Local Government AVC Facility Amendment form Printed form Please use black ink and write in CAPITAL LETTERS or tick as appropriate. Any corrections must be initialled. Please do not use correction fluid as this will invalidate your application. About this form This form is for existing members of the local government pension scheme AVC facility, who want to amend their additional voluntary contributions (AVCs). If you are not actively paying AVC contributions you are only able to restart your AVC in certain circumstances. If you are unsure, please call our specialist team on the telephone number below. Please return printed form to: Customer Service Centre, Prudential, Lancing BN15 8GB. Please note: If you are contributing towards Life Cover with Prudential and wish to amend your level of cover, please contact our Retirement Specialist Team on 0800 032 6674* who will arrange for the appropriate form to be forwarded to you. *Opening hours: 9am to 6pm, Monday Friday. Please read the Key Features Document, Key Facts about our services and the Key Features Illustration as these will provide you with important information regarding the key risks and benefits of the product(s) to help you make a decision. Please also read the Fund Guide as this will provide you with full details of the funds available, their objectives, Prudential s Risk rating of these funds and charges to help you select the funds suitable for your needs. These documents can be found at www.pru.co.uk/localgov within Increase your AVC pot. Amendment form: LAVF10036 04/2018 Page 1 of 12
Part 1 Your personal details Title Prof Dr Sir Mr Mrs Miss Other Surname Forename(s) National Insurance number Date of birth D D M M Y Y Y Y Home telephone number Gender Male Female Address Postcode Page 2 of 12 Amendment form: LAVF10036 04/2018
Part 2 Employment details Local Authority s name Employer s name Employer s address Postcode Payroll office Payroll reference no As shown on your Benefit Statement. Current pensionable pay Scheme reference It may be possible to combine your AVC plans, subject to scheme rules. If you move employer you may be required to combine your plans. This will normally result in a new AVC plan being created. This plan and any future payments into it, will be subject to 2014 scheme rules. Please read your Key Features Document and speak to your Scheme Administrator for further information. Amendment form: LAVF10036 04/2018 Page 3 of 12
Part 3 Amendment of contributions Please amend my AVCs as follows: The government limits the amount that can be contributed every year before incurring tax penalties, for more information please see your Key Features Document which is available on request or online at www.pru.co.uk/ localgov. Existing regular contributions New contribution level or or of pensionable pay* * England and Wales, if your AVC started before 01/04/2014 you can pay up to 50% of your pensionable pay. If your AVC started on or after 01/04/2014 you can pay up to 100% of your pensionable pay (subject to other deductions). This will include variable pay (such as overtime). For Northern Ireland you can pay up to 50% of your pensionable pay. For Scotland, you can pay up to 100% of your pensionable pay (subject to other deductions). % gross of pensionable pay* Please state how you are paid. Your contributions will be deducted with the same frequency as you are paid. Weekly Fortnightly Four-weekly Monthly % gross You may wish to make a lump sum payment from your pay instead of increasing regular contributions. Please make sure that you have sufficient funds in your pay as the deduction will be made on the next available pay date. Lump sum payment: gross Number of months, within the same tax year, over which the payment is to be spread Please note that the contribution you have specified is gross of income tax and is the full amount which will be credited to your pension fund. Your payroll will be asked to confirm all amounts chosen by you and all payments will be made by deductions from your salary. Tax relief will normally apply to your own contributions up to 100% of your earnings, subject to scheme rules and HM Revenue and Customs (HMRC) limits. For more information please see your Key Features Document. This information is based on our understanding of current taxation, legislation and HM Revenue and Customs practice. These tax rules could change in the future without notice and will depend on your individual circumstances. Page 4 of 12 Amendment form: LAVF10036 04/2018
Part 4 Investment instructions I wish to (please tick appropriate box(es)): a) Invest my new contribution level in the same funds and in the same proportions as my existing contributions. b) Invest my future contributions in different proportions and/or different funds. c) Switch my existing investment into different funds and show the percentages to be applied. You do not need to complete the remainder of Part 4. Complete Section A Investment Allocation of Future Contributions. Complete Section B Switch of Existing Investment. Details of the funds can be found in the Fund Guide. If you are unsure which funds are being made available by your particular Local Authority, please contact their pension section or visit our website at www.pru.co.uk/localgov within Increase your AVC pot. Amendment form: LAVF10036 04/2018 Page 5 of 12
Part 4 Investment instructions continued Section A Investment Allocation of future contributions Please indicate below the proportions to which your contributions are to be invested, up to a maximum of ten funds. If this section is not completed, your contributions will be invested as directed in your latest instruction to us. If you have not previously told us where you wish your contributions to be invested they will be invested in your plan s Default Fund. Investment Fund Regular Payments Regular Payments Lump Sum Payments Lump Sum Payments Total 100% Please ensure that the proportions you have indicated add up to 100% or choose the Lifestyle option. Lifestyle option: Please note that if you choose to invest in the Lifestyle option, you cannot invest your contributions into any other funds. Please tick the appropriate Profile: Profile 6 Profile 8 Profile 10 Page 6 of 12 Amendment form: LAVF10036 04/2018
Part 4 Investment instructions continued When selecting the Lifestyle option, 100% of your existing investment is automatically switched into the Lifestyle option you have chosen on page 6. Please note that this excludes savings invested in the With-Profits Fund, if applicable. If you have savings invested in the With-Profits Fund, do you wish to switch this into the Lifestyle option? Yes No 100% of your existing With-Profits Fund investment will be switched. A Market Value Reduction may be applied. Your existing savings will remain invested in the With-Profits Fund. If you require any further information about this option, please refer to the Fund Guide or go to the Lifestyling section on our website www.pru.co.uk/lifestyling. Section B Switch of Existing Investment Please confirm on the table on page 8 the percentages of the existing investment to be switched, the fund(s) to which the investment is now to be applied and the proportion to be applied to the fund(s). Please see the example below for guidance. Example: A customer wants to transfer 50% of the money they have invested in the With-Profits Fund to the Cash Fund and the UK Equity Fund. They would like 25% of the switched funds to be invested in the Cash Fund and the remainder in the UK Equity Fund. Amendment form: LAVF10036 04/2018 Page 7 of 12
Part 4 Investment instructions continued Investment Fund % of existing investment to be switched Fund(s) into which the investment is now to be applied % of amount being switched to be applied to each new fund indicated With-Profits Fund 50% Cash Fund 25% UK Equity Fund 75% 100% Investment Fund % of existing investment to be switched Fund(s) into which the investment is now to be applied % of amount being switched to be applied to each new fund indicated % 100% Please note > You may invest in up to a maximum of ten funds. > If the percentage of the investment to be applied to the new fund(s) is not stated, the amount available for the investment will be split equally between the funds selected. > Instructions received before noon will normally receive the price calculated at noon that day. Instructions received after noon will normally receive the price calculated at noon on the following working day. > Details of switch terms and available funds are contained in the Fund Guide, or on our website at www.pru.co.uk/localgov > A switch from the With-Profits Fund may be subject to a Market Value Reduction. For more information, please refer to the Key Features document www.pru.co.uk/localgov. Page 8 of 12 Amendment form: LAVF10036 04/2018
Important notice a) Your employer does not accept responsibility for the accuracy, or otherwise, of any statements or representations made in Prudential s literature; b) because individual circumstances vary, you should, before amending the level of your AVCs, consider your position carefully; c) because the facility is a way of investing money in order to provide pension benefits, those benefits will depend on the contributions paid, the performance of the investments and on interest rates at retirement. Therefore there is no guarantee that any particular level of benefit will be available at retirement; d) you may vary or cease your contributions at any time in the future but you have no cancellation rights conferred under the Financial Services and Markets Act 2000 and cannot therefore cancel your election retrospectively. Amendment form: LAVF10036 04/2018 Page 9 of 12
Declaration I confirm that I am a contributing member of the Local Government Pension Scheme (LGPS). I authorise the deduction from my earnings of the Additional Voluntary Contributions (AVCs) specified on this AVC Amendment Form. I declare that the total of my contributions does not exceed the limits described in Part 3. I understand that any benefits which become payable will be paid in accordance with the LGPS Pension Regulations. I also accept the provisions in the Important Notice. I confirm I can afford to pay the level of contribution chosen by me. I am aware of the Local Government additional regular contributions option. I understand what happens if my AVC pension causes HM Revenue and Customs benefit limits to be exceeded at retirement. The consequences are explained in the Key Features document (under heading Risks ), a copy of this document is available on request or from our website. I understand that reinvesting a tax-free lump sum from another pension arrangement into this AVC facility (known as recycling ) either as regular or single premium payments, mean I could be liable to an unauthorised payment charge of up to 55% from HMRC. Page 10 of 12 Amendment form: LAVF10036 04/2018
How we use your personal information For a copy of our latest Data Protection Notice, please visit www.pru.co.uk/mydata-cp. This details how and why we use your personal information (including any sensitive personal information), who we may share it with and your rights around your personal information. Alternatively, you can request a hard copy to be sent to you by writing to The Data Protection Officer, Customer Service Centre, Lancing, BN15 8GB. Please note that we collect personal information from you that is necessary for us to either provide you with the product or service you ve requested or to comply with statutory or contractual requirements. Unfortunately if you don t provide all of the information we require this may mean we are unable to provide our products and services to you. Before submitting this application, please confirm you have read the documentation provided. For your own benefit and protection, you need to read carefully the documentation provided before signing this form. You need to also read carefully any further documentation provided to you in the future. If there is anything you do not understand, please ask us for further information. Your signature 7 Date D D M M Y Y Y Y Print full name (in capitals) A copy of the terms and conditions and completed form are available on request. Amendment form: LAVF10036 04/2018 Page 11 of 12
www.pru.co.uk "Prudential" is a trading name of The Prudential Assurance Company Limited, which is registered in England and Wales. This name is also used by other companies within the Prudential Group. Registered office at Laurence Pountney Hill, London EC4R 0HH. Registered number 15454. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. LAVF10036 04/2018 Page 12 of 12