Flexible Retirement Account Application Form PENSIONS BY DESIGN
Flexible Retirement Account ( Scheme ) We are required by HMRC to state that it is a serious offence to make false statements or false claims - the penalties are severe and could lead to prosecution. Guidance Notes Membership Number FOR OFFICE USE ONLY 1. PERSONAL DETAILS Title:MR/MRS/MISS/OTHER Please delete as appropriate or indicate other title Surname Forename/s (in full) Date and Country of Birth Sex: Male/Female (delete as appropriate) Marital status Spouse's/Partner's name and date of birth Permanent Residential Address (Please note: work or "care of" addresses contravene HMRC requirements) Address for correspondence: (if different) Postcode Please attach your birth certificate or a certified copy. Please state whether married or single. If you are a married woman, please also attach your marriage certificate or a certified copy. If you have lived there for less than three years, your previous permanent residential address Contact numbers: Home: Office: Mobile: Fax: E-mail address: National Insurance Number: (THIS MUST BE PROVIDED IN ALL CASES) If you do not have a national insurance number, please indicate here 2. STATUS If you are employed, you can find your National Insurance Number on your salary slip. National Insurance is not required if the applicant is (a) under the age of 16 or (b) a citizen of a country outside of the UK who is not resident in the UK. In order to ascertain your membership status, please tick ONE of the following, are you:- 1. Employed Persons A person chargeable to tax under Chapter 2 of Part 2 of the Income Tax (Earnings and Pensions) Act 2003 for the tax year concerned in respect of employment income as defined in that Act. 2. Pensioners A person chargeable to tax under Part 9 of the Income Tax (Earnings and Pensions) Act 2003 for the tax year concerned in respect of a pension. 3. Self Employer Persons A person chargeable to tax under Chapter 2 of Part 2 of the Income Tax (Trading and Other Income) Act 2005 for the tax year concerned in respect of annual profits or gains arising or accruing from any trade, profession or vocation carried on by an individual. 4. Children A child under 16? 5. Any Others Not Falling in 1, 2 or 3 Above I am: Caring for one or more children aged under 16 Caring for a person aged 16 or over In full-time education Unemployed Other Full Details
If you have ticked either Box 1 or Box 2 on the previous page please give the full name and address of your employer if employed or trading details if self-employed Guidance Notes Exact nature of occupation Estimate of earnings/profits in current tax year Basis Year - end on 5th April If contributions exceed the contributions threshold, then we will require evidence of your earnings to justify the contribution Please provide ONE of the following: EMPLOYEES Week 52/Month 12 payslip Employer's letter confirming salary Copy tax return P60 SELF EMPLOYED Copy tax return Copy of latest trading accounts Accountant's confirmation of profits Please state position and name of business. Please provide support evidenceeg. your latest P60 or payslip (see question below). Where the annual evidence of earnings plus 10% is less than the estimated earnings, maximum contributions will be determined by reference to the earnings shown on the evidence provided, not the estimate. If documentary evidence of earnings is not submitted the provider will not be able to proceed with the application. 3. CONTRIBUTIONS Cheques should be made payable to Flexible Retirement Account Re (your name)". (a) Do you intend to pay contributions? Yes No Member contributions are contributions paid by the applicant personally, or by someone else on the applicant's behalf, e.g. a parent, grandparent or spouse. They do not include employer contributions. If YES, are these to be regular? Yes Annually Monthly Quarterly No If YES, please confirm amount to be paid: Personal (net of basic rate tax) Employer (gross) If your employer is to pay contributions on your behalf, please advise your employer's name, address and postcode Employer's Name... Address..... All member contributions (whether you are employed or self employed) are payable net of basis rate tax. We will reclaim basic rate tax from HM Revenue & Customs (HMRC) and credit it to the (arrangement bank account). If the applicant is a higher rate tax payer, the difference between higher rate and basic rate tax can be reclaimed via self assessment. Please note that if you are paying contributions on behalf of the applicant you will not be entitled to reclaim the difference between higher rate and basic rate tax relief. Unless member contributions are made by cheque drawn on a UK bank or building society account, further checks may be required. All employer contributions are payable gross. Where an employer intends to pay regular contributions by direct debit the first payment MUST be made by cheque drawn on a UK bank or building society account in the employer's name. Single contributions must also be paid by cheque drawn on a UK bank or building society account in the employer's name.. (b) Intended retirement age. This can be altered at any time, and if you choose not to (b) nominate a retirement age, we will assume a retirement age of 75. Unless you fall into a special category this can be any age from 55 4. DETAILS OF TRANSFERRING SCHEMES, IF APPLICABLE (a) Do you intend to make transfers into this scheme Yes No If YES, a Transfer Questionnaire will be forwarded to you to facilitate the transfer. In the meantime, Company/Scheme Policy number(s)/scheme reference Company/Scheme Policy number(s)/scheme reference Company/Scheme Policy number(s)/scheme reference (a) Do you intend to make in-specie transfers (i.e. a transfer of assets rather than of cash)? Yes No
5. INVESTMENT CHOICE Please indicate how you wish your funds to be invested. If this section is not completed then pending the receipt of investment instructions, and if necessary the appropriate application forms, any funds received will be held in the pension scheme s designated current account. Other Investment Manager Name Address Regulator/Regulator's Ref. Number Independent Financial Advice (i) Do you have a professional adviser? Yes No If "yes" Name Address (ii) Is the adviser to receive remuneration by deduction from the fund? If "yes" Yes No Initial Payment or Renewal % of contributions % of fund value If this section is left blank, we will assume that no remuneration is to be paid direct from the pension scheme bank account. Any amendment to these instructions requires the written consent of the scheme member. or The definition of "Member Fund" in the Trust Deed and Rules and clause 7 of the Trust Deed and Rules governing the Scheme empowers the Scheme Trustee or the Scheme Administrator to meet all expenses in connection with the banking, administration, management, transactions and investment of the Scheme from your Member Fund in the Scheme (as defined in the Trust Deed and Rules). You should advise the Scheme Trustee of any relevant fees to be met by exercising these powers.
DECLARATIONS IMPORTANT If you wish to see a copy of the governing Trust Deed and Rules of the Scheme before signing this application, copies are available from Talbot and Muir SIPP LLP on request. Talbot and Muir SIPP LLP as the scheme administrator ( Scheme Administrator ) agrees to administer the Scheme in accordance with the governing Trust Deed and Rules of the Scheme. General Declaration I hereby apply to become a member of the Scheme. I agree to be bound by the Trust Deed and Rules of the Scheme and by the terms and conditions provided to me by Talbot and Muir SIPP LLP, including the Key Features Document, Member Agreement, and Schedule of Fees and Services, in each case as may be amended from time to time. I have had an opportunity to consider these documents and ask questions about their meaning and effect and I have read and understood the Key Features document in relation to the Scheme. I declare that the information provided in this application form and any other documents completed in connection with this application is, to the best of my knowledge and belief, correct and complete. I agree to the Scheme Administrator deducting the amount of any scheme sanction charge or other tax charge or fine or penalty levied by HMRC on the scheme trustee or Scheme Administrator from the funds held for me under the Scheme. I agree to pay the Scheme Administrator the amount by which any such tax charge, fine or penalty exceeds the value of my Member Fund under the Scheme. I authorise you to verify my identity by checking the details I have provided against those held on databases with a credit reference agency and/or information from the Electoral register and/or fraud prevention agencies. I understand that: scoring methods will be used in the verification process as this gives a more thorough check of the available data a record of this process will be kept that may be used to help other companies to verify my identity if I supply false or inaccurate information and you suspect fraud, you may record this and share this information with other organisations I understand that, subject to the above, any information supplied by me will be treated in the strictest of confidence and will be held in accordance with the Data Protection Act 1998. I understand that it is the responsibility of my Adviser to disclose to me all commission and Adviser Remuneration earned in respect of my SIPP. Declaration Where Contributions Are To Be Paid If contributions are to be paid, I declare that: (a) I* am under age 75 and am a relevant UK individual (see Note 1): (b) (c) (d) the total of the member contributions paid to this Scheme and to other registered pension schemes, in respect of which I* am entitled to tax relief, under section 188 of Finance Act 2004, will not exceed, in any tax year, the higher of: the basic amount ( 3,600 for the 2011/2012 tax year or such other amount as may be specified by HM Treasury by Order from time to time), or my* relevant UK earnings (see Note 2 below) in that tax year; the declaration in (b) is correct, to the best of my knowledge and belief; I will give notice to the Scheme Administrator if an event occurs, as a result of which I* will no longer be entitled to relief on member contributions, under section 188 of Finance Act 2004. I will give this notice by the later of: 5th April in the year of assessment in which the event occurs; and the date which is 30 days after the occurrence of the event. (*refers to the applicant if this declaration is being made by a parent or legal guardian). Note 1: An individual is a relevant UK individual for a tax year if they: (a) (b) (c) (d) (e) have relevant UK earnings (see Note 2) chargeable to income tax for that tax year; or are resident in the United Kingdom at some time during that tax year; or were resident in the UK at some time during the five tax years immediately before the tax year in question and they were also resident in the UK when they joined the pension scheme; or have for that tax year general earnings from overseas Crown employment subject to UK tax (as defined by section 28 of the Income Tax (Earnings and Pensions) Act 2003 (ITEPA), or are the spouse or civil partner of an individual who has for the tax year general earnings from overseas Crown employment subject to UK tax (as defined by section 28 of ITEPA). For individuals within (b) to (e) above, who do not have relevant UK earnings, the maximum member contribution is the basic amount ( 3,600 for the 2011/2012 tax year). Note 2: Relevant UK earnings are: (a) (b) (c) employment income such as salary, wages, bonus, overtime, commission chargeable to tax under Section 7(2) Income Tax (Earnings and Pensions) Act 2003 (ITEPA), income derived from the carrying on or exercise of a trade, profession or vocation (whether individually or as a partner acting personally in a partnership) chargeable under Part 2 Income Tax (Trading and Other Income) Act 2005, income arising from patent rights and treated as earned income under section 833 (5B) Income and Corporation Taxes Act 1988 (ICTA). Where relevant UK earnings are not taxable in the United Kingdom due to a double taxation agreement (section 788 of ICTA 1988), those earnings are not regarded as chargeable to income tax and so will not count towards the annual limit for relief. Parent Or Legal Guardian Declaration If this application is being made on behalf of an applicant who is under the age of 18, I declare that: - (a) I am making this declaration on behalf of the applicant named in section 1 of this application form; and (b) I will be responsible for the applicant's pension arrangements under the Scheme until the applicant reaches 18. I understand that contributions paid into the Scheme may only be returned to the applicant in the form of benefits payable under the rules of the Scheme (after age 55, except in the case of earlier serious ill health). I agree to advise the Scheme Administrator of the applicant's National Insurance number when they reach age 16. I request that contributions received from me or by my employer are applied to 1,000 separate, but identical, arrangements for the purpose of the Scheme. Transfer Payments 1. Request to transfer I request that the administrator of the transferring plan applies the whole of my available transfer value from that arrangement. I understand that, following the application of the transfer value, neither I nor my spouse or dependants will have any further entitlement under the transferring plan. I authorise the trustees, administrator or insurers of the transferring plan to provide T M Trustees Ltd and Talbot and Muir SIPP LLP with any information they may request in relation to any benefits provided for me.
2. Multiple Transfers I understand that where I have applied for multiple transferpayments and the payments are received at different times, then the monies received will be applied to a holding account until the receipt of the final transfer payment or the expiry of 60 days from the date of the receipt of the first transfer payment. I understand that I will be able to review the amount of income withdrawals, within the limits set down by the Rules of the Scheme and by legislation, but if I do so an extra charge may be levied from my fund by cancellation of units or encashment of other investments to meet the additional administration costs. General declaration relating to Drawdown I understand that where I instruct T M Trustees Ltd and Talbot and Muir SIPP LLP to pay any monies (tax free cash and/or income payments) and then subsequently change my mind and cancel the plan (where a cancellation right exists), I will pay back in full any such payments received from the Scheme. In addition I will also pay T M Trustees Ltd's and/or Talbot and Muir SIPP LLP's reasonable administration and/or legal costs in recovering this money. I understand that I will be able to review the amount of income withdrawals, within the limits set down by the Rules of the Scheme and by legislation, but if I do so an extra charge may be levied from my Member Fund by cancellation of units or encashment of other investments to meet the additional administration costs. Data Protection I confirm that: I understand Talbot and Muir SIPP LLP and T M Trustees Ltd will process and hold on computer or otherwise information obtained about me as a result of this application. I hereby give my consent to them obtaining, recording and holding this information and other such personal data as may be required in the future to administer my benefits. I also give consent to them disclosing to a third party such basic information about me as may be required by that third party to enable them to trace my whereabouts in the future should they be unable to do so and require their assistance. I understand that I have the right to ask for a copy of the personal data held in respect of me in return for the payment of a small fee and to require the correction of any inaccuracies in that data. Where I have disclosed the personal data relating to other individuals, I also confirm that, as agent, on behalf of those individuals, I have: given consent on their behalf; and informed them of the identity of the data controllers, and the purposes for which their personal data will be processed. I declare that I will provide such information as is required by Talbot and Muir SIPP LLP from time to time. Such information will be provided within the time frames and in the form specified by Talbot and Muir SIPP LLP. Furthermore, I declare that I will keep Talbot and Muir SIPP LLP informed of any enhanced lifetime allowance or enhanced protection or fixed protection entitlement I intend to rely on prior to the occurrence of any benefit crystallisation event. I confirm that, to the best of my knowledge and belief, the details given on this Application Form are correct and complete. If you are proposing to join the Scheme in your own capacity as an adult please complete Box A below. However, if you are signing the form in your capacity as parent or legal guardian on behalf of an applicant who is under the age of 18 please complete box B below. BOX A Signed by the Applicant Dated BOX B PARENT OR LEGAL GUARDIAN MAKING PROPOSAL ON BEHALF OF THE MINOR NAMED IN SECTION 1 OF THIS APPLICATION SURNAME PERMANENT RESIDENTIAL ADDRESS Post Code FORENAMES (in full) PERMANENT RESIDENTIAL ADDRESS Post Code Dates: from to Note: Only Applications that have been signed and dated can be processed. The completed Application should then be returned to: - Talbot & Muir 22-26 Clarendon Street Nottingham NG1 5HQ 0115 841 5000 Fax: 0115 841 5027 e-mail: enquiries@talbotmuir.co.uk www.talbotmuir.co.uk