Premier Stakeholder Pension Transfer Plan application form

Premier Stakeholder Pension Transfer Plan application form TA1 Some important information before you start Please return all eight pages of this form to: Freepost, Prudential, Lancing BN15 8GB. We kindly ask that parts 1, 2, 3 and 6 are completed by the customer and 4, 5 and 7 by the administrator or insurer of the transferring arrangement. Please be aware The adviser should complete pages 7 and 8. Please use a separate form for each transfer value. As you complete the form, please read the notes which are there to help you. Copies of the plan terms and conditions and the completed application form are available on request. It s a serious offence to give false information, and to do so could lead to prosecution. Please read your Key Features Document as this will provide you with important information regarding the key risks and benefits of the product to help you make a decision. Please also read your Fund Guide, available at pru.co.uk/funds/guides, as this will provide you with full details of the funds available, their objectives, Prudential s Risk rating of these funds and charges to help you select the funds suitable for your needs. Questions about this form? Advisers in the first instance, get in touch with your usual Prudential contact or please call our Adviser Centre on 0808 234 0808 Calls may be monitored or recorded for quality and security purposes. Policyholders please speak to your financial adviser Our web addresses are pruadviser.co.uk for financial advisers and pru.co.uk for policyholders. How to fill in this form Please use black ink and write in CAPITAL LETTERS or tick as appropriate. Any corrections must be initialled. Please do not use correction fluid as this will invalidate your application. 1. Customer s details Title Mr Mrs Miss Ms Dr Other If Other, please state title. Surname Full forename(s) Date of birth Sex Male Female Permanent residential address Postcode Include postcode. National Insurance number Selected Retirement Date

1. Customer s details continued HM Revenue and Customs normally only allow pension ages earlier than 55 where the member has a protected early pension age. You may have a protected early pension age if you were the member of a pension scheme before 6 April 2006 and you had an unqualified right to take your benefits before the normal pension age. Have you previously accessed benefits flexibly? Yes No If Yes, please specify the date these were accessed Please now complete Part 2. TA2 Page 2 of 8 * 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. 2. Investment details This section allows you to decide what funds you would like to invest in. Investment in the With-Profits Fund is not available. Please be aware if you do NOT complete this section we will invest your transfer value in the default investment fund. If you want a Lifetime Investment Option or Profile (see below), you can also choose the investment linked fund(s) to be used initially, or you can leave the selection to us (i.e. use the default funds ). If you do NOT want a Lifetime Investment Option or Profile, please complete the table below to confirm the investment fund(s) to be used. If you want the Pension Protector Option (see below), you must choose the investment fund(s) to be used. Chosen fund(s) to be invested in each fund Total 100 The default investment fund for Stakeholder is the Lifetime Investment Profile targeting retirement options. Please show the percentage investment split you want for your plan. Fractions of 1 should not be used. You can invest in up to six funds. Please make sure your total equals 100. If you want one of the following lifestyle options, please complete the rest of this section. Otherwise, please go to Part 3. Lifetime Investment Profiles/Lifetime Investment Options/Pension Protector Option Lifetime Investment Profile targeting retirement options Lifetime Investment Profile targeting an annuity Lifetime Investment Profile targeting 100 cash Lifetime Investment Profile targeting drawdown Lifetime Investment Option (Cautious) Lifetime Investment Option (Opportunity) Pension Protector Option Please note that the Lifetime Investment Option (Balanced) is closed to individuals not already invested in this option. Additionally, it is not possible for existing investors in this option to increase contributions to it. If you have chosen one of the Lifetime Investment strategies without choosing any investment linked fund(s), we will assume that you are happy to start with the funds we choose for you. There is a set basis, we do not make an individual choice. Please now go to Part 3.

3. Payment of death benefits TA3 Page 3 of 8 Failure to complete this section may delay payment of death benefits. Nomination of beneficiary Prudential or Prudential Assurance Company Limited are not legally bound to follow your wishes, but will take them into account. Title Mr Mrs Miss Ms Dr Other Surname Full forename(s) The discretionary distribution of death benefits means that inheritance tax will not normally apply. If you want to change these details later, you should write to Prudential, quoting your plan number and the revised information. Address Postcode Relationship to you (if any) Proportion of benefits (If not 100, details of any additional beneficiaries should be attached to this application.) Please now sign and date the Declaration in Part 6. The administrator or insurer of the transferring arrangement should complete parts 4, 5 and 7. 4. Details of transferring arrangement Full name of scheme/arrangement HMRC reference number Name and address of Trustee and Administrator or Insurer Where is the transfer coming from? UK Scheme Transfers Occupational Scheme Other or Overseas Scheme Transfer Postcode Please tick the appropriate box Further information may be required for transfers from overseas schemes. Any other source approved by HM Revenue and Customs Please give full details evidence of approval will be required. Is the transfer a result of a divorce pensions splitting order? Yes No Is the pension being shared a pension in payment? Yes No Please show your Scheme Earnings

5. Transfer details stakeholder pension option Total amount of transfer value TA4 Page 4 of 8 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? Yes No If Yes, and this does not apply to the whole transfer value, please confirm the value that has already attracted tax-free cash. Is the transfer part of a block transfer from a registered pension scheme? Yes No Note: If the member has been a member of our scheme for more than 12 months we will ignore any details given below. Does the investor qualify for Protected Tax-Free Cash for pre 6 April 2006? Yes No Does the investor have a Protected Early Pension Age? Yes No If Yes, to either of the protection questions above please complete the rest of this section. 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) Does the Transfer Value include the value of any contributions paid, or benefits earned, after 5 April 2006? Yes No Has there been a previous partial transfer out from the scheme Yes No If Yes, value of previous transfer out Are all benefits available from the scheme payable as a Standalone Lump Sum? Yes No

6. Declaration TA5 Page 5 of 8 We ask that you take some time and read the documentation provided before signing this form. This is for your own benefit and to give you peace of mind. Please also read carefully any further documentation provided to you in the future. If there is anything you do not understand please ask us for further information. Declaration to the Existing Pension Provider 1. I authorise and instruct you to transfer sums and assets from the plan(s) as listed in Part 4 directly to Prudential and to provide any instructions and/or discharge required by any relevant third party to do so. 2. I authorise Prudential, the current provider and any financial intermediary named in this application to obtain from each other, and release to each other, any information that may be required to enable the transfer of sums and assets to Prudential. 3. I authorise Prudential, the current provider and any employer paying contributions to any of the plan(s) as listed in Part 4 to obtain from each other, and release to each other, any information that may be required to enable the transfer of sums and assets to Prudential. 4. Until this application is accepted and complete, Prudential s responsibility is limited to the return of the total payment(s) to the current provider(s). 5. When payment is made to Prudential as instructed, this means that I shall no longer be entitled to receive pension benefits from the whole of the plan(s) listed in Part 4 where the whole of the plan(s) are transferring, or that part of the plan(s) represented by the payment(s) if only part of the plan(s) are transferring. Declaration to Prudential and Existing Pension Provider 1. I accept responsibility in respect of any claims, losses, expenses, additional tax charges or any penalties that Prudential and the current provider may incur as a result of any incorrect, untrue, or misleading information in this application or given by me, or on my behalf, or of any failure on my part to comply with any aspect of this application. This includes where I have been asked to provide any original policy document(s) in return for the transfer of funds and I am unable to do so. 2. If I have taken benefits from any pension arrangement, with the current or any other pension provider, in a way which means I am subject to the Money Purchase Annual Allowance (MPAA), I have supplied the date the MPAA first applied to me in Part 4. Declaration to Prudential: 1. I apply for membership of the Prudential (SAL) Stakeholder Scheme and agree to abide by its rules. 2. I request that the Trustee and Administrator or Insurer of my previous scheme or arrangement pays a transfer value to Prudential and that Prudential set up a Premier Stakeholder Pension plan for me in respect of this transfer value, as confirmed in this application form. 3. I declare that the information given by me in this form is correct and complete to the best of my knowledge and belief and agree that this application, including any other written statement by me or the administrator or insurer of the transferring arrangement to Prudential and Prudential s acceptance shall be deemed to form part of any resultant contract or contracts. 4. I understand that the administrator or insurer of the transferring arrangement will be discharged of all liability to or in respect of me under the transferring arrangement, in so far as the benefits under the said arrangement are represented by the transfer value shown in this form. 5. I understand that no benefits arising as a result of this transfer are capable of commutation, surrender or assignment except as permitted by the plan conditions and by Chapter 2 of Part 4 of the Finance Act 2004. 6. I consent to Prudential s giving to or obtaining from the administrator or insurer of the transferring arrangement or others, such further information as may be reasonably necessary for the installation and administration of any plan set up as a result of the transfer. 7. I consent to Prudential providing the financial adviser detailed in this Application Form, information on all my Prudential Individual Pension Plans (including group arrangements). This authority is valid until it is cancelled, in writing, by me, or by submission of future applications.

6. Declaration continued TA6 Page 6 of 8 How we use your personal data The Prudential Assurance Company Limited, its group companies* and its business partners will use your information together with other information for administration, credit decisions, customer services, marketing and profiling your purchasing preferences. We will pass your information to them (including our service providers and agents) for these purposes. If you are a joint applicant, we will also pass your information to the other joint applicant/s. For certain products, we may search the files of credit reference agencies that will record any credit searches on your file. This is to help us make credit decisions about you, to prevent fraud, to check your identity and to prevent money laundering. We may disclose details of how you conduct your account to such agencies. The information will be used by other credit grantors for making credit decisions about you and the people with whom you are financially associated, for fraud prevention, moneylaundering prevention and occasionally for tracing debtors. This information may be used to recheck these purposes. We will pass your information to any legal or regulatory body if required to do so. It may also be necessary, for the above purposes, to transfer your information to countries that provide a different level of data protection from the UK. In such circumstances, we will put a contract in place to ensure your information is protected. By completing and submitting this form, you consent to us processing your sensitive data and to the processing mentioned above. You have a right to obtain a copy of your personal information (for which we may charge a fee) and to have any inaccuracies corrected by writing to: The Information Risk & Security Team, Prudential, Lancing BN15 8GB. To make sure we follow your instructions correctly and to improve our service to you through training of our staff, we may monitor or record communications. * Prudential Assurance Company Limited is part of the Prudential group of companies which at the time of printing includes Prudential UK & Europe, the M&G Investments Group, Prudential Corporation Asia, Jackson National Life, and PPM America Inc (indirect wholly owned subsidiary). Acting on someone s behalf? When giving us information about another person, you confirm that they have appointed you to act on their behalf. This includes providing consent to: the processing of their personal and sensitive data; receive any data protection notices on their behalf; receive marketing information as indicated. Marketing choice We would like to keep you up to date with information on our products and services. To do this, we would like to contact you by telephone, post, email or text. If you would not like to be contacted, please tick this box. Signature of investor Date Prudential as Administrator of the Prudential (SAL) Stakeholder Scheme agrees to administer the scheme as required by the rules of the scheme. 7. 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; 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 Date For and on behalf of the administrator of the transferring scheme or the insurer of the transferring arrangement or contract. The Prudential (SAL) Stakeholder Scheme, under which Stakeholder Pension plans are issued by Prudential, is a stakeholder scheme and has been allocated HMRC reference number 00613765RA and ASCN A7800023E. Tick box.

TA7 Page 7 of 8 For completion by financial adviser essential information all sections must be completed 1. Your FCA number (Registered Individuals) R.I. number e.g. A B C 1 2 3 4 5 or Registered Individual s forename and Registered Individual s surname Please provide the appropriate information in relation to this sale. Application forms cannot be processed unless this information is provided. 2. Was advice given? Yes No 3. Your Agency details Your Prudential Agency number or Agency name and address stamp e.g. 1 2 3 4 5 X 4. Your Customer Reference Number (if any) 5. Commission Prudential will not facilitate adviser charging or pay commission on this product. Nil commission 4

For completion by financial adviser essential information all sections must be completed continued 6. Routing instructions You should ignore this section if the investor already has a Premier plan as your previous routing instructions will be followed. (Note: the investor must always get the original certificate even where this is initially sent via someone else.) Transfer Certificate to: Investor You Special destination* Copy Transfer Certificate to: Investor You Special destination* * Special destination name Address Postcode Use of this address must have been authorised by the investor, to maintain client confidentiality. Signature Position in firm Name in block capitals Date For Prudential use only Cheque acknowledgement number Date stamp Cheque amount SD agreed by Advice given PFR Yes No CCC Yes No M Yes No EC Yes No SCC AM AC Yes No AOI pru.co.uk The Prudential Assurance Company Limited (PACL) 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. P539 02/2018