RETIREMENT ACCOUNT TRANSFERRING SCHEME DETAILS (ONLINE ADVISED TRANSFERS INTO RETIREMENT PLANNING)

RETIREMENT ACCOUNT TRANSFERRING SCHEME DETAILS (ONLINE ADVISED TRANSFERS INTO RETIREMENT PLANNING)

Scottish Widows will only accept transfers where financial advice has been given. Warning: You must not make false statements when filling in this application; it is a serious offence. The penalties are severe and you could be prosecuted. If you have applied to HM Revenue & Customs for Enhanced or Fixed Protection from any potential lifetime allowance tax charge, such protection could be lost on transfer. For further information, speak to your financial adviser. Please read the Retirement Account literature before completing this application. Please use block capitals or tick relevant boxes. Government rules allow certain individuals to protect entitlements to: tax-free cash which exceeded 25% of the value of that individual s pension fund as at 5th April 2006 and/or a lower or earlier pension age, where a right to take pension benefits at that age existed prior to 6th April 2006. This protection will be lost on transfer from one scheme to another unless the transfer is a block transfer. To be a block transfer, two or more members must transfer all sums and assets held within a scheme at the same time to a single receiving scheme. Please note that in any event you will lose tax free cash protection/protected pension age if you have already been a member of the receiving scheme for longer than 12 months before the transfer (please ensure that you check this with the receiving scheme prior to transfer). For further information please speak to your financial adviser. Government rules do not allow entitlement to tax-free cash if the transfer results from either : a pension sharing order and any part of the ex-spouse/ex-civil partner s pension is already in payment at the time of the divorce/ dissolution of the civil partnership or if the transfer value relates to pension benefits for a continued rights member of an occupational scheme who has taken their tax-free cash on or after 27th July 2004 whilst deferring their pension. In these circumstances, a separate plan will need to be set up. For further information, please speak to your financial adviser. Note: Failure to complete all parts of this application form will delay processing. Financial Advisers please ensure section A is complete. Financial Advisers/Applicant complete section B. Applicant complete sections C. to to E. 1

A. FINANCIAL ADVISER DETAILS (TO BE COMPLETED BY YOUR FINANCIAL ADVISER) Your Scottish Widows agency number A Name Address Postcode Telephone Number (incl. code) (useful if there is a query) Mobile number Online illustration reference number: B. TRANSFERRING SCHEME S DETAILS To be completed by the financial adviser or applicant. Where is the transfer coming from? (If the transfer is coming from more than one source, please complete a separate form for each transfer). Full Name of scheme or provider/administrator: Address Postcode Contact name Contact Telephone Number HM Revenue & Customs Registered Scheme Number (if known) Plan number (transferring plan) Expected transfer amount TV amount 2

NOTES TO SECTION C (1) This should be your permanent residential address. We will send all correspondence to this address. Please ensure the postcode is provided. (2) Warning: sending personal information by email is not secure. Only include your email address if you agree to Scottish Widows sending you emails. (3) Your National Insurance Number can be found on a payslip or P60, or on a tax return. If you have a National Insurance Number, it is essential that you provide it. Without a National Insurance Number, we are unable to accept contributions and cannot process your application. If you cannot find your National Insurance Number please phone the HM Revenue & Customs National Insurance Registration Helpline 0300 200 3502. C. YOUR DETAILS Your title Mr Mrs Miss Ms Other (please specify) Surname First name(s) Address (see note 1) Postcode Your phone number (useful if there is a query) Email address (see note 2) Your date of birth (DD MM YYYY) Your National Insurance Number (see note 3) Retirement Account Number: D. MARKETING PREFERENCES Our policy on Data Privacy is included in the additional sheet Important notes for applications. We would like to keep you up to date on products and offers that may be of interest to you. Please select how you would like to hear from us below. These choices won t affect any necessary information we need to send you such as statements and, don t worry, you can change your mind and update your preferences at any time. SCOTTISH WIDOWS WEBSITES You may see relevant messages when you log in to our online services. If you choose no, you may still see messages, but they will not be tailored to you. Yes No EMAIL Yes No POST Yes No DEVICE NOTIFICATIONS As we develop mobile applications you ll receive relevant notifications to your mobile device Yes No TEXT MESSAGES Yes No PHONE Yes No By saying yes, you are giving consent for Scottish Widows to use your personal information to send you relevant offers and information about our products. Scottish Widows includes the following legal entities: Scottish Widows Ltd, Scottish Widows Unit Trust Managers Limited, Scottish Widows Administration Services Limited and HBOS Investment Fund Managers Limited. Occasionally we will send you selected offers from other companies within Lloyds Banking Group that may be relevant to you. 3

E. DECLARATION THE DECLARATION SHOULD BE COMPLETED BY THE APPLICANT. SCOTTISH WIDOWS APPROPRIATE PERSONAL PENSION SCHEME (the Scheme) Declaration to Scottish Widows To enable your transfer value to be paid to Scottish Widows, you must be a Member of the Scheme. Scottish Widows is the Administrator of the Scheme and is responsible for running it according to the Scheme Rules. I confirm that I am a member of the Scheme and that I have requested that Scottish Widows accept a transfer payment from the transferring scheme detailed above, for the purposes of providing benefits under the Scheme. I consent to Scottish Widows seeking further information from other pension providers, trustees or scheme administrators, for any other pension arrangements under which I have benefits. I authorise the provision of any information requested. To the best of my knowledge and belief, all the statements I have made, whether in my own handwriting or not, are true and complete. Your signature Date (DD MM YYYY) A copy of the completed transfer application, Scheme Rules and Policy Provisions are available from Scottish Widows. Warning: Deciding whether or not to transfer can be complicated. Therefore before you sign your application you should satisfy yourself that transferring your pension fund is right for you. It is important that you are sure about the suitability of transferring and that you understand the risks. Your adviser will have discussed the relevant issues with you for your circumstances. Further information on pension transfers can be viewed on the following website: www.moneyadviceservice.org.uk 4

Scottish Widows Limited. Registered in England and Wales No. 3196171. Registered office in the United Kingdom at 25 Gresham Street, London EC2V 7HN. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services Register number 181655. 25703 06/18