Additional Transfer Form Beacon House, 27 Clarendon Road, Belfast BT1 3BG 0800 022 3131 www.metlife.co.uk Before you start You can use this form if you already have a and wish to transfer in benefits from another pension scheme. It is essential that you complete all the relevant sections of this form. You must take reasonable care to answer the questions fully and accurately. The completed form must be legible. Incomplete or illegible information may delay your application. If you are unsure about any aspect of this form, please take advice from your Financial Adviser before you fill in the form. Unfortunately this product isn t available to US Citizens and US residents. If you have become a US Citizen or a US resident since your application, you must let us know immediately. Please note that the references to MetLife throughout this form refer to MetLife Europe d.a.c. The detail in this application must match your selected illustration. Please provide the MetLife illustration reference number which this application form relates to: 1 About the policyholder Title Mr Mrs Miss Ms Other - please specify First name(s) Surname Date of birth Sex National Insurance Number Nationality D D M M Y Y Y Y Male Female Permanent residential address City Country Postcode MetLife Policy No. L Page 1 of 13
2 Transferring benefits Please provide below details of the pension scheme you want to transfer benefits from. We will notify you when each transfer is complete, or if you need to do anything else. We require funds and information from the transferring scheme, therefore the process may take several weeks. If you need to provide details of more than two transfers, please copy pages 2 and 3. Please ensure each transfer declaration is signed. 2.1 About the transferring scheme Transfer Scheme Details of Transferring scheme name Policy number Contact name Contact number Transferring scheme address Postcode Is this an Occupational Pension Scheme? Yes No If Yes is it a Defined Benefit Scheme, or a Section 32 Buy Out that originated from a Defined Benefit Scheme? Yes - Defined Benefit Scheme Yes - Section 32 Buy Out No Are there any safeguarded benefits in relation to this scheme? Yes No If yes: What is safeguarded? Please tick all that apply Guaranteed Annuity Rate (GAR) or Guaranteed Annuity Option Guaranteed minimum level of income Guaranteed Lump Sum* Guaranteed investment returns during accumulation* Tax free cash greater than 25* Transfer value Full transfer Partial transfer Is this transfer already in drawdown before transfer? Capped drawdown Flexi-access drawdown No Does any part of the fund you are transferring relate to the pension benefits you have received from an ex-spouse or civil partner on divorce or dissolution of the partnership? Yes No If Yes, was any part of your ex-spouse s or civil partner s pension already being paid? Yes No Is there an Earmarking order? We require certified copies of Earmarking orders. Yes - please provide a copy No *Not a safeguarded benefit unless there are other safeguarded benefits attached to the policy, such as a promise about a guaranteed rate of income (such as a GAR). Page 2 of 13
Transferring benefits continued... 2.2 Policyholder declaration - please read and sign below I make the following declarations for the benefit of MetLife and the transferring scheme(s). References to you in the declarations in this section 2.2 mean the transferring scheme(s). I wish to transfer my existing pension benefits from the schemes detailed in section 2.1 into the. I authorise you to transfer funds from the plan(s) in section 2.1 directly to MetLife. Where you have asked me to provide original policy document(s) in return for the transfer of funds and I am unable to do so, I promise to accept responsibility for any claims, losses and expenses of any nature which you may incur as a result of having made the transfer(s) listed in section 2.1. I authorise you to release all necessary information to the receiving provider to enable the transfer of funds to the receiving provider. I authorise you to obtain from and release to the Financial Adviser named in this application any additional information that may be required to enable the transfer of funds. If an employer is paying contributions to any of the plans as listed above, I authorise you to release to that employer any relevant information in connection with the transfer of funds from the relevant plan(s). Until this application is accepted and complete, MetLife s responsibility is limited to the return of the total payment(s) to the current provider listed in section 2.1. Where the payment(s) made to MetLife represent(s) all of the funds under the plan(s) listed in section 2.1 then payment made as requested will discharge the current provider of all claims and responsibilities in respect of the plan(s) listed. Where the payment(s) made to MetLife represent(s) part of the funds under the plan(s) listed in section 2.1, then the current provider will be discharged of all claims and responsibilities only in respect of the part of the plan(s) represented by the payment(s). I promise to accept responsibility in respect of any claims, losses and expenses that MetLife and the current provider may incur as a result of any incorrect information provided by me in this application or of any failure on my part to comply with any aspect of this application. I understand that my personal data will be used in accordance with the declaration and consent in my completed application. Policyholder name Policyholder signature Date D D M M Y Y Y Y The policyholder must sign here Page 3 of 13
Transferring benefits continued... 2.3 About the transferring scheme Transfer Scheme Details of Transferring scheme name Policy number Contact name Contact number Transferring scheme address Postcode Is this an Occupational Pension Scheme? Yes No If Yes is it a Defined Benefit Scheme, or a Section 32 Buy Out that originated from a Defined Benefit Scheme? Yes - Defined Benefit Scheme Yes - Section 32 Buy Out No Are there any safeguarded benefits in relation to this scheme? Yes No If yes: What is safeguarded? Please tick all that apply Guaranteed Annuity Rate (GAR) or Guaranteed Annuity Option Guaranteed minimum level of income Guaranteed Lump Sum* Guaranteed investment returns during accumulation* Tax free cash greater than 25* Transfer value Full transfer Partial transfer Is this transfer already in drawdown before transfer? Capped drawdown Flexi-access drawdown No Does any part of the fund you are transferring relate to the pension benefits you have received from an ex-spouse or civil partner on divorce or dissolution of the partnership? Yes No If Yes, was any part of your ex-spouse s or civil partner s pension already being paid? Yes No Is there an Earmarking order? We require certified copies of Earmarking orders. Yes - please provide a copy No *Not a safeguarded benefit unless there are other safeguarded benefits attached to the policy, such as a promise about a guaranteed rate of income (such as a GAR). Page 4 of 13
Transferring benefits continued... 2.4 Policyholder declaration - please read and sign below I make the following declarations for the benefit of MetLife and the transferring scheme(s). References to you in the declarations in this section 2.4 mean the transferring scheme(s). I wish to transfer my existing pension benefits from the schemes detailed in section 2.3 into the. I authorise you to transfer funds from the plan(s) in section 2.3 directly to MetLife. Where you have asked me to provide original policy document(s) in return for the transfer of funds and I am unable to do so, I promise to accept responsibility for any claims, losses and expenses of any nature which you may incur as a result of having made the transfer(s) listed in section 2.3. I authorise you to release all necessary information to the receiving provider to enable the transfer of funds to the receiving provider. I authorise you to obtain from and release to the Financial Adviser named in this application any additional information that may be required to enable the transfer of funds. If an employer is paying contributions to any of the plans as listed in section 2.3, I authorise you to release to that employer any relevant information in connection with the transfer of funds from the relevant plan(s). Until this application is accepted and complete, MetLife s responsibility is limited to the return of the total payment(s) to the current provider listed in section 2.3. Where the payment(s) made to MetLife represent(s) all of the funds under the plan(s) listed in section 2.3 then payment made as requested will discharge the current provider of all claims and responsibilities in respect of the plan(s) listed. Where the payment(s) made to MetLife represent(s) part of the funds under the plan(s) listed in section 2.3, then the current provider will be discharged of all claims and responsibilities only in respect of the part of the plan(s) represented by the payment(s). I promise to accept responsibility in respect of any claims, losses and expenses that MetLife and the current provider may incur as a result of any incorrect information provided by me in this application or of any failure on my part to comply with any aspect of this application. I understand that my personal data will be used in accordance with the declaration and consent in my completed application. Policyholder name Policyholder signature Date D D M M Y Y Y Y The policyholder must sign here Page 5 of 13
3 Your investments 3.1 Please indicate below the investments you have selected for your Additional Transfer(s). All investments must be in whole percentages. If you have selected the Secure Capital Option (SCO) or Secure Income Option (SIO) the minimum investment is 1,000. The Secure Income Option and Secure Capital Option are only available with MetLife s Active Asset Allocation. The allocations in the Growth and Secure Assets can change daily with market conditions. Guaranteed investments Secure Capital Option - Using the MetLife Active Asset Allocation SCO maturity date / term Singles/Transfers Please indicate the maximum percentage of your investment in the Secure Capital Option that you would like to be invested in the Growth Asset. 25 35 Secure Income Option - Using the MetLife Active Asset Allocation Please indicate the maximum percentage of your investment in the Secure Income Option that you would like to be invested in the Growth Asset. 50 Singles/Transfers 25 35 Other investments Protected Growth Funds MetLife Protected Growth Fund 80 MetLife Protected Growth Fund 70 Other Portfolios (non guaranteed) MetLife Managed Wealth Portfolio - Foundation MetLife Managed Wealth Portfolio - Min MetLife Managed Wealth Portfolio - Mid MetLife Managed Wealth Portfolio - Max MetLife Defensive Managed Portfolio MetLife Conservative Managed Portfolio MetLife Cautious Managed Portfolio MetLife Balanced Managed Portfolio MetLife Aggressive Managed Portfolio MetLife Defensive Index Portfolio MetLife Conservative Index Portfolio MetLife Cautious Index Portfolio MetLife Balanced Index Portfolio MetLife Aggressive Index Portfolio MetLife BlackRock Sterling Liquidity Fund Singles/Transfers Singles/Transfers TOTAL (Must add up to 100) 100 Page 6 of 13
Your investments continued... 3.2 Secure Income Option If you have chosen the Secure Income Option would you like it on a single or joint life basis? Single life - please go to section 4 Joint life - please complete the below By selecting joint life, the Secure Income Option will continue for your nominated joint life following your death. Once this decision has been made it cannot be changed. This applies to all investments into the Secure Income Option funds. Title Mr Mrs Miss Ms Other - please specify First name(s) Surname Date of birth Sex National Insurance Number D D M M Y Y Y Y Male Female Permanent residential address City Country Postcode Relationship to you Spouse Civil Partnership Partner Other 4 Taking retirement benefits 4.1 Do you want take any retirement benefits or amend and existing instruction? Yes - complete a separate Withdrawal Form and submit with this form No - please go to section 5 Page 7 of 13
4 Adviser Charging Do you want MetLife to make any payments to your Financial Adviser for advice they have given to you in relation to this application? Yes - please read the important information in section 4.1, complete section 4.2 and sign the confirmation in section 4.3 No - please proceed to section 5 4.1 Important information about Adviser Charging MetLife will facilitate Adviser Charges on your behalf in accordance with its terms and conditions, details of which can be found in our current Charges Booklet provided to you by your Financial Adviser, further copies of which are available from MetLife using the contact details on the back page of this form. MetLife monitors the level of Adviser Charges paid from its policies, and reserves the right not to facilitate an Adviser Charge if it considers that the payment requested would have a detrimental effect upon your investment, such that the MetLife product that you are invested in would no longer perform in accordance with its design. The amounts in section 4.2 below must match the selected illustration indicated on the front page of this application form. 4.2 Adviser Charging If you do not provide full details here, MetLife will not be able to make any payments to your Financial Adviser. Please note that MetLife cannot take payment details from your illustration. Initial Adviser Charge Ongoing Adviser Charge or of transfers (after deduction of any PCLS or UFPLS). Please leave this section blank if you have an existing instruction and would like this to continue unaltered. Please choose one of the following options: I do not have an existing Ongoing Adviser Remuneration instruction, and would like to set up a new instruction. I have an existing Trail Commission or Ongoing Adviser Charge instruction on the whole of my plan and would like to change my existing instruction. I understand if this existing instruction is for Trail Commission this will cancel the existing instruction and set up an Ongoing Adviser Charge instruction. I have an existing Trail Commission instruction on part of plan and would like to set up an Ongoing Adviser Charge alongside my existing Trail Commission instruction. I have an existing Trail Commission and Ongoing Adviser Charge instruction and would like to change the Ongoing Adviser Charge part of my instruction. I understand this will be based on the same source of funds as my existing instruction (see Option A and Option B below). The existing Trail Commission instruction will continue unaltered. For further information on Ongoing Adviser Charges, please refer to the Charges Booklet. Page 8 of 13
Adviser charging continued... Please indicate the amount of the payment you wish us to make, how often you would like us to make this payment and from which investments you would like the payment to be made. or per annum of full fund value, to be taken: Monthly Quarterly 4 Mths 6 Mths Annually from the following investments: One option must be ticked - PLEASE NOTE, THIS PAYMENT SOURCE CANNOT BE AMENDED AT A LATER DATE. If you don t tick an option we ll assume you are going with option A and want to pay Adviser Charges from all investments A. Please pay Ongoing Adviser Charges from all investments. This will include any new funds invested into my Retirement Portfolio in future. Payments from Secure Income or Secure Capital Investments will proportionately reduce the guaranteed benefits. B. Please pay Ongoing Adviser Charges from my Protected Growth Funds and Non-Guaranteed Investments. If there is not enough money in these funds, or I have initially decided not to invest in them, the payments will be made from my Secure Income and/or Secure Capital Investments proportionately reducing the guaranteed benefits they provide, until additional monies are paid into the Protected Growth Funds and/or Non-Guaranteed Investments. Please note, if you already have Ongoing Adviser Charges in payment you cannot change the fund(s) this is paid from and this payment must match the original selection. Ongoing Adviser Charges will commence based on the frequency selected, i.e. if quarterly is selected the first charge will be taken in three months time. When you pay Ongoing Adviser Charges You can choose to start your Ongoing Adviser Charge immediately or somewhere in the future. Please give us a start date in the field below. If you leave the start date blank we will pay Ongoing Adviser Charges at your chosen frequency in arrears. You can stop or change this arrangement at any time. Starting on: D D M M Y Y Y Y 4.3 Confirmation Please sign below to confirm you have read and understood the important information in this section 4, agreed the amounts stated in section 4.2 with your Financial Adviser and to confirm your instruction to MetLife to facilitate such amounts on your behalf. By signing below you also agree that: a. MetLife may set off any Adviser Charges that you instruct MetLife to facilitate against any amount that your Financial Adviser owes to MetLife provided that your Financial Adviser has agreed that you will no longer be obliged to pay the amount of Adviser Charges set off; and b. Unless you instruct MetLife in writing to the contrary, if your Financial Adviser transfers some or all of its business to another Financial Adviser (the New Adviser), including the business it does with you, MetLife will pay any facilitated Adviser Charges to the New Adviser. Applicant name Applicant signature Date D D M M Y Y Y Y The Applicant must sign here All alterations must be made by crossing out the part you want to change, writing your amend and signing against it. Page 9 of 13
5 Financial Adviser details Details Title Mr Mrs Miss Ms Other - please specify First name(s) Surname Business name Business address City Country Postcode Phone number (inc STD code) Email address FCA registration number If you are part of an Independent Financial Adviser network, please give the details below. Independent Financial Adviser network Independent Financial Adviser registration number Business address City Country Postcode Phone number (inc STD code) Financial Adviser Declaration 5.1 I confirm that I have provided advice in relation to this Additional Transfer Form and that I will act as adviser to this Policy. I confirm that where the application includes a transfer of benefits from an Occupational Scheme the suitability of the adviser provided has been reviewed by an appropriately qualified individual, certified by us. I have shared the illustration provided in relation to this additional transfer with the policyholder and I have provided a copy of the relevant terms and conditions and Key Features Document. I confirm that I will take any and all reasonable steps to ensure that the client is the instigator of any request, especially for payment from the plan. MetLife will not indemnify me against any fraudulent claims as a result of any failure in my controls. Financial Adviser name Financial Adviser signature Date D D M M Y Y Y Y Page 10 of 13
6 Declarations Your Financial Adviser will have explained the current MetLife terms and conditions for these investments to you and will have provided you with a copy of these as well as copies of the relevant product literature. Your earlier investments will continue to be governed by the terms and conditions provided to you at the time of those investments. It is important that you read these documents carefully and keep them in a safe place for future reference. Our investment terms and conditions vary from time to time. I have read and understood the terms and conditions and relevant product literature provided to me in relation to this investment request and I hereby confirm and accept that my/our new investments will be subject to these terms and conditions. I make declarations (a) to (h) inclusive below for the benefit of MetLife and the transferring scheme(s). References to you in declarations (a) to (h) inclusive mean the transferring scheme(s). a. I wish to transfer my existing pension benefits from the previous scheme(s)/arrangement(s) listed in section 3 of this application into the. I authorise you to transfer sums and assets from the plan(s) listed above directly to MetLife. Where you have asked me to provide any original policy document(s) in return for the transfer of sums and assets and I am unable to do so, I promise that I will be responsible for any claims, losses and/or expenses of any nature, which you may incur as a result of having made the transfer(s) listed in section 3 of this application and which are the result, and which a reasonable person would consider to be the probable result, of any untrue, misleading or inaccurate information deliberately or carelessly given by me, or on my behalf, either in this form or with respect to benefits from the plan. b. I authorise you to release all necessary information to MetLife to enable the transfer of sums and assets to MetLife. c. I authorise you to obtain from and release to the Financial Adviser named in this application any additional information that may be required to enable the transfer of sums and assets. d. If an employer is paying contributions to any of the plans as listed in section 3 of this application, I authorise you to release to that employer any relevant information in connection with the transfer of sums and assets from the relevant plan(s). Until this application is accepted and complete, MetLife s responsibility is limited to the return of the total payment(s) to the current provider listed in section 3 of this application. e. Where the payment(s) made to MetLife represent(s) all of the sums and assets under the plan(s) listed in section 3 of this application then payment made as requested will discharge the current provider of all claims and responsibilities in respect of the plan(s) listed. f. Where the payment(s) made to MetLife represent(s) part of the sums and assets under the plan(s) listed in section 3 of this application, then the current provider will be discharged of all claims and responsibilities only in respect of the part of the plan(s) represented by the payment(s). g. I promise to accept responsibility in respect of any claims, losses and expenses that MetLife and the current provider may incur as a result of any incorrect information provided by me in this application or of any failure on my part to comply with any aspect of this application. h. I understand that my personal data will be used in accordance with the declaration and consent in my completed MetLife Retirement Portfolio application. Applicant name Applicant signature Date D D M M Y Y Y Y The applicant must sign here Making false statements can be a serious offence and carries severe penalties, including criminal prosecution. If there is any conflict between the provisions of this application form and the Member Terms and Conditions, the provisions in the Member Terms and Conditions will apply. Page 11 of 13
Declarations continued... If you have signed as a person with a Power of Attorney for the applicant, or countersigned as a Trustee in Bankruptcy, please fill in your details below: Title Mr Mrs Miss Ms Other - please specify First name(s) Surname Address City Country Postcode Capacity Title Mr Mrs Miss Ms Other - please specify First name(s) Surname Address City Country Postcode Capacity Please provide documentary evidence that you possess a Power of Attorney for the applicant. MetLife Pension Trustees Limited, as Scheme Administrator, shall administer your MetLife Personal Pension in accordance with the provisions of the Trust Deed and Rules of the Scheme. A copy of this completed Application Form, the Trust Deed and Rules of the Scheme are available on request from MetLife. The MetLife Personal Pension Scheme is a registered pension scheme. MetLife Pension Trustees Limited is both the Scheme Administrator and Trustee. 7 Where to send this form Once you have checked the form and any supporting documents, please send it with your attachments to: MetLife, Beacon House, 27 Clarendon Road, Belfast BT1 3BG. Page 12 of 13
MetLife Sales Desk (Pre-sale information for Financial Advisers) One Canada Square, London E14 5AA Tel: 0800 022 3131 Email: salesresource@metlife.com MetLife Customer Service Centre (Post-sale information for Financial Advisers and policy holders) Beacon House, 27 Clarendon Road, Belfast BT1 3BG Tel: 0800 022 4443 Fax: 0289 023 2965 Email: customerservice@metlife.co.uk Products and services are offered by MetLife Europe d.a.c. which is an affiliate of MetLife, Inc. and operates under the MetLife brand. MetLife Europe d.a.c. is a private company limited by shares and is registered in Ireland under company number 415123. Registered office at 20 on Hatch, Lower Hatch Street, Dublin 2, Ireland. UK branch office at One Canada Square, Canary Wharf, London E14 5AA. Branch registration number: BR008866.MetLife Europe d.a.c. (trading as MetLife) is authorised by the Central Bank of Ireland and subject to limited regulation by the Financial Conduct Authority (FCA) and Prudential Regulation Authority (PRA). Details about the extent of our regulation by the FCA and PRA are available from us on request. www.metlife.co.uk WM16 00 366 l 2002.11 SEP 2016