Optons form Once you have flled n ths form, please return t wth your orgnal brth certfcate to: Premer PO Box 108 BLYTH NE24 9DY Fll n ths form usng BLOCK CAPITALS and black nk. Mark all answers wth an X. We wll already have sent you a quote, showng the possble trval lump sum avalable to you from ths penson. Ths optons form relates to that quote. Please provde your membershp reference number below, along wth your chosen retrement date. We cannot process your applcaton wthout ths nformaton. Please note that f you are marred or n a cvl partnershp, your husband, wfe or cvl partner also have to agree to ths trval lump sum beng pad by fllng n the declaraton on page 6. Membershp reference Your chosen retrement date If you choose to trvally commute a penson (take t as a cash lump sum), you have one year to complete ths process for all of your pensons. If you have never trvally commuted a penson before, and do so now, the retrement date you state below wll be your chosen nomnaton date for HM Revenue & Customs purposes. You then have one year from ths date to contact all of your other penson provders to commute your pensons (f ths s what you want to do). Trval lump sum quoted Please confrm the trval lump sum quoted on the llustraton. Ths amount could change f your date of retrement, the factors used to value the lump sum or the value of your money-purchase funds change. For your own beneft, we recommend you read your penson scheme s explanatory booklet before you decde how to take your penson. If you are not sure whether takng ths trval lump sum s n your nterests, you should take ndependent fnancal advce. R5V1 Page 1 of 8
About the retrement optons form You need to fll n ths form to confrm that you accept the retrement quotaton. Ths wll mean we can gve the trustees nformaton so they can start payng your penson. Please fll n all sectons of the form and return t to us, along wth your orgnal brth certfcate, by recorded delvery. If you choose to use the ed servce (see page 7) then you do not need to send us your brth certfcate. Parts of the opton form nclude questons set by HM Revenue & Customs whch you must answer. We cannot pay your benefts unless you answer all questons and sgn the declaraton at the end of the form. We can only accept your orgnal brth certfcate, not a copy. About you Your detals Mr, Mrs, Mss, Ms, Dr Frst names Surname Date of brth Sex Male Female Martal status Sngle Marred or n a cvl partnershp Dvorced or dssolved Separated Wdowed Date of marrage, dvorce, separaton or partner s death Address Postcode - Home phone Moble phone Emal address Natonal Insurance number Check my dentty usng ed Yes No - f you select no to ths opton then you must send ths form to us wth your orgnal brth certfcate. More nformaton on ed s provded on page 7. Trval lump sum [R5.0] v1.0/14 2014 Premer Pensons Management Ltd Page 2 of 8
Payment detals Please confrm the account detals of where you want to have your lump sum pad to. Ths must be an account of whch you are ether the only or jont account holder. Lump sum amount Name of bank or buldng socety Address of you bank or buldng socety Postcode Sort code - - - Account number Account holders (names) Buldng socety roll number Only fll n the followng secton f you want your lump sum to be pad to an overseas bank account. All overseas payments wll be sent n sterlng and your local recevng bank wll be responsble for all currency exchanges, costs and commssons that may have to be pad. Overseas account detals Terms and condtons I confrm that I have read and accept the terms and condtons about payng pensons to overseas accounts. I agree to you takng the extra charges from my penson. Country Local currency Account holders (names) Bank SWIFT, BIC or ID IBAN (EEA only) Account number Bank name Bank address Trval lump sum [R5.0] v1.0/14 2014 Premer Pensons Management Ltd Page 3 of 8
R5.0 Trval lump sum Detals of your other pensons You wll not be able to take a trval lump sum f you have prevously swapped a small penson for a cash lump sum (trval commutaton) that would have been gven on or after 6 Aprl 2006 and that was pad more than ago. Queston 1 Have you ever taken all of a penson as a lump sum? Ignore any partal lump sums, we only want to know f you have gven up all of your penson for a lump sum n the past. No - go to queston 2. Yes - please fll n the followng secton wth detals of lump sums taken. Detals of lump sums pad to you Provde us wth detals below of each lump sum you have taken from each one of your penson schemes. Amount of lump sum pad Date lump sum pad to you Queston 2 Ignorng the State Penson, are you recevng any other pensons? You should gnore the State Penson and any husband s, wfe s, cvl partner s or dependants pensons beng pad to you. No - go to queston 3. Yes - please fll n the followng secton wth detals of your other pensons. Pensons currently beng pad to you Provde detals n ths secton of any pensons (other than the State Penson) beng pad to you now. Annual amount of penson Date penson pad from Queston 3 Have you ever transferred a penson out of the UK to another country? No - go to queston 4. Yes - please supply us wth a copy of your transfer statement showng the value and date of the transfer. Go to queston 4. Page 4 of 8 Trval lump sum [R5.0] v1.0/14 2014 Premer Pensons Management Ltd
Detals of your other pensons Queston 4 Ignorng the state State penson, Penson, do do you have any other pensons that are not yet beng pad to pad you? to you? Ths ncludes amounts that you have bult up up n n personal pensons or or those wth another employer that have not yet come nto been payment. pad. No - go to declaraton. Yes - please fll n the followng secton wth detals of your other pensons. Pensons bult up elsewhere but not currently beng pad to you Provde detals n ths secton of any pensons (other than the State Penson) that you have bult up n other places. If you have more than three other pensons please provde ths same nformaton about your other pensons on a separate pece of paper and attach t to ths form when you send t back to us. 1. Frst other penson What type of penson s ths? Defned contrbuton (money purchase). Ths ncludes personal pensons. Current value of ths penson fund Date of valuaton Defned beneft (fnal salary) Total annual value of ths penson Date of valuaton 2. Second other penson What type of penson s ths? Defned contrbuton (money purchase). Ths ncludes personal pensons. Current value of ths penson fund Date of valuaton Defned beneft (fnal salary) Total annual value of ths penson Date of valuaton 3. Thrd other penson What type of penson s ths? Defned contrbuton (money purchase). Ths ncludes personal pensons. Current value of ths penson fund Date of valuaton Defned beneft (fnal salary) Total annual value of ths penson Date of valuaton Trval lump sum [R5.0] v1.0/14 2014 Premer Pensons Management Ltd Page 5 of 8
Declaraton Please remember that t s a serous offence to make false statements. The penaltes are severe and could lead to prosecuton. Important nformaton Usng your nformaton: We and the trustees take your prvacy very serously. We use the personal nformaton from ths form and any other nformaton that you gve us to: We and other organsatons may also access and use ths nformaton to prevent fraud and money launderng, for example, when processng a clam to pay benefts. 1. provde you wth products and servces and deal wth your enqures and requests; 2. handle your benefts, ncludng processng clams and makng payments; and 3. carry out market research and analyse statstcs. We do not share nformaton wth anyone else for marketng purposes. Dsclosures: We wll release your nformaton to other companes wthn the Premer Pensons Management group of companes, regulatory bodes, law-enforcement agences, future owners of our busness, supplers we employ to process nformaton on our behalf and, when necessary, to nsurance companes f an annuty s beng bought or benefts provded by them. To prevent fraud, when you make an applcaton we share your nformaton wth companes who carry out checks on your dentty. Ths sometmes ncludes a search of your credt records. Access: You have the rght to ask for a copy of your nformaton f you pay a small fee. To get a copy of your nformaton, please wrte to: Premer PO Box 108 BLYTH NE24 9DY We wll check your detals wth fraud-preventon agences. If you gve false or naccurate nformaton and we dentfy fraud, we wll pass your detals to fraud-preventon agences. Law-enforcement agences may access and use ths nformaton. If you are marred or are n a cvl partnershp, your husband, wfe or cvl partner must also sgn the declaraton provded below. By acceptng the trval lump sum, you may be gvng up benefts that would have been pad to your next of kn when you de, so the trustees need to make sure everyone accepts gvng up all future clams for benefts from ths penson scheme. Sgned by you (the scheme member) Agreement I accept the trval lump sum payment as full and fnal settlement of all my penson benefts from ths penson scheme. In acceptng the trval lump sum, I understand that I wll gve up all rghts to any further benefts from ths penson scheme, both now and n the future, ncludng those of my next of kn f I de. Name (prnted) Sgnature and date X Sgned by your husband, wfe or cvl partner Does not apply Agreement Ths does not apply to my crcumstances. I accept the trval lump sum payment as full and fnal settlement of all current and future clams to benefts I may receve from ths penson scheme when my husband, wfe or cvl partner des. Name (prnted) Sgnature and date X Trval lump sum [R5.0] v1.0/14 2014 Premer Pensons Management Ltd Page 6 of 8
Informaton Electronc dentfcaton servce (ed) ed s Premer s electronc dentty checkng servce. If you choose to use ths servce then you do not need to send us your orgnal brth certfcate. If you want us to check your dentty electroncally tck the opton for ed on page 2 (your detals). Usng a range of UK publc regsters, and credt agency reports, we wll then automatcally verfy your dentty to make sure t matches our records. Ths process wll leave a search footprnt on your credt hstory record but wll not affect your credt ratng. All checks we perform wll be logged as ID check and these have no mpact on your credt ratng. Ths servce s only avalable to UK resdents. ed If you fal our onlne ID checks then you wll be asked to send your orgnal brth certfcate as well as evdence of your current home address. In agreeng to have your ID checked n ths way you are agreeng for us to share your personal nformaton wth thrd party dentfcaton search agences. You are also agreeng for us to perform a search aganst your credt record. If you would lke ths form n a dfferent format, such as large prnt, please contact us on 0800 122 3200 or emal admn@premercompanes.co.uk. Trval lump sum [R5.0] v1.0/14 2014 Premer Pensons Management Ltd Page 7 of 8
Returnng your form Returnng your optons form Send to: If you are not usng the ed servce then Premer you need to return your form along PO Box 108 wth your orgnal brth certfcate. BLYTH We wll not accept photocopes or NE24 9DY copes certfed by a solctor or other professonal. More questons In all cases you must supply your If you have any questons about ths form orgnal certfcate. or need help fllng t n you can contact our admnstraton team. Lost or mssng brth certfcate? Onlne If you are not able to provde your brth certfcate, we wll accept your orgnal, premercompanes.co.uk/getntouch current, vald passport or photo drvng By phone lcence nstead. 0203 727 9850 or 0800 122 3200 Returnng your certfcates By emal We wll return your orgnal certfcates admn@premercompanes.co.uk by recorded delvery wthn 48 hours of recevng them. When contactng us, please make sure that you quote the name of your penson Processng your optons scheme and your membershp reference It wll take about two weeks to number. process your optons. We wll wrte to you once your lump sum has been pad. premercompanes.co.uk Trval lump sum [R5.0] v1.0/14 2014 Premer Pensons Management Ltd Page 8 of 8