Retirement claim form Tax-free cash and annuity Individual pension plans
How to fill in this form To make sure any payment is not delayed, it is important to fully complete the sections relevant to you before returning it to us with any supporting documents. 1) Your details. You must complete this section, including any partner s or dependant s details. 2) Advice or guidance. You must read and tell us about any advice or guidance you have taken. 3) Tax-free cash. You must fully complete this section. 4) Your pension annuity choice. You must fully complete or provide information for one part only of this section a or b. 5) The lifetime allowance information. You must read this section. 6) The lifetime allowance questions. You must answer all the questions. 7) Declaration. You must read, complete and then sign. You are entitled to free guidance about your retirement options. The Government has set up a guidance service called Pension Wise which offers a free, impartial service to help you understand your choices at retirement. Pension Wise can provide you with guidance by telephone, over the internet, or face to face. You can visit their website, www.pensionwise.gov.uk If you want to take an uncrystallised funds pension lump sum or a small lump sum payment, please let us know as you will need to complete a different form. You cannot take flexible income (drawdown) under this plan. If you want to transfer to another plan, where you can take drawdown, please let us know and we will send you a transfer form. Please complete this form in capital letters and in ink. 1 Your details Name Previous surname (If applicable) Plan number Address Date of birth Postcode Sex Male Female If you want to take benefits before your selected retirement date please advise us of this date. Date Please note. The final plan value will be calculated on the later of the next valuation date following: receipt of this fully completed claim form and any other information required, or the date you have chosen to take benefits. If you invest in a with-profits fund we may apply a market value reduction if you don t take your benefits on the selected retirement date. Marital status (for example, married or civil partner, single, widowed, divorced or dissolved civil partnership) National Insurance number (This must be shown)
Your details (continued) Contacting you We may need to contact you to discuss the claim and if you provide your telephone number this will help to avoid any delays. Daytime telephone number Evening telephone number If you would like to receive email and text updates on the progress of your claim, please provide an email address or a mobile phone number. I would like to receive email and text updates on my claim Yes No Mobile telephone number Email address The above contact details will not be used for marketing purposes, unless you have previously agreed to such use. Your spouse s, registered civil partner s or dependant s details Name Title Mr Mrs Ms Miss Other (please specify) Date of birth Sex Male Female What is their relationship to you? Husband Wife Registered civil partner Other (please specify) Your bank details Please give us details of the account you want us to pay any cash lump sum and/or the pension annuity in to: Name of Bank/Building Society Branch name Sort code Branch address Account number/building society roll number Postcode Account holder(s) Account type (for example sole/joint) 2 Have you taken advice or guidance on your retirement options? We recommend you consider taking regulated financial advice or use the guidance available from Pension Wise before making a decision. Have you used the guidance available from Pension Wise? Yes No Please confirm if you have received advice from a regulated financial adviser before making this claim: Have you received advice? Yes No
3 Tax-free cash Do you want to take any tax-free cash from this plan? No Yes*, maximum available Yes, an amount of *Note: The normal maximum is 25% of the plan value. Zurich will pay any tax-free cash into your chosen Bank/Building Society account unless you give us alternative instructions. If yes, do you intend to use any of it to fund a significantly increased contribution(s) to another registered pension scheme? Yes* No * If you answered yes, we won t pay any tax-free cash because there are HM Revenue & Customs (HMRC) anti-avoidance rules around recycling it. If you use the tax-free cash sum from this plan to fund any contributions to any other registered pension scheme, the tax-free cash sum could be treated as an unauthorised payment and subject to tax of at least 40%. Ask your adviser if you are concerned this might affect you. 4 Your pension annuity (secure lifelong income) choice You must fully complete or provide information for only one part of this section either option a) or b) for your choice of pension annuity. Notes: We will assume you want to use your entire final value for the option you choose, unless you tell us otherwise. If you don t want to do so, you must confirm this, in writing, when you return this form. If you want to use part of your final value for this option and another part for a different option, you need to confirm the split you want. Please do so when you return this claim form and the other claim form for the different option you ve chosen. The final value will be calculated on the later of the next valuation date following receipt of this fully completed claim form and any other information required by Zurich, or any date given in section 1. In the following options, if your plan contains both non-protected rights and former protected rights we will set up pension annuities for both or transfer both to another insurer named below unless you give us written alternative instructions. a) Pension annuity from Zurich Please provide the following if you want a Zurich pension annuity. Sign, date and return a copy of the Zurich pension annuity illustration to us with this claim form. Note: We will pay the pension annuity into your chosen Bank/Building Society account unless you give us alternative instructions. b) Pension annuity from another insurer (Open market option) Please complete if you want to buy a pension annuity from an insurer nominated by you or your financial adviser. If you have chosen this option, that insurer will set up your pension annuity for you. (This is known as the open market option (OMO)). Please make the payment to: Name of insurer Address of insurer Postcode Reference Pension scheme tax reference
5 The lifetime allowance information Since 6 April 2006, each time benefits are taken from a pension plan, the pension provider will usually issue a Benefit Crystallisation Certificate that explains the percentage of the lifetime allowance used. These percentages can be added together to calculate your total percentage of lifetime allowance used. If the total benefits you take, across all registered pension schemes, have a value that exceeds the standard lifetime allowance the excess will be subject to a tax charge called the lifetime allowance charge. The charge is 55% if you take excess benefits as a lump sum or 25% if you take them as a taxed pension. The standard lifetime allowance is 1,250,000 for tax years 2014/2015 onwards. The standard lifetime allowance is subject to change by the Government. Before you take your benefits you ll need to check whether you are below or above the lifetime allowance. To do this you need to add up the value of all your pensions (whether with Zurich or other providers). You need to include: if you are receiving a pension (excluding drawdown pension plans) which started before 6 April 2006, the gross yearly amount of that pension if you are receiving a drawdown pension (formerly known as income drawdown) which started before 6 April 2006, the maximum gross yearly amount you can take the percentage of the standard lifetime allowance you have used under any pension plans since 6 April 2006 (This covers all pensions, tax-free cash, uncrystallised funds pension lump sums (UFPLS), ill health lump sums and transfers to a qualifying recognised overseas pension scheme), and the fund value of other pension plans (including drawdown pensions) you might take benefits from before you take benefits from this plan. (The value of a defined benefit pension, run by an employer for its employees, is calculated differently. If you have benefits under one of these occupational pension plans, contact the trustees or administrators of your pension to find out its value for the lifetime allowance). You can ignore any state pensions or other state benefits. Please fully complete the following questions. It will help us check whether this could affect you.
6 The lifetime allowance questions Please answer all the following questions. Please ignore the value of state pensions or any pension you receive due to another person s membership of a scheme (for example dependant s or widow(er) s pensions). 1a Are you currently receiving a pension that started before 6 April 2006 or do you have a drawdown pension which was set up before 6 April 2006? Yes No If you answer No go to Q2a. If you answer Yes go to Q1b. 1b Do you have a drawdown pension which was set up before 6 April 2006? Yes No If you answer No, go to Q1e. If you answer Yes and it is capped drawdown go to Q1c. If Yes and it is flexible (flexi-access) drawdown go to Q1d. 1c What is the maximum annual amount you could take from the capped drawdown pension plan(s)? (If there has been a benefit crystallisation event (BCE) since 6 April 2006, you should show the maximum annual amount at that date. If there hasn t been a BCE since 6 April 2006, we need to know the current maximum annual amount you could take). If there has been a BCE since 6 April 2006, please tell us the date of the first BCE. 1d What was the maximum annual amount you could take from the capped drawdown pension plan(s) at the point it became a flexible (flexi-access) drawdown plan? (If there has been a BCE since 6 April 2006, you should show the maximum annual amount at that date. If there hasn t been a BCE since 6 April 2006, we need to know the current maximum annual amount you could take). Did you convert your plan to flexible drawdown before 6th April 2015? Yes No If Yes, did you request this in a drawdown pension year that began before 27 March 2014? Yes No If there has been a BCE since 6 April 2006, please tell us the date of the first BCE. 1e What is the total gross amount of pension(s) started before 6 April 2006 excluding amount(s) from drawdown pension(s)? (If there has been a BCE since 6 April 2006, you should show the total gross amount at that date. If there hasn t been a BCE since 6 April 2006, we need to know the current total amount you receive). 2a Have you taken any benefits and/or made any transfers overseas from a registered Yes No pension scheme since 6 April 2006? If you answered No, go to question 3a. If Yes, please answer question 2b. 2b What is the total percentage of the standard lifetime allowance used? % Your pension scheme will have given you a Benefit Crystallisation Certificate which shows this. 3a Do you intend to take benefits from any other registered pension schemes before Yes No you take benefits from this plan? If you answered No, go to question 4. If Yes, please answer question 3b. 3b What is the current total value of those plans? 4 Do you have Enhanced Protection and/or Primary Protection and/or any other Lifetime Allowance Enhancement Yes No If you answered yes, please send us a copy of the HMRC certificate(s). 5 Do you have Fixed Protection 2012 or Fixed Protection 2014? Yes No If you answered yes, please send us a copy of the HMRC certificate. 6 Do you have Individual Protection 2014? Yes No If you answered yes, please send us a copy of the HMRC certificate. Note: We may need to ask you for more information if the value of your total pension benefits is above or near the standard lifetime allowance or if we need more details on the answers you have given. 6
7 Declaration Warning: Zurich must report certain details in this form to HM Revenue & Customs (HMRC). If any of the details and statements you have made in this form are not true or complete this may lead to severe penalties being imposed on you by HMRC. We have enclosed information on the things you should consider before making your claim. If you do not understand the information we ve provided or would like to ask any questions, then please contact us, use the guidance available from Pension Wise or speak to a financial adviser before signing and returning this claim form. I authorise Zurich Assurance Ltd to: pay the plan proceeds as detailed in this claim form and as permitted by the plan terms and conditions and any other supporting documentation use the information provided on this form for the administration of and payment of benefits arising from this plan in accordance with the Data Protection Act 1998. Where I am providing information relating to a third party, I have their permission to do this provide the insurer named in Your pension annuity choice with the information they require to set up the pension annuity and confirm that once complete, Zurich will have no further liability under this plan. I am aware that: Zurich recommend I consider taking regulated financial advice or use the guidance available from Pension Wise the amounts payable may be adjusted to take into account the value of the plan at the date benefits are taken the pension income payable may be adjusted due to any change in pension annuity rates if this claim form and other documents are not returned to Zurich by the guaranteed date if my total benefits exceed my lifetime allowance I will need a new illustration and my benefits will need to be recalculated the final plan value will be calculated on the later of: the next valuation date following receipt by Zurich of this fully completed claim form and any other information required, or the date I have chosen to take benefits in section 1, if any. if I buy a pension annuity from Zurich it will not be based on my health or factors affecting how long I might live such as: any medication I take; where I live; my occupation; and whether I smoke. An annuity which takes these factors into account is known as an enhanced annuity and, if I am eligible for one, another provider could offer a much higher level of income. if I buy a pension annuity on the open market and ask the pension annuity provider to pay an adviser charge from the pension annuity fund, the adviser charge must: relate only to advice regarding this pension arrangement, be appropriate for the service provided by the adviser, and be a genuinely commercial remuneration arrangement. If the adviser charge does not meet all these requirements, all or part of the adviser charge will be regarded as an unauthorised payment and I will incur additional tax charges. I declare that: I am not bankrupt and have not been since starting this plan the benefits in the plan do not form part of a divorce settlement and I understand I must tell Zurich if this is the case the statements and information contained in this form, and the details Zurich holds in respect of me are, to the best of my knowledge and belief, true and complete. I authorise Zurich to pay the benefits detailed in this form in full and final settlement of my claim. Signature Date 7
PW711115053 (CH) (03/15) RRD Zurich Assurance Ltd, authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Registered in England and Wales under company number 02456671. Registered Office: The Grange, Bishops Cleeve, Cheltenham, GL52 8XX.