Pru Flexible Retirement Transfer Plan Transferring Scheme Information (Personal Pension, Drawdown with SIPP Option) Please use black ink and write in CAPITAL LETTERS or tick 4 as appropriate. Any corrections must be initialled. Please do not use correction fluid as this will invalidate your form. About this form If you have any questions about this form, you can call us on 0808 234 0808 between 8am and 6pm Monday-Friday. We might record your call to make sure our service is up to standard. Please return all six pages of this form in the enclosed reply paid envelope to: Prudential, Lancing BN15 Part 1 Client details Name Address Postcode * There are a number of possible ways you may trigger the Money Purchase Annual Allowance (MPAA) when accessing your benefits flexibly. Your pension scheme or provider will have informed you if this is the case. For further information please speak to your financial adviser. Date of birth Plan reference number D D M M Y Y Y Y Have benefits previously been accessed flexibly?* If, please specify the date these were accessed D D M M Y Y Y Y Part 2 Details of transferring arrangement Full name of scheme/arrangement HM Revenue and Customs Reference number Address Postcode Please tick the appropriate box. If Other, please give full details evidence of approval may be required. Please note, further information may be required for transfers from overseas schemes. Where is the transfer coming from? UK Scheme Transfers Occupational Scheme S32 with GMP Other OR Overseas Scheme Transfer Page 1 of 6
Part 2 Details of transferring arrangement continued Is the transfer a result of a divorce Pensions Splitting order? Is the pension being shared a pension in payment? If, please show the amount of the transfer value from which no further tax free cash may be taken. Is the transfer as a result of benefits received on death? If, the transfer must be a dependant/nominee/successor drawdown to drawdown transfer. Go straight to Part 3.6. Part 3 Transfer details 3.1 Total amount of transfer value 3.2 Are there any crystallised rights included in the transfer value? If, please also complete the "Information for Drawdown to Drawdown Transfer" section. 3.3 Is any part of the transfer uncrystallised rights that originated in an approved occupational pension scheme where, on or after 27 July 2004 but before 6 April 2006, the applicant took a tax-free lump sum but delayed taking pension? If, and this does not apply to the whole transfer value, please confirm the value that has already attracted tax-free cash. 3.4 Is the transfer part of a block transfer from a registered pension scheme? te: If the member has been a member of our scheme for more than 12 months we will ignore any details given below. If, go to 3.5 Does the investor qualify for Protected Tax-Free Cash for pre 6 April 2006? Does the investor have a Protected Early Pension Age? If, to either of the protection questions above please complete the rest of this section. If, please go to Drawdown to Drawdown section overleaf if required, or direct to the declaration on page 4. Protected Tax-Free Cash amount at 5 April 2006 Fund value at 5 April 2006 Protected Early Pension Date (this date must be a birthday) D D M M Y Y Y Y Does the Transfer Value include the value of any contributions paid, or benefits earned, after 5 April 2006? Has there been a previous partial transfer out from the scheme If, value of previous transfer out Are all benefits available from the scheme payable as a Standalone Lump Sum? Page 2 of 6
Part 3 Transfer details continued 3.5 Information for drawdown to drawdown transfers Does the transfer payment include Drawdown Funds with: > Different GAD (Government Actuary Department) review dates?* If, we need the following information for each fund separately (please complete on a separate sheet). > Pre and post 5 April 2006 drawdown? If, we need the following information for each fund separately (please complete on a separate sheet). If, is the transfer payment all pre 5 April 2006 OR all post 5 April 2006 Transfer Value of Drawdown Fund When was the last GAD review?* D D M M Y Y Y Y Current Capped Drawdown limit (max GAD)* Will the current drawdown limit change at the start of the new GAD year as a result of part annuitisation or pension sharing or additional designation of drawdown funds in the same arrangement?* If, what will the new limit be?* Total amount withdrawn in the current GAD year* Value of fund at date funds were first designated to drawdown (Post 5 April 2006 drawdown only). gross gross (If funds were phased show the total of the fund values when they were designated into drawdown). If the funds were designated to drawdown after 5 April 2006, what is the percentage of total standard Lifetime Allowance used by all BCEs connected to the transfer value quoted in this section % Does the member have any short term annuity contracts currently in payment from the drawdown fund? If, we will contact you for further details. * This applies to capped drawdown only 3.6 Information for dependant/nominee/successor drawdown to drawdown transfers Does the transfer payment include Drawdowns Fund with: > Different GAD review dates?* If, we need the following information for each fund separately (please complete on a separate sheet). Transfer Value of Drawdown Fund When was the last GAD review?* D D M M Y Y Y Y Current Capped Drawdown limit (max GAD)* Page 3 of 6
Part 3 Transfer details continued Will the current drawdown limit change at the start of the new GAD year as a result of part annuitisation or pension sharing or additional designation of drawdown funds in the same arrangement?* If, what will the new limit be?* Total amount withdrawn in the current GAD year* gross gross Value of fund at date funds were first designated to drawdown Does the member have any short term annuity contracts in payment from the drawdown fund? If, we will contact you for further details. * This applies to capped drawdown only Type of beneficiary drawdown Dependant's Drawdown (capped) minee's Flexi-Access Drawdown Dependant's Flexi-Access Drawdown Successor's Flexi-Access Drawdown Has a successor been nominated? If, please provide successor nomination details. Name Address Postcode If transfer is from a dependants/1st nominee's drawdown, age of original member at date of death If transfer is from a successor drawdown, age of immediate preceding dependant/nominee/successor at date of death If the age noted above is under 75, is the drawdown income tax free under ITEPA 579CZA (1) or (2)? If, which of the following sections of ITEPA 579CZA is the drawdown income taxable under: 4 5 6 Other If Other, please provide reason here. Page 4 of 6
Declaration and certification from transferring arrangement 1. We declare that to the best of our knowledge and belief the information given in all parts of this application is correct and complete. 2. We confirm that the transfer value detailed in this form is consistent with UK legislation and meets the requirements for equal treatment of retirement benefits between males and females in the same category of employment to the extent required by the Treaty of Rome. 3. If the transfer value is subject to a Court Order following the Investor s divorce (an earmarking order ), a copy of this order is attached. Copy attached Signature 7 Date D D M M Y Y Y Y For and on behalf of the administrator of the transferring scheme or the insurer of the transferring arrangement or contract. The Prudential (SAL) Personal Pension Scheme is an appropriate personal pension scheme and has been allocated HMRC pension scheme tax reference number 00605330RK and ASCN A7001074K. Page 5 of 6
www.pru.co.uk The Prudential Assurance Company Limited, 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. PPFF10002 02/2018 Page 6 of 6