COLLECTIVE RETIREMENT ACCOUNT (CRA) APPLICATION

*APCRA0600F* COLLECTIVE RETIREMENT ACCOUNT (CRA) APPLICATION For use by financial advisers only Please answer the following question. Failure to do so may delay your application. Have you received financial advice for this application? If Yes, on what basis was the advice given? u Your financial adviser will help you answer this. Yes Restricted No Independent Type of investment (please tick) New investment Top up account number: 4 Did you know? Your financial adviser can apply for you online in which case we do not require a paper application as well because we will only use the information submitted online. WITH THIS FORM YOU CAN: Open a new CRA Top up an existing CRA Including: Transfers Immediate maximum tax-free cash and income withdrawal for all lump sum investments and/or transfer investments detailed in this application. This form cannot be used: In conjunction with the Managed Portfolio Service (MPS) this Charge Basis 3 service is only available online through financial advisers. We regularly update our forms. You can confirm that this May 2018 version is the latest by checking the literature library on our website at www.oldmutualwealth.co.uk If you are applying for multiple lump sum investments and/or transfer investments where immediate maximum tax-free cash and income withdrawal is required on some, but not all of these investments, separate application forms will be required. Decisions about pension investments are so important, and some of the technical information involved so complex, that we recommend you ask your financial adviser for help in completing this form. Non UK Tax If you are subject to tax in any country outside the UK, please contact your tax specialist, to understand whether you will be liable for tax in that country. Tick/complete this form, as applicable, using BLOCK CAPITALS and blue or black ink. This form must be signed as appropriate and sent to the address below: Old Mutual Wealth, Old Mutual House, Portland Terrace, Southampton SO14 7AY 1 of 25

1A Personal details Client reference number (if known) Title (tick) Mr Mrs Miss Surname Other (please specify) Full forename(s) Date of birth (dd/mm/yyyy) National Insurance number Tick here if you have never been issued with a National Insurance number UK individual status u Required for taxation purposes, for further information see 1(d) and 1(e) of the Declaration in section 8. I am a UK relevant individual I am not a UK relevant individual Gender (tick) Male Female Permanent residential address Postcode Contact telephone number E-mail address Applicant s status u Please tick the option relevant to you. Employed Chargeable to tax on earned income for the income tax year of assessment concerned in respect of an office or employment held by you. Pensioner Chargeable to tax on earned income for the income tax year of assessment concerned in respect of a pension. Self-employed Chargeable to tax for the income tax year of assessment concerned in respect of annual profits or gains arising or accruing from any trade, profession or vocation carried on by you. Child under 16. Caring for one or more children aged under 16. Caring for a person aged 16 or over. Full-time education. Unemployed. Other u please specify Opt Out Declaration This section is for applicants who are employed and at least 18 years old (not self-employed or retired applicants). Failure to answer the questions may result in your application being delayed. 1. Are you setting up this account as a result of opting out of your employer s occupational pension scheme or Group Personal Pension to which your employer is contributing, or are you planning to opt out? 2. Have you chosen not to join your employer s occupational pension scheme or Group Personal Pension to which your employer is contributing, which you are eligible to join, or which you will be able to join at the end of a waiting period? Yes Yes No No Selected Retirement Date Selected pension age OR Selected Retirement Date (dd/mm/yyyy) Before you reach your Selected Pension Age or Selected Retirement Date we will write to you regarding your pension options - unless you have already elected to take benefits from your pension between the ages of 55 and 74. Your Selected Retirement Date may be any date from age 55 onwards. Other dates may be permitted in some circumstances. For income withdrawal this is the age or date at which you anticipate converting to an annuity. 2 of 25

1B LEGAL GUARDIAN S DETAILS u Only required where the applicant is under 18 years. Title (tick) Mr Mrs Miss Other u Please specify. Surname Full forename(s) Residential address Postcode 1C Power of attorney DETAILS Where there is more than one attorney, please attach the same information for each one on a separate sheet of paper. We will need the original power of attorney, or a copy certified as a true copy of the original in ink on each page by a solicitor, stockbroker or the donor (ie the person giving the power). Surname Full forename(s) Full postal address u if correspondence for this account is to be sent to this address, please enter it in section 1 Date of birth (dd/mm/yyyy) Postcode Under HMRC regulations, we can only accept a CRA application made under a Power of Attorney if we have confirmation that the applicant is physically or mentally incapacitated and therefore unable to apply him/herself. Please indicate the nature of the applicant s incapacity: Physical Mental I can confirm that I have been shown and have read the privacy notice. Attorney s signature u you must sign both here and in section 8. Date (dd/mm/yyyy) as attorney 2 0 3 of 25

2 investment details Money purchase annual allowance u If the boxes are left blank we will take that as your confirmation that you are not subject to the money purchase annual allowance. I am subject to the reduced 4,000 Money Purchase Annual Allowance (tick). Yes No If yes on what date did you become subject to the reduced money purchase annual allowance? (dd/mm/yyyy) To make lump sum, regular investments and transfer of uncrystallised funds, you must be no more than 74 years of age. This means that your investment should be received at least five working days before your 75th birthday. To transfer crystallised funds into a new account you must be no more than 84 years of age. This means that your investment should be received at least five working days before your 85th birthday. If this is the first contribution to the account, the first pension input period will automatically end on the first 5 April which follows the payment of this contribution. Electronic bank transfers should be made to Old Mutual Wealth Life & Pensions Limited. Bank: NatWest. Sort code: 56-00-68. Account number: 37632116. In the reference field on your bank transfer please enter your postcode and surname to help us process your application. Investor contribution Lump sum investment (gross) or (net) Please select payment method (tick) Cheque number Cheque u Please enclose a cheque payable to Old Mutual Wealth Life & Pensions Limited. Electronic bank transfer Regular investment uplease complete the direct debit instruction at the end of this form. (gross) or (net) Frequency (tick) Monthly Annually I wish to increase the regular contribution automatically each year in line with Average Weekly Earnings. If you are a Partner making payments from a partnership account please complete partnership details in section 4A. Third-party contribution Lump sum investment (gross) or (net) Please select payment method (tick) Cheque number Cheque u Please enclose a cheque payable to Old Mutual Wealth Life & Pensions Limited. Electronic bank transfer Regular investment u Please complete the direct debit instruction at the end of this form. (gross) or (net) Frequency (tick) Monthly Annually I wish to increase the regular contribution automatically each year in line with Average Weekly Earnings. Please complete third-party details in section 4B. Employer contribution Lump sum investment (gross) Please select payment method (tick) Cheque number Cheque u Please enclose a cheque payable to Old Mutual Wealth Life & Pensions Limited. Electronic bank transfer Regular investment u Please complete the direct debit instruction at the end of this form. (gross) Frequency (tick) Monthly Annually I wish to increase the regular contribution automatically each year in line with Average Weekly Earnings. Please complete employer details in section 4C. 4 of 25

2 investment details (continued) Transfer payments u Estimated value Uncrystallised Crystallised Total Transfer 1 Transfer 2 Transfer 3 Transfer 4 Please complete and sign the Transferring Scheme Authority at the end of this form, and send it to us with this application. If you have more than one transfer, we will need a separate authority for each transfer payment, which you can provide by printing additional copies of the authority provided. 3A FUND CHOICE Tick one of the following to indicate which investment range your fund choice is from, then list the funds below: SelfSelect u Available for accounts on Charge Basis 1, 2 or 3. Bundled funds Where both bundled funds (full Annual Management Charge (AMC) with rebates) and unbundled funds (lower AMC with reduced rebates) are available, we will automatically default to unbundled funds even if you currently hold the bundled version in your account. Tick here if you wish us to use the bundled version of the funds selected (where available) OR WealthSelect u Only available for accounts on Charge Basis 3. Full name of fund or portfolio u The funds must all be from the same investment range, not a mixture from both. 1 0 0 An investment choice continuation sheet is available on request. Funds may offer a choice of income units or accumulation units. We always buy accumulation units with your investment unless the fund you have chosen does not offer accumulation units, in which case we will buy income units. If the fund choice you give is: missing, illegible or otherwise invalid, or from an investment range that is not available for your Charge Basis We will place the investment into the BlackRock Cash Fund, after which you or your adviser can switch into a revised fund choice. If you have automatic rebalancing on your bond, switches will cause it to be cancelled and you will need to provide us with a new rebalancing instruction for it to continue. If you are topping up a CRA on Charge Basis 3, and have chosen a different investment range from that which you currently hold, we will automatically swap all of the funds in your account and replace them with the funds listed below before carrying out your top-up application. However, we will not automatically apply a switch fee as part of the swap process. continued 5 of 25

3B Phased Investment or Automatic Rebalancing Phased investment u Not available in conjunction with Automatic Rebalancing We can place your investment into the BlackRock Cash Fund then phase it into your selected fund choice on the first working day of each month over 3, 6 or 12 months. To request phased investment, complete the required frequency and start date below: Phase every month for: 3 months 6 months 12 months Starting on: 0 1 2 0 Phased investment instructions will apply to all BlackRock Cash Fund holdings within your CRA, not just the investment in this application. You cannot phase back into the BlackRock Cash Fund. If you do not specify a start date, phasing will begin in the next available month following your application. AUTOMATIC REBALANCING u Not available in conjunction with Phased Investment We can automatically rebalance your CRA back to your selected fund choice and proportions on the 15th of the month every 3, 6 or 12 months. To request automatic rebalancing complete the required frequency and start date below: Automatically rebalance every: 3 months 6 months 12 months Starting on: 1 5 2 0 If you do not specify a start date, rebalancing will begin on the next available date for the frequency selected. If automatic rebalancing applies to your account, and you top up with a different fund choice, or you switch funds, you will need to complete a new rebalancing instruction to continue with it. You can obtain the necessary form from your financial adviser or by calling our Customer Contact Centre on 0808 171 2626. 4A Partnership details If you are a partner making payments from a partnership account, you must complete this section. Name of partnership Registered address for partnership Postcode Registered partners u Only detail 3 including yourself if more than 3 in the partnership. Declaration u To be signed by the applicant in the capacity of a partner. I can confirm that I am self employed. As such my personal contributions to my pension plan will be deducted from my entitlement to self employed drawings from the partnership account. These should be treated as member net contributions into my personal pension. Signed Capacity and name Date (dd/mm/yyyy) 2 0 4B THIRD PARTY DETAILS This must be completed with details of any third party paying for your lump sum or direct debit investment. Surname/company name Full forename(s) Full postal address Postcode Date of birth (dd/mm/yyyy) Company registration number u UK companies only 6 of 25

4C employer details This section should be completed by the employer where the employer is remitting contributions. Please note we require a direct debit instruction per payer (eg investor and employer). It is imperative that the group co-ordinator named below advises Old Mutual Wealth Life & Pensions Limited of any changes to these payments within 30 days. If you fail to complete this section we are unable to monitor payments as detailed in section 2 in accordance with the Pensions Act 2004, and you may be reported to The Pensions Regulator (TPR). The due date will always be the 19th of the month following the month in which the deductions were made from payroll. This is the final date under The Pensions Regulator (TPR) requirements. Employer s name Person dealing with correspondence Employer s address Postcode Company registration number Contact telephone number Declarations 1. We declare that to the best of our knowledge and belief the statements made in this section and any related documents are correct and complete and that we have not concealed any material fact. 2. We agree to pay Old Mutual Wealth Life & Pensions Limited regular contributions for the member. 3. We understand that, although we can contribute to the member s benefits, the contracts exist between the member and Old Mutual Wealth Life & Pensions Limited direct. 4. We understand that we will be responsible for dealing and corresponding with Old Mutual Wealth Life & Pensions regarding the payment or non-payment of contributions for the member. 5. We undertake to advise Old Mutual Wealth Life & Pensions Limited within 30 days of the member ceasing to be employed by us or where contributions are reduced or terminated. 6. We understand that if any payment due is not received by Old Mutual Wealth Life & Pensions Limited within 90 days of the due date or where Old Mutual Wealth Life & Pensions Limited feels that non-payment is of significance, you may be required to advise The Pensions Regulator (TPR) and the member. 7. We understand that it is our responsibility to ensure Old Mutual Wealth Life & Pensions Limited is provided with relevant information to monitor payments and that should we fail to provide it we will be reported to TPR. 8. Your personal information We can confirm that we have been shown and have read the privacy notice. 9. We understand you may make our personal information available to a third party by electronic or other means for the purpose or verifying identity in accordance with the Money Laundering Regulations. Employer s signature Date (dd/mm/yyyy) 2 0 continued 7 of 25

5 Benefit Crystallisation EventS This section should be completed if you wish to draw benefits as a pension commencement lump sum and/or income withdrawal. Any withdrawal of funds from your account is known as a Benefit Crystallisation Event (BCE). You may only effect this event upon reaching your minimum pension age, which is typically 55. Evidence of age Where this is your first Benefit Crystallisation Event, we must receive evidence of age. Your adviser can confirm this in section 9, or you can send us your original birth certificate and if you have changed your name, eg by deed poll or marriage, any certificate showing this. Copies of these documents certified by a professional person are acceptable. Failure to provide this information may cause your application to be delayed. 5A IMMEDIATE TAX-FREE CASH ONLY AVAILABLE FOR NEW LUMP SUM OR TRANSFER INVESTMENTS I want to take the maximum tax-free cash from the new transfer or lump sum investment and allocate the balance for any income I require now or in future. Tax-free cash will be paid by selling units proportionately from your account. 5B INCOME WITHDRAWAL Capped drawdown If you started capped drawdown before 6 April 2015 and have not since converted to flexi-access drawdown, your account is still in capped drawdown. In taking further tax-free cash the maximum capped annual income withdrawal available to you will be re-calculated. If it is higher than what was previously available it will have immediate effect on the income withdrawals you can take each year under capped drawdown rules. If the amount is lower, the lower amount will only apply from the start of the next income payment year. You will be notified of the revised annual amount of withdrawals you can make under capped drawdown rules. Income withdrawals can be changed up to the maximum limits set at your last review. Future reviews will be conducted every three years until age 75. After age 75 these reviews will be annual. Certain events will also trigger a review and you have the option to recalculate your maximum income each year. Please bear in mind that if you are in capped drawdown and select a specified regular income amount of more than the maximum amount permitted, your plan will automatically convert to flexi-access drawdown at the point your income in the year exceeds the maximum. Flexi-access drawdown There is no cap on the amount of income you can take using flexi-access drawdown. However, once you take income in this way, the amount you can pay into money purchase (also known as defined contribution ) schemes in any tax year without being liable to a tax charge is subject to a limit called the Money Purchase Annual Allowance (MPAA). This is currently 4,000. You have the option to convert to flexi-access at any time. You can do this by ticking option i) below. For more information please contact your financial adviser. For those who took tax free cash for the first time after 6 April 2015, you will be subject to the Money Purchase Annual Allowance the first time you take income from your account. How is income taxed? You will have to pay tax on the income you receive in the same way as you would on a salary. How much you pay depends on your total income. If this is the first time that you will be taking an income withdrawal from your account, generally the provider will not know your overall income and will use an emergency tax code to start with. This means you may pay too much tax initially and have to claim the money back. Alternatively you may owe more tax if you have other sources of income. If you have taken income previously, tax will be deducted based on the tax code that has been provided by HM Revenue & Customs. Please see our Guide to Income Tax and Your Pension for further information. Complete as required i) Convert to flexi-access Tick here if you are in capped drawdown and you want to immediately change to flexi-access drawdown uthis means your annual income will no longer be capped and there will be a reduction in the annual amount you can pay into money purchase pensions known as the Money Purchase Annual Allowance or MPAA. For more information please contact your financial advisor. 8 of 25

5B INCOME WITHDRAWAL (continued) ii) One-off withdrawal u If we make an income payment to you in good faith, based on your instruction, we are not able to accept it back at a later date and this may affect your tax position. I want to take the following amount Please confirm the month you want to receive your one-off payment uif left blank, income will be paid in the next available month. (before tax) I want to take my full crystallised holding leaving the uncrystallised amount invested uany regular income you currently receive will continue unless you complete the regular income withdrawals section below. iii) Regular income withdrawals a) I do not want to take any income. u If this is a top up to an existing account, any current income will stop. b) I want my regular income paid to me on a Monthly basis and the amount I want paid monthly is OR Yearly basis and the amount I want paid Yearly is u Before tax u Before tax Please confirm the month you want your regular income to start uif left blank, income will be paid in the next available month. c) Capped maximum amount required u Only available if you have a capped drawdown policy. I want the maximum income permitted paid to me on a: Monthly basis Yearly basis Please confirm the month you want your capped income to start uif left blank, income will be paid in the next available month. If you request monthly payments, the maximum amount will be divided by the number of months left in the scheme year. This will change to the maximum amount divided by 12 when you start a new scheme year. For example: If your maximum income amount is 12,000 each year and you select this option with 6 months remaining, we will pay 2,000 each month for 6 months until the start of the new scheme year. We will then pay 1,000 each month. 5C Choice of funds to use for income PAyments We will meet your income payments by selling units proportionally across all funds. If you are not invested in the Managed Portfolio Service (MPS), and you do not hold a mixture of uncrystallised and crystallised funds, you can instead choose to sell proportionally from specific funds by selecting an alternative fund choice below or you can write largest fund if preferred. Fund name 9 of 25

5D Bank details Please state which bank account you wish the proceeds to be paid into. We cannot make payments to third parties. We will need to see proof of the bank account ownership. Details of acceptable proof are in the guidance notes at the end of this form. Name of bank/building society account holder Bank/building society name Branch address of bank/building society u This must be in the UK. Postcode Bank/Building society account number Sort code Building society roll number u If applicable. 5E PROTECTION benefits u If you are not applying for any form of protection go to section 5F. Please tick below if you have any of the following. By ticking you confirm that your entitlement to these protection benefits has not been revoked. If you have one of these protection benefits, you will have received a reference number from HMRC. If you have a certificate, please send a copy with this form. Primary Protection Individual Protection 2014 Individual Protection 2016 Fixed Protection 2012 Fixed protection 2014 Enhanced Protection Lifetime Allowance enhanced factors Fixed Protection 2016 Scheme Specific Protection (Block Protection) HMRC reference number Pension Scheme Administrator reference u E.g. PSA12345678A. This applies to online protections only. OR HMRC Certificate - If you were issued a certificate for this protection by HMRC, please send us a copy of the certificate with this form. Block Protection If you have protected tax free cash or an early retirement age, please be aware that: a) you must fully crystallise all funds you have in your CRA at the same time or you will lose these protections. This will mean you will be limited to a maximum of 25 of the uncrystallised value as a tax free lump sum, and a minimum retirement age of 55. This includes any uncrystallised funds you may have in other CRAs. b) if your right to draw benefits before age 55 is subject to certain conditions, then you will need to confirm to Old Mutual Wealth that those conditions have been met before any payment can be made. Primary Protection Tax-free cash received to date (dd/mm/yyyy) Tax-free cash paid For office use only... 10 of 25

5F LIFETIME ALLOWANCE When you crystallise all or part of your savings in any pension scheme, the provider will tell you what percentage of your Lifetime Allowance has been used up. We need the following information to ensure you do not exceed the lifetime allowance, which could lead to a tax charge. We cannot process this form if this section is not completed the guidance notes at the end will help you. Please tick/complete any/all of the following that apply to you. You must complete at least one. A I have never taken any benefits from a UK registered pension scheme B I have only taken benefits from my Collective Retirement Account(s) Before and after 6 April 2006; you must complete both section C and D if you have previously taken benefits from one or more pension schemes before and after 6 April 2006. C I have taken benefits from one or more UK registered pension schemes on or after 6 April 2006. The total percentage of the standard Lifetime Allowance I have used is: The first time I took pension benefits after 5 April 2006 was: (dd/mm/yyyy) Now go to section D uonly required if both C and D are being completed D I have taken benefits from one of more UK registered pension schemes before 6 April 2006, these are not included in any lifetime allowance figure completed above in option C. (Please complete all that apply) If you have also completed option C, please provide the figures that were applicable at the date you first took a pension benefit after 5 April 2006 I m in capped drawdown and my gross maximum annual income limit is: AND/OR I m in flexi-access drawdown and my previous gross maximum annual income was: AND/OR I m paid a lifetime annuity/scheme pension and the gross amount I receive each year is: 5G Insufficient Lifetime Allowance You do not need to complete this section if you are claiming Enhanced Protection (see section 5E above). If the amount being used to provide benefits is greater than your remaining Lifetime Allowance, please specify how the excess is to be paid: to be taken as cash lump sum. u Only applicable before age 75. to be taken as income. 1 0 0 Total u These percentages must total 100. Please note that a tax charge will be due on the excess amount, more information is in the guidance notes. 5H OVER 75 DECLARATION If you are under 75, you do not need to complete this section. Tick here if you have never taken any benefits from a UK registered pension scheme What was the lifetime allowance used up prior to the age 75 Lifetime allowance test? Have you taken any pension benefits after reaching 75? If yes please complete the details below: How much have you crystallised? How much have you crystallised? How much have you crystallised? date when this was crystallised (dd/mm/yyyy) date when this was crystallised (dd/mm/yyyy) date when this was crystallised (dd/mm/yyyy) 11 of 25

5I Guidance notes to help complete section 5 The purpose of this Benefit Crystallisation Event (BCE) section is to enable you to immediately crystallise your investment and take the maximum amount of tax-free cash permitted to you, which is typically 25. The balance of your crystallised investment must be allocated to take a taxable lump sum or a flexi-access income withdrawal. 5A Immediate maximum tax-free cash By selecting this option your investment(s) detailed in this application form (excluding regular investments) will immediately become crystallised and the immediate maximum permitted tax-free cash will be paid to you. The residual fund after payment of tax free cash will be designated to provide for income withdrawals, and you cannot use this option to withdraw all funds from your account. You will need to contact us for the appropriate form. Tax-free cash and taxable lump sums will be calculated on the value of the investment received. 5B Income Withdrawal capped drawdown only The balance of your crystallised investment may be used to draw an income from your account. There are three options to select, you may only choose one: Option 1 Take a specific annualised amount; please tick and enter this amount (enter nil if no income is required at this time). Option 2 Tick to receive the maximum amount of income permitted to you. Option 3 Continue with the current level of income paid to you on your Collective Retirement Account. (Any crystallised balance not used for income will go into a drawdown pension fund.) The minimum level of income is nil, ie tax-free cash only, and the maximum level of income is dependent on calculations using your age, size of investment and the limits set by the Government Actuary s Department (GAD). The maximum level is subject to review on at least every three years until age 75. From the first pension year anniversary after age 75 these reviews will be held annually. Certain events will also trigger a review. If you have already crystallised part of your account to draw income, subsequent crystallisations will be subject to a review at the same time as the original crystallisation. All crystallisations will go into the same drawdown pension fund except where an existing income withdrawal arrangement was set up before 6 April 2006, where a separate Collective Retirement Account must be set up. Payment of your income from a flexi-access or capped drawdown account Income payments will normally be paid on the 25th of the month. Provided we have received all of our requirements by the cut-off dates below, payments will start in the month we receive your request (or the month you have specified, if different). (Where the request is received after the specified cut-off date, payment will be made in the following month.) Cut-off dates: 7th of the month for new applications and for clients taking flexi-access income withdrawal 9th of the month for income requests on existing accounts. Our minimum income payments are: 25 a month or 300 for annual or ad hoc payments. Income will be paid using an emergency tax code, until we are notified by HMRC. Income payable from your account is subject to UK income tax. The amount of regular income indicated must be the gross income required, before the deduction of tax, and must not exceed the maximum income permitted. If you are subject to tax in any country outside the UK, please contact your financial adviser or a tax specialist in the country concerned, to understand whether you will be liable for tax in that other country as a result of receiving a payment from a UK pension scheme. Your financial adviser can discuss the maximum income available to you and the implications of your chosen level of income. Please complete the payment details accordingly. 5D Bank details Proof of the bank account ownership can be an original voided cheque or bank account statement dated within the last six months. If you have online bank account statements, a printed copy certified* by your adviser as a true copy will suffice. If we don t have the required proof, payment will be made by cheque instead. * Copies must be certified on each page in ink by a professional such as your financial adviser, solicitor, accountant, GP or bank manager (including the bank s stamp). We cannot accept photographs of documents. 5E Protection benefits This section is applicable if you are claiming protected benefits or an enhanced Lifetime Allowance. If you are, please let us know in this section and enclose a certified copy of your HM Revenue & Customs (HMRC) certificate of protection. If your protection is online only, and you don t have a certificate, please provide us with both your Protection reference and Pension Scheme Administrator (PSA) reference numbers, which you can check online with HMRC. 5F Lifetime Allowance When the Benefit Crystallisation Event is completed we will send you a Benefit Crystallisation Statement. This will detail the percentage of Standard Lifetime Allowance used by this event. If you have crystallised a pension arrangement elsewhere since 6 April 2006, the administrators of these crystallised pension arrangements will have provided you with a statement showing the proportion of Standard Lifetime Allowance used by the benefits under those arrangements. Please indicate the total of all proportions used to date. If you have any pension income that commenced before 6 April 2006, we will also need to know the date of your first benefit crystallisation and the value of your pre-6 April 2006 pension income at that date. If you were in receipt of a pension or pensions prior to 6 April 2006, and have not crystallised any more benefits since then, please indicate the total current annual pension in payment. If this relates to an income drawdown arrangement please quote the current annual maximum permitted income at the last review date. 5G Insufficient Lifetime Allowance The Lifetime Allowance is the value of tax-privileged pension saving each individual is able to accrue in their lifetime. If the amount you accrue exceeds your Lifetime Allowance, this will be subject to a charge by HMRC. If you choose to take the excess funds as a cash sum, a charge of 55 will be deducted before the balance is paid to you. If you choose to take the excess funds as income, the charge will be 25 and the income will be subject to income tax. The charge is applied to recover the tax savings previously made on the excess contributions and investment growth and will be deducted by Old Mutual Wealth Life & Pensions Limited and paid to HMRC. Please speak to your financial adviser for advice on your Lifetime Allowance. Please indicate whether you require any excess to be paid as a cash lump sum, income or a combination of both. 12 of 25

6 CHARGES, ADVISER FEES AND COMMISSION The Charge Basis for your account will determine which parts of section 6 you complete. 6A CHARGES basis If you are opening a new CRA Your account will be on Charge Basis 3 If you are topping up a CRA on Charge Basis 1 If you have not received financial advice for this transaction, your account will remain on Charge Basis 1 However, if you want to convert it to Charge Basis 2 or 3, complete section 6B If you have received financial advice for this transaction, your account will convert to Charge Basis 2 However, if you want to convert it to Charge Basis 3, complete section 6B If you are topping up a CRA on Charge Basis 2 Your account will remain on Charge Basis 2 However, if you want to convert it to Charge Basis 3, complete section 6B If you are topping up a CRA on Charge Basis 3 Your account will remain on Charge Basis 3 Charge Basis 1 Charge Basis 2 Charge Basis 3 This applies to CRAs opened before 18 December 2012, which have not been converted to Charge Basis 2 or 3 (where applicable), either by request or automatically.* They are subject to the Investor Charge and financial advisers (where applicable) are entitled to receive commission. This applies to CRAs that have been converted from Charge Basis 1, either by request or automatically.* They are subject to the Investor Charge and Adviser Charging, where financial advisers (where applicable) are paid by fees rather than commission. * The Terms and Conditions outline which transactions automatically convert accounts to a new Charge Basis. This applies: CRAs opened from 18 December 2012 CRAs converted to Charge Basis 3 by request. They are subject to the Old Mutual Wealth Product Charge and Adviser Charging, where financial advisers (where applicable) are paid by fees rather than commission. 6B CONVERTING TO A NEW CHARGE BASIS Complete this section only if you want to convert from Charge Basis 1 to 2, or from Charge Basis 2 to 3. a) Tick here to convert from Charge Basis 1 to Charge Basis 2. This will mean that: all commission payments to your financial adviser will stop part of any fund manager rebates will be reinvested into your account you can authorise us to pay fees from your account to your financial adviser by completing section 6D once you have converted to Charge Basis 2, you cannot go back to Charge Basis 1. b) Tick here to convert to Charge Basis 3. This will mean that: all commission payments to your financial adviser under Charge Basis 1 will stop all fund manager rebates will be reinvested into your account you can authorise us to pay fees from your account to your financial adviser by completing section 6D your account will be subject to different Terms and Conditions, which you should obtain from us or your financial adviser(see declaration point 5 in section 8) your account will be subject to the Product Charge and you will need to complete section 6E you cannot subsequently charge to a different Charge Basis. 6C COMMISSION CHARGE BASIS 1 ONLY This section is only relevant to you if your account is on Charge Basis 1, is to remain on Charge Basis 1, and you have received no advice for this investment. Initial commission u If you leave this section blank, then we will pay the maximum commission amount to your financial adviser. If our records show that you do not have a financial adviser then Old Mutual Wealth will make an initial charge of 4.5 of your investment amount, which we will deduct before we invest the balance into your account. The standard initial commission rate is 4.5 Reduction of Use multiples of 0.05 initial commission u Please enter the by which the standard amount of commission is to be reduced. For example, if no commission is payable, this should be completed as 4.5. Trail commission option u If you leave this section blank, fund-based trail will apply. Fund-based trail OR Nominated trail of Up to 0.5 depending on the funds selected Minimum 0 maximum 1.5 Payments will be met from rebates we receive from fund managers; they are not deducted from your account. If our records show that you do not have a financial adviser then Old Mutual Wealth will retain any rebates we receive from the fund managers in respect of the funds in your account. Enter the rate in multiples of 0.1 or 0.25. This is an annual rate, which we will divide by 12 to make monthly payments to your adviser. Payments will be met by fund-based trail commission, but if this is not enough to meet the required amount, we will deduct any shortfall from your account, as an additional charge, by selling units. 13 of 25

6D ADVISER CHARGING CHARGE BASIS 2 AND 3 ONLY This section is only relevant to you if your account is on or is converting to Charge Basis 2 or 3. Percentage fees must be entered in multiples of 0.05. Initial fee ulump sum/transfer payment top-ups if you leave this section blank: we will apply the latest percentage fee authorised for lump sums/transfer payments; in the absence of an authorised percentage fee, we will assume no Initial Fee is required. Direct debit payments any Initial Fee authorised will apply to all direct debit payments including increases, unless we are instructed otherwise. You can agree to pay your financial adviser a percentage or monetary amount from your lump sum/transfer payments or direct debit investments. (tick) initial fee required: OR OR OR from each direct debit payment paid by you, the investor from each direct debit payment paid by your employer from each direct debit payment paid by a third party from lump sum/transfer payments OR (after deduction of any immediate tax-free cash) For lump sums and transfer payments, a Global initial fee applies. Any initial fee selected will apply to all lump sums and transfer payments included in this application. Where you have agreed the fee as a specific amount of money, we will deduct it from the first payment submitted for your application, up to 7 of the payment value. If the initial fee has not been fully met from the first payment, we will deduct the shortfall from the subsequent payments, up to 7 from each, until the fee is met. This limit is for operational purposes only and should not be interpreted as a comment on the appropriateness of any level of fees. Note: If the lump sum/transfer payment relates to an immediate tax free cash application type, tax free cash will first be paid to you, and the balance of the amount paid will be invested into your account. If a percentage initial fee is selected it will apply to the balance invested into your account after any immediate tax-free cash has been deducted and not to the total lump sum/transfer payment. Fund Switch Fee u Top-ups if you leave this section blank: we will continue to apply any Switch Fee already authorised. switch fee required up to: OR from each switch The amount you agree and authorise using this form is the maximum fund switch fee payable to your financial adviser. You will need to stipulate the actual fee payable for each switch up to this limit, at the time the switch instruction is given. Any switch fee you authorise here will apply to the entire account and will override any existing switch fee instruction on your account. Servicing Fee u Top-ups if you leave this section blank: we will continue to apply any Servicing Fee already authorised. This is an annual amount which will be divided by the payment frequency selected below and paid to your adviser accordingly. servicing fee required: OR each year Add VAT to the Servicing Fee? (tick) Yes If VAT applies to this fee, your financial adviser can either include VAT within this fee or add it on top. If VAT is added it will be at the rate applying when the servicing fee is deducted and will be added to the amount shown above. Select the frequency required (tick) Monthly Quarterly Half-yearly Yearly Any servicing fee you authorise here will apply to the entire account and will override any existing servicing fee instruction on your account. Where a percentage fee amount is agreed, the fee paid to your financial adviser may go up or down depending on the value of your account on the date the fee is calculated. We will only pay an ongoing adviser fee to your authorised financial adviser. If you are receiving discretionary fund management services from a third party, your adviser may pay all or a proportion of the fee to the third party as payment for these services, and where relevant, to cover any associated VAT. 6E DEDUCTION PREFERENCE - CHARGE BASIS 2 AND 3 ONLY We will meet your Old Mutual Wealth Product Charge and Adviser Servicing Fees by selling units proportionally across all crystallised funds in the first instance. Where there are no crystallised funds or insufficient funds to meet these payments, we will sell units from your crystallised funds. If you are not invested in the Managed Portfolio Service (MPS), and you do not hold a mixture of uncrystallised and crystallised funds, you can instead choose to sell proportionally from specific funds by selecting an alternative fund choice below or you can write largest fund if preferred. Fund name 14 of 25

7A EXPRESSION OF WISH Use this section to nominate one, or more, person and/or other legal entity to receive benefits from your CRA in the event of your death. Usually, any beneficiary will be able to receive either a lump sum payment or a regular income through drawdown or purchase of a lifetime annuity. Any one, or more, beneficiary will be chosen at the discretion of the trustee(s) or scheme administrator, as appropriate. However, you can tell the trustee(s) or scheme administrator how you would like them to pay any death benefit by using these form to nominate your preferred beneficiaries. If there is insufficient space to list all preferred beneficiaries, please provide the details of any others by using a copy of this page and attach it to this form. If you would like to provide additional information about your wishes, please do so on a separate page and attach it to this form. If you nominate a trust as a beneficiary, we are not responsible for the content of the Trust and will not comment on its suitability. BENEFICIARIES DETAILS u Tick whether the beneficiary is an individual, a trust or a charity and complete the details as appropriate. 1. Full name of beneficiary Their address Postcode Individual Date of birth (ddmmyyyy) Relationship to you Trust Date of trust (ddmmyyyy) Name of lead trustee Charity Registered charity number Nomination priority 2. Full name of beneficiary Their address Postcode Individual Date of birth (ddmmyyyy) Relationship to you Trust Date of trust (ddmmyyyy) Name of lead trustee Charity Registered charity number Nomination priority 3. Full name of beneficiary Their address Postcode Individual Date of birth (ddmmyyyy) Relationship to you Trust Date of trust (ddmmyyyy) Name of lead trustee Charity Registered charity number Nomination priority The Guidance Notes overleaf include an example of how to complete this section if a nomination priority is required 15 of 25

7B EXPRESSION OF WISH GUIDANCE S NOMINATION PRIORITY This is not a mandatory field but is for you to give a priority order for your nominated beneficiaries, if required. See the example below. Proportion 1. Full name of beneficiary Mrs Jane Smith 1 0 0 Relationship to you Wife Nomination priority I firstly nominate my wife, but if she dies before me, or is alive when I die but does not wish to receive any payment, I nominate my two children below. Proportion 2. Full name of beneficiary Mr John Smith 5 0 Relationship to you Son Proportion 3. Full name of beneficiary Mrs Susan Brown (née Smith) 5 0 Relationship to you Daughter PAYMENTS ON DEATH In the event of your death, we would pay any death benefit as a lump sum and/or as income, subject to prevailing pension rules and the Terms and conditions of your pension plan. We will choose the beneficiary(ies)(form all potential beneficiaries) at our absolute discretion. However, if you complete an Expression of Wish form, we will take into account your wishes. Details of the options applicable to any beneficiary are provided below. lump sum payments If you die before your 75th birthday, any lump sum payment would be paid free of UK tax.* # However, any beneficiary would be liable to a lifetime allowance tax charge in respect of any value in excess of your remaining lifetime allowance. If you die on, or after, your 75th birthday, any lump sum payment would be subject to the following UK tax treatment: Type of beneficiary UK individual beneficiary UK tax rate(s) The individual s marginal income tax rate(s) A UK charity No tax charge # Any other UK beneficiary (such as a discretionary trust) 45 tax charge If a lump sum is paid into a discretionary trust and then paid to a UK individual potential beneficiary of that trust as income, that beneficiary would be given a tax credit for the 45 tax charge previously paid and, depending on their UK tax position, they may be able to reclaim some, or all, of this amount from HM Revenue & Customs. Income payments Instead of, or as well as, a lump sum payment, a beneficiary may use the remaining fund to provide an income payable by the purchase of a lifetime annuity or drawdown pension. if you die after purchasing a lifetime annuity, the terms of that annuity will determine what if any, death benefit will be payable (including the possible continuation of the regular payments to a beneficiary). if you have not taken any benefits when you die, or you were taking drawdown pension benefits when you died, income benefits may be paid to your dependant(s)** or nominee(s)***. This can be in the form of a lifetime annuity and/or drawdown pension. if you die before your 75th birthday, any income payment to a UK individual would be paid free of UK tax.* However, any beneficiary would be liable to a lifetime allowance tax charge in respect of any value in excess of your remaining lifetime allowance. if you die on, or after, your 75th birthday, any income payment to a UK individual would be subject to the beneficiary s marginal income tax rate(s). Notes: * For uncrystallised funds, this is subject to payment being made within two years of the scheme administrator being notified of the death. ** A dependant, when you die, would be: your surviving spouse/civil partner; or your surviving child under the age of 23 (or over the age of 23 if, in our opinion, they were dependent on you because of their physical or mental impairment); or anyone else who, in our opinion, was financially dependent on you, financially inter-dependent with you, or who was dependent on you because of physical or mental impairment *** A nominee, when you die, would be any individual, other than a dependant, who you nominate to receive an income. # Payments to UK charities will be tax-free if you leave no surviving dependant at the point of your death. If any charity payments were made whilst there was a surviving dependent these would be seen as unauthorised payments and taxed as such. 16 of 25

8 declaration Please read this section carefully before signing and dating the declaration. 1. Where I am applying for a Collective Retirement Account a) I apply for a Collective Retirement Account and to become a member of the Old Mutual Wealth Personal Pension Scheme. I agree to be bound by the Terms and Conditions contained in the Key Features Document and Terms and Conditions. b) Where I am making an additional investment to an existing Collective Retirement Account, I request that the changes detailed in this application are made to my existing Account. c) Where completing this form as a legal guardian on behalf of an applicant aged under 18, I declare that: i) I will be responsible for the contract as if I were the applicant ii) any contributions paid can only be returned to the applicant as authorised payments under the rules of the Account. Authorised payments are defined in law and will usually be restricted to retirement or death benefits. d) If I am a relevant UK individual for this tax year I declare that: i) I have relevant United Kingdom (UK) earnings chargeable to income tax for this tax year; or ii) I will be resident in the UK at some time this tax year; or iii) I have been resident in the UK at some time during the five tax years immediately before this tax year and was also resident in the UK when I joined this pension scheme; or iv) I have for this tax year general earnings from Crown employment subject to UK tax (as defined by section 28 of the Income Tax (Earnings and Pensions) Act 2003); or v) I am the spouse or civil partner* of an individual who has for this tax year general earnings from Crown employment subject to UK tax (as defined by section 28 of the Income Tax (Earnings and Pensions) Act 2003). vi) the total contributions paid by me or on my behalf to any registered pension scheme on which I am entitled to tax relief do not exceed the higher of the basic amount ( 3,600 gross) or my relevant UK earnings for that tax year. e) If I am currently not a relevant UK individual I declare that I will inform you should this change. f) I understand that, from time to time, I will be asked to provide prescribed information to Old Mutual Wealth Life & Pensions Limited related to my registered pension provision in order for them to meet obligations under the tax legislation relating to pension tax reliefs. g) I understand that, in certain circumstances, the pension tax legislation requires Old Mutual Wealth Life & Pensions Limited to deduct tax from payments to me. Typically this would be the Lifetime Allowance Charge and tax payable on any income withdrawal payments. h) I understand that if my contribution (or a contribution paid on my behalf) exceeds limits and allowances provided by legislation, HM Revenue & Customs will recover any tax relief not due. Old Mutual Wealth Life & Pensions Limited is not required and is unable to monitor whether contributions are within those limits or allowances. i) I understand that it is my responsibility to advise you of any other pension arrangements that I may hold with another provider that contribute towards my Standard Lifetime Allowance. j) I understand that if I provide false information to Old Mutual Wealth Life & Pensions Limited in respect of my registered pension arrangements, I may be liable to tax and possibly penalties from HM Revenue & Customs. k) I authorise Old Mutual Wealth Life & Pensions Limited: i) to hold my cash investment, Collective Retirement Account investments, interest, dividends, rebates and any other rights or proceeds in respect of those investments and any other cash, and ii) to make on my behalf any claims to relief from tax in respect of my investments l) I understand that Old Mutual Wealth Life & Pensions Limited reserves the right not to accept this application in which event my payment will be returned to the originator. * as defined by the Civil Partnership Act 2004. m) I understand that Old Mutual Wealth Life & Pensions Limited accepts no responsibility for any loss incurred as a result of any delay between submission and receipt of the application form by Old Mutual Wealth Life & Pensions Limited. n) I understand that it is a serious offence to give false information in order to obtain tax relief on contributions, which could lead to prosecution and severe penalties. Further I declare it is my responsibility to inform you of any changes which affect my tax status. o) If the investor is suffering from a mental disorder, I confirm that I am a parent, attorney, guardian, spouse, civil partner, son or daughter of the investor. p) I declare that if I am no longer eligible to tax relief on my contributions or if I am no longer a UK resident I will inform you. I will give this notice to you by the later of: i) 5 April in the year of assessment in which the event occurs; and ii) the date which is 30 days after the occurrence of that event. q) I declare that investments made to the plan have not been funded from a tax-free cash sum from a registered pension scheme to the extent that either myself or Old Mutual Wealth Life & Pensions Limited will suffer a tax liability. If I have taken benefits from any pension arrangement, with the current or any other pension provider, in a way that means I am subject to the Money Purchase Annual Allowance (MPAA), I will supply the date the MPAA first applied to me. 2. Where I am paying a new lump sum investment/ transfer and I am taking maximum immediate taxfree cash: a) I understand that immediate maximum tax-free cash will apply to all lump sum investments/transfers included in this application. b) I understand that tax-free cash will be paid upon completion of the investment or each investment where there is more than one. c) I understand that income withdrawals will commence once the investment is completed or final investment is completed where there is more than one. d) I undertake to inform Old Mutual Wealth Life & Pensions Limited of any change to the information provided occurring after the date of this Declaration and before the Benefit Crystallisation Event takes place. e) I declare that any payment by Old Mutual Wealth Life & Pensions Limited of the benefits under this Collective Retirement Account shall constitute a full discharge from all liabilities and claims arising thereunder. f) I understand that where I have sufficient unused Lifetime Allowance to allow the payment of the benefits in full they will be paid without deduction of any surplus Lifetime Allowance tax charge. g) I understand that where I have insufficient unused Lifetime Allowance to allow the payment of the benefits in full, without the deduction of a Lifetime Allowance tax charge, you will apply the relevant tax charge to any excess benefits prior to the payment of such benefits. h) Any tax-free cash will not be used to fund further contributions to any registered pension scheme to the extent that either myself or Old Mutual Wealth Life & Pensions Limited will suffer a tax liability. 3. I can confirm that I have been shown and have read the privacy notice. Where a potential beneficiary is a child, this will relate to the child and myself. continued 17 of 25