GROUP PERSONAL PENSION PLAN TRANSFER APPLICATION FORM

GROUP PERSONAL PENSION PLAN TRANSFER APPLICATION FORM

If you already have a Group Personal Pension with us, please tell us the plan number. We will add your transfer to your existing plan. Plan Number NOTE: FAILURE TO COMPLETE ALL PARTS OF THIS APPLICATION FORM WILL DELAY PROCESSING. FINANCIAL ADVISERS PLEASE ENSURE SECTIONS A TO C ARE COMPLETE. THIS APPLICATION MUST BE USED IN CONJUNCTION WITH THE TRANSFER SPREADSHEET (22599) IN ORDER TO CAPTURE THE TRANSFERRING SCHEME DETAILS AND TRANSFER VALUE DATA. Warning: You must not make false statements when filling in this application; it is a serious offence. The penalties are severe and you could be prosecuted. Government rules allow certain individuals to protect entitlements to: tax-free cash which exceeded 25% of the value of that individual s pension fund as at 5 April 2006 and/or a lower or earlier pension age, where a right to take pension benefits at that age existed prior to 6 April 2006. This protection will be lost on transfer from one scheme to another unless the transfer is a block transfer. To be a block transfer, two or more members must transfer all sums and assets held within a scheme at the same time to a single receiving scheme. Please note that you will lose tax free cash protection / protected pension age if you have already been a member of the receiving scheme for longer than 12 months before the transfer (please ensure that you check this with the receiving scheme prior to transfer). For further information please speak to your financial adviser. If you have applied, or are considering applying, to HM Revenue & Customs for Enhanced Protection from any potential lifetime allowance tax charge, such protection could be lost on transfer. For further information, please seek financial advice. Please read the Personal Pension Plan literature before completing this application. Please use BLOCK CAPITALS or tick relevant boxes. 1

PERSONAL PENSION PLAN TRANSFER APPLICATION FORM Note Please note that Scottish Widows can only accept applications from individuals who are habitually resident in the United Kingdom, or in a limited number of overseas territories. Unless you are habitually resident in the United Kingdom, or in one of the other territories referred to, we will be unable to accept your application. If you are not resident in the United Kingdom, please speak to your financial adviser or contact us to confirm your eligibility. You have opted to transfer your existing pension plan detailed in section A to the Scottish Widows Appropriate Personal Pension Scheme. The Scottish Widows Appropriate Personal Pension Scheme is a Registered Pension Scheme, as defined under Part 4 of the Finance Act 2004 (Pension Scheme Tax Reference 00605435RH). Contact details for Scottish Widows 08457 697 567 Fax 08457 125740 Please return your completed Transfer Application Form to: Grant Thornton UK LLP, Benefits Administration Department, 300 Pavilion Drive, Northampton Business Park, Northampton, NN4 7YE. Scottish Widows reference number: (to be completed by Scottish Widows) NOTES TO SECTION A 1) A birth certificate should be sent to us with your application. If you have changed your surname, for example, through marriage or a registered civil partnership, a copy of the appropriate certificate should also be sent. 2) Your National Insurance Number can be found on a payslip or P60, or on a tax return. If you have a National Insurance Number, it is essential that you provide it, otherwise we are unable to accept contributions and cannot process your application. If you cannot find your National Insurance Number, please phone the HM Revenue & Customs Enquiry helpline 0845 915 7006. A. CLIENT DETAILS 1. Your title Mr Mrs Miss Ms Other (please specify) 2. Your surname 3. Your first name(s) 4. Your date of birth (DD MM YYYY) (see note 1) 5. Your National Insurance Number (see note 2) If you do not have, and have never been given, a National Insurance Number, please tick this box 6. Full name and address of transferring arrangement 7. Please tick this box if you are eligible now or at the end of a specified waiting period to join your employer s pension scheme, but have declined to do so, or will decline to do so at the end of the specified waiting period. Please also tick this box if you have left your employer s pension scheme to take out this pension plan. 2

NOTES TO SECTION B 1) You can ask to change your investment choice at any time. 2) Each of our Pension Investment Approaches invests using one or more of our four Pension Portfolio funds. These Pension Portfolio funds use a varying mix of higher and lower risk investment assets. The Pension Portfolio fund you will initially be invested in will depend on your chosen Pension Investment Approach and the time until your selected pension age. Over time, your pension fund will be progressively moved to lower risk investment funds. By the time you reach your selected pension age, approximately 75% of your fund will be invested in our Pension Protector Fund and 25% in the Cash Fund. For more details, please see our Pension Investment Approach Guide. 3) We may need to contact you to confirm your instructions if you have set up different investment option(s) for different types of payment under your plan. 4) Please note that if you invest the transfer payment in one of our Pension Investment Approaches or invest it in a different way from the current investment choice/option(s) applicable to your Scottish Widows Group Personal Pension plan this could override the investment choice/option(s) already set up under your plan. Please contact us if you want any further information on this matter. B. YOUR INVESTMENT CHOICE Investment selection is a very important decision. (see note 1) You can choose for the transfer payment to be invested either: in the same way as the current investment option(s) applicable to your Scottish Widows Group Personal Pension plan, to do so please complete part 1 below, or in one of the Grant Thornton Risk Graded Portfolios designed by Grant Thornton Employee Benefits Consultancy, to do so please complete part 2 below, or in one of the Scottish Widows Pension Investment Approaches, to do so please complete part 3 below, or in one or more of the Scottish Widows investment funds, to do so please complete part 4 overleaf. You can only select one of the above. Please note If you don t want to select an investment choice, we will automatically invest the transfer payment using your current investment selection you have made for your regular payments. (see note 4) If your scheme commenced prior to 1 April 2006, please contact your Employer as there may be a different default investment option applicable to your plan. 1. Same basis as current investment option Please tick this box if you want the transfer payment to be invested in the same way as the current investment option(s) applicable to your Scottish Widows Group Personal Pension plan (see note 3) 2. Grant Thornton Risk Graded Portfolios This part should only be completed if you wish to select one of the Grant Thornton Risk Graded Portfolios designed by Grant Thornton Employee Benefits Consultancy. (See note 4) The Grant Thornton Cash Plus Portfolio The Grant Thornton Cautious Risk Portfolio The Grant Thornton Below Average Risk Portfolio The Grant Thornton Average Risk Portfolio The Grant Thornton Above Average Risk Portfolio The Grant Thornton Adventurous Risk Portfolio Please tick as appropriate If you are considering using one the Grant Thornton Risk Graded Portfolios designed by Grant Thornton Employee Benefits Consultancy, please refer to your Joining Guide for further details. 3

B. YOUR INVESTMENT CHOICE (CONTINUED) 3. Scottish Widows Pension Investment Approaches This part should only be completed if you wish to select a Scottish Widows Pension Investment Approach. (see note 2 & 4) Cautious Pension Approach Balanced Pension Approach Adventurous Pension Approach Please tick as appropriate As you get closer to your selected pension age, we will automatically gradually adjust and move your pension fund into lower risk investment funds. You can choose to stop the gradual adjustments, or even change your investment choice, at any time. If you are considering using one of the Scottish Widows Pension Investment Approaches, please read our Pension Investment Approach Guide to find out further information and details of the investment funds used by each Approach. 4. Scottish Widows Investment Fund Selection You can invest in up to 10 funds at any one time. Restrictions may apply to the amount that can be invested in some funds. Please contact us for details of any restrictions. For further details of the funds available please refer to the Scottish Widows Pension Funds Investor s Guide. (see note 4) Fund % split for transfer amount Total 100% We may change the selection of funds that we make available. 4

C. DECLARATION THE DECLARATION SHOULD BE COMPLETED BY THE APPLICANT. SCOTTISH WIDOWS APPROPRIATE PERSONAL PENSION SCHEME (the Scheme) To enable your transfer value to be paid to Scottish Widows, you must either be or become a Member of the Scheme. Scottish Widows is the Administrator of the Scheme and is responsible for running it according to the Scheme Rules If you become a member of the Scheme, a policy will be issued by Scottish Widows in your name. If you are already a member of the Scheme, the transfer value will be applied to your existing policy, unless you instruct us otherwise. I am or wish to become a member of the Scheme and: a) I understand that this application forms part of my contract with Scottish Widows, along with the Rules of the Scheme, the policy provisions, the policy schedule and any document amending the policy schedule. Copies of these are available from Scottish Widows. b) I agree to the payment of the transfer value to Scottish Widows to provide benefits for me under the Scheme. c) I agree that this application will be treated as a separate application in respect of each of the Arrangements under the policy. The transfer value will be invested equally in 1,000 arrangements. d) If I am transferring benefits currently held as GMP or section 9(2B) rights in the transferring scheme, I confirm that I have acknowledged in writing to the transferring scheme that: I have received a statement from Scottish Widows showing the benefits to be awarded in respect of the transfer payment I accept that the benefits to be provided by Scottish Widows may be in a different form and of a different amount to those which would have been payable by the transferring scheme and I accept that there is no statutory requirement on Scottish Widows to provider for survivor s benefits out of the transfer payment. e) I also acknowledge that Scottish Widows is not accepting liability to provide benefits in the form of GMP or section 9(2B) rights. f) I understand that on acceptance of the transfer value(s) by Scottish Widows, the transferring scheme or arrangement will cease to have any liability to me in respect of the transferred benefits, and that neither I nor my dependants, or other beneficiaries, will have further claim on the transferring scheme or arrangement in respect of the said benefits. g) I consent to Scottish Widows seeking further information from other pension providers, trustees, or scheme administrators, for any other pension arrangements under which I have benefits. I authorise the provision of any information requested. h) To the best of my knowledge and belief, all the statements I have made, whether in my own handwriting or not, are true and complete. i) I have received the Important Notes for Applications document and the Key Features Document. Lloyds Banking Group companies may use your information to contact you by mail, telephone, email or text message about products and services that may be of interest to you. If you do not wish to receive this information please tick this box. For your own benefit and protection, please read these documents before you sign this application. Scottish Widows will rely on them when administering your contract. If you do not understand any point, please let us know. Your signature Date (DD MM YYYY) A copy of the completed transfer application, Scheme Rules and Policy Provisions are available from Scottish Widows. Warning: Deciding whether or not to transfer can be complicated. Therefore before you sign your application you should satisfy yourself that transferring your pension fund is right for you. It is important that you are sure about the suitability of transferring and that you understand the risks. If you have received financial advice your adviser will have discussed the relevant issues with you for your circumstances. If you have chosen not to obtain financial advice you should take the opportunity to read the Key Features document and our product literature. Further information on pension transfers can be viewed on the following FSC website: www.moneymadeclear.org.uk 5

Scottish Widows plc. Registered in Scotland No. 199549. Registered Office in the United Kingdom at 69 Morrison Street, Edinburgh EH3 8YF. Telephone: 0131 655 6000. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services Register number 191517. 49180 11/14