New Generation Company Pension Bulk transfer-in application
New Generation Company Pension Bulk transfer-in application Please read this before completing the form. This form should only be completed for members who are transferring benefits into our New Generation Company Pension from: 1) another Aviva policy held under the same employer s occupational pension scheme 2) outside Aviva where we are taking over the occupational pension scheme s documentation 3) another occupational pension scheme of the same employer (or a different employer only because of a merger, take-over etc). This form should not be used for any other type of transfer. Please complete all the appropriate sections. Part 1 to be completed by the transferring scheme Member details Your title Mr Mrs Miss Ms Other Your surname Your forename(s) Your permanent home address Postcode Your date of birth Your nationality Your daytime telephone number Your evening telephone number Your email address Your National Insurance number Transferring scheme details Name of transferring scheme Transferring scheme number Administrator s name Administrator s address Postcode Administrator s telephone number HM Revenue & Customs Pension Schemes Tax Reference 2
Transfer details Total amount of transfer value Cumulative total percentage of the standard lifetime allowance crystallised under the transferring scheme: Cash rights exceeding 25 Does the member have tax-free cash sum rights of more than 25 of their rights on 5 April 2006 in the transferring scheme? If you have answered : a) Total value of member s rights on 5 April 2006 b) Member s tax-free cash sum rights on 5 April 2006 c) Have any contributions been paid on or after 6 April 2006? If, please state the amount Where the transfer value does not represent all the member s benefits under the transferring scheme, the member s tax-free cash sum on 5 April 2006 should be split proportionately to the amount of each transfer payment. In respect of the rest of the member s benefits, please give details of the provider and policy number. Low retirement age protection Does the member have a protected low normal retirement age? If, what is that age? Nil cash transfer Does the transfer value relate to a pre-1987 regime member of an occupational pension scheme who has already taken their tax-free cash sum? If, no further tax-free cash sum can be paid under this policy. Are the transferring benefits subject to an attachment order or an order relating to the distribution of lump sum benefits following divorce or dissolution of a civil partnership? If, please attach a copy of the order and supply any further details. Transfer of contracted-out rights Does the transfer value include funds arising from Section 9 (2B) Rights and/or a Guaranteed Minimum Pension (i.e. contracted-out benefits under a defined benefit scheme)? If, does the transfer comply with the conditions set out in Regulation 6 of Statutory Instrument 2011/1245 (The Pensions Act 2007 (Abolition of Contracting-out for Defined Contribution Pension Schemes) (Consequential Amendments) Regulations 2011)? Has the member flexibly accessed their Money Purchase Annual Allowance pension rights? If so, on what date? We request the trustees of the receiving scheme to accept the transfer value to provide benefits for the member in the receiving scheme instead of under the transferring scheme. On receipt of the transfer value by the receiving scheme, the transferring scheme will be discharged from providing any benefits in respect of the member under that scheme. We declare that to the best of our knowledge the information in this part is correct. Two separate signatures required) Signature Name (please print) Signature Name (please print) For and on behalf of the trustees of the transferring scheme. 3
Part 2 to be completed by the receiving scheme Receiving scheme Name of employer Name of receiving scheme Scheme name We confirm that we accept the transfer value into the receiving scheme in place of benefits for the member under the transferring scheme. Investment choice Please state the investment choice that is to apply to the member s plan at outset. If you have agreed, the member will have the option to change the investment choice once their account has been set up. Lifetime investment programmes Lifetime investment programmes manage all of a member s investments throughout the life of their plan. Insert name of the lifetime investment programme or ne Investment funds (do not complete if you have chosen a lifetime investment programme) Please state the percentage of the transfer value to be allocated to each fund. You may choose to invest in up to ten funds from the funds available, including any lifestyle investment programme funds (see the investment funds brochure for details). Investment fund name of transfer value Please use whole percentages only and make sure that the total is 100. Total 100 Lifestyle investment programme (do not complete if you have chosen a lifetime investment programme) Insert name of the lifestyle investment programme or ne Investment programme retirement date If you have chosen an investment programme, it will run to the selected retirement date unless you have agreed that members can have individual choice. If you have agreed, the member will have the option to change the investment programme retirement date once their account has been set up. Your chosen IPRD (birthday) Important: When the investment programme starts, the member s pension funds will automatically be proportionately switched in line with your/the member s instruction. 4
Your declaration Important: It is a serious offence to make false statements. If you do so, you may be prosecuted. The penalties are severe. I request the trustees/administrator of the transferring scheme to pay the transfer value detailed below to Aviva. This is to provide me with additional benefits in the receiving scheme named on page 5, instead of those under the transferring scheme. I authorise the trustees/administrator of the transferring scheme to provide Aviva and/or the trustees of the receiving scheme with all the information they need to accept the transfer value. I discharge the I have received financial advice about the transfer from the following professional adviser: Company/Firm name Address trustees/administrator of the transferring scheme from providing any benefits in respect of me under that scheme when they pay the transfer value. I apply for benefits under the rules of the receiving scheme. I request the trustees of the receiving scheme to accept the transfer value from the transferring scheme. Postcode I understand that the trustees of the receiving scheme may refuse to accept the transfer if I have not taken professional advice. I accept that my benefits will be set up under an Aviva Life & Pensions UK Limited policy, as held by the trustees of my employer s scheme. I have read over the replies to all the questions in this application. To the best of my knowledge and belief, all information given is correct and complete. I confirm That where the transfer payment includes funds arising from Section 9 (2B) Rights and/or a Guaranteed Minimum Pension (i.e. contracted-out benefits under a defined benefit scheme), I acknowledge that; I have received a statement from the receiving scheme showing the benefits to be provided in respect of the transfer payment and I accept that; the benefits to be provided may be in a different form and a different amount to those which would have been payable by the existing scheme; and there is no statutory requirement on the receiving scheme to provide for survivor s benefits out of the transfer payment. Data protection and financial crime Data Protection Use of personal information We ll use the information you give us to: process and/or underwrite your application decide if we can offer cover and on what terms administer your policy and handle any claims help detect and prevent fraudulent activity. Other companies from across the Aviva group, or third parties who provide services to us, in any country (including those outside the European Economic Area) could also use your information in this way. If they do, we ll make sure they agree to treat your information with the same level of protection as we would. We may share your information with regulatory bodies, other insurers (directly or using shared databases), your insurance intermediary, or third parties providing services to them. To keep our products and services competitive and suitable for customers needs, we may also use your information for research and customer profiling. By signing this form I consent to this use of my personal data as set-out above. Your signature Your name (please print) From time to time, we may tell you about other products or services which may be of interest. I do not wish you to contact me by: Post Phone Email You can change your mind at any time by contacting us Aviva, NPE Dept, PO Box 582, Bristol, BS34 9FX. Financial Crime To verify your identity and prevent financial crime, your information may be used by any company within the Aviva group and may be shared with third parties who provide services to us, as well as other organisations where required to by law and regulatory requirements. A record may be kept of any searches carried out and any suspicions of financial crime and related details may be retained and used to assist other companies for verification and identification purposes. The search is not a credit check and your credit rating should not be affected. Your signature Your name (please print) Aviva agrees to administer the scheme in accordance with the scheme rules. 5
How to contact us If you have any questions, you can phone us or write to us. Call us on 0345 602 9221 at the following times: Monday to Friday between 8.30am and 5.30pm. We may record calls to improve our service. Calls may be charged and these charges will vary; please speak to your network provider. Write to us at Aviva, PO Box 1550, Milford, Salisbury, Wiltshire SP1 2TW For further information on any of our products and services, visit our website www.aviva.co.uk. Aviva office Financial adviser Please tick as appropriate Advised sale Advice given after 31/12/2012 Please note that commission cannot be taken if advice was given after 31/12/2012. n-advised sale By ticking this box, Aviva will assume no advice was given. Adviser name Address Your postcode Telephone Email address Adviser s reference number Aviva Life & Pensions UK Limited. Registered in England. 3253947. Registered office: Aviva, Wellington Row, York, YO90 1WR. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Firm Reference Number 185896. Telephone 0345 602 9189 calls may be recorded. www.aviva.co.uk EPEN3/C 10/2017