered pension scheme to which I m contributing or have contributed, any information you feel is necessary to administer my arrangements under the Scheme.
7 Declaration continued (p) I agree that deliberate or careless failure to answer any questions correctly and completely to the best of my knowledge and belief may result in the beneits not being payable. (q) I agree that this declaration applies for each and every contract and/or arrangement that I ve applied for. (r) I have the Group pension application form notes (ref: GPPAN4). (s) I conirm I ll notify you as soon as possible of any change in my health or in any other material fact between the date of signing this application and the date on which any waiver of contribution beneit comes into force. A material fact is information which might be likely to inluence how you deal with this application. (t) Insofar as the plan is efected under a Group Personal Pension plan, I consent to the documents relating to the scheme s administration (including beneit statements) being sent to my employer: (i) relating to information needed for scheme administration for completion by my employer; (ii) which are passed on to me for completion. The information in this application is required for income tax purposes and if I give false information this may lead to my prosecution by the tax authorities with severe penalties. Date Signature of applicant Important note We ll issue to the individual a plan(s) in the individual s name in respect of the beneits provided under this Scheme. On request, we ll supply an example of the standard policy conditions and a copy of the completed application form. We won t assume risk for waiver of contribution beneits until the application for these beneits has been accepted, you ve been notiied of this acceptance and the contribution has been paid. Scottish Equitable plc, the provider and scheme administrator of the Scheme, agrees to administer the Scheme in accordance with the rules and arrangements of the Scheme. Aegon is a brand name of Scottish Equitable plc. Scottish Equitable plc, registered oice: Edinburgh Park, Edinburgh EH12 9SE. Registered in Scotland (No. 144517). Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services Register number 165548. An Aegon company. www.aegon.co.uk 2018 Aegon UK plc WPS 00253816 01/18