Income Drawdown Plan (Pre 75)

Income Drawdown Plan (Pre 75) Application for Flexible Access Drawdown opening a plan with a drawdown to drawdown transfer Please use this form if you want to apply for an Income Drawdown Plan (Pre 75) and: designate and transfer funds from a Clerical Medical plan (other than the Executive Pension Plan EPP), or transfer funds already designated for drawdown pension. If you have an EPP you will need to complete the EPP version of the Income Drawdown Plan application form (reference G1319) instead of this form. You must complete sections 1, 3, 4, 5 and 8 in all circumstances. However: If you re transferring funds not yet designated from a Clerical Medical product (other than an EPP) please also complete section 2 part A and sections 6 and 7. If you re transferring funds already designated for drawdown pension (or that were in income drawdown before 6 April 2006) under another Clerical Medical product (other than an EPP), please also complete section 2 part B. If you re transferring designated funds from another provider please also complete section 2 part C. You ll also have to complete section 1 of the Drawdown to drawdown transfer information form on page 8. Sections 2 and 3 of the Drawdown to drawdown transfer information form on page 8 should be completed by the provider you are making the transfer from, who we will contact directly. Please complete in CAPITAL LETTERS and Declaration before signing it. Please note: We do not accept transfers from non-registered schemes, other than certain overseas schemes. Overseas schemes have to meet certain requirements before we can accept a transfer. Please refer to your financial adviser or Clerical Medical for the information required before we can accept such a transfer. The Income Drawdown Plan (Pre 75) is not available to certain foreign nationals, or UK citizens living in certain countries. Please speak with your adviser for further details. Each drawdown to drawdown transfer must go into a separate Income Drawdown Plan (Pre 75). You will need to complete an application form for each transfer. If you have enhanced or fixed protection, any transfer of funds must be a permitted transfer. If you wish to maintain your protection, you and your adviser should be satisfied that this transfer meets the requirements. This plan will be on a Flexible Access Drawdown basis. Any transfers that are currently on a Capped Drawdown basis will be switched to Flexible Access Drawdown on receipt. If you take any income from this plan, you will be subject to the Money Purchase Annual Allowance (MPAA). This will significantly reduce the amount you can pay to other pension plans each year. Please speak to your financial adviser for further details. where appropriate. Give careful consideration to your answers and to the Did your adviser give you advice in respect of this application? Advice given Advice not given

1. Your personal details You must complete this section in ALL circumstances. Mr/Mrs/Miss/Ms or other title Sex Male Female Surname Previous surname (if applicable) Full forename(s) Permanent residential address Postcode Daytime telephone number If you ve lived at this address for less than three months, please also supply details of your previous address Postcode Date of birth (DD MM YYYY) Please note: you must be under age 74. Nationality (list all if more than one held) Country of residence (if other than UK) Occupation National Insurance number OR Please tick one of the following I am a citizen of a country outside of the UK and am not resident in the UK. I do not have a National Insurance number (this will only be acceptable in certain circumstances). 1

2. Your transfer payments You must complete ONE of the following sections. Part A. Transferring funds from an existing Clerical Medical product Designating funds within, and taking tax-free cash (known as a pension commencement lump sum) from, an existing Clerical Medical product before transferring them to an Income Drawdown Plan (Pre 75). Details of the product from which you are designating then transferring: Product name Policy number Designating within your existing product will allow you to take any tax-free cash in excess of 25% to which you may be entitled, but each transfer must be used to open a new Income Drawdown Plan (Pre 75), and you must designate the entire amount under the plan. Section 7 sets out more information about designating within your existing plan. Payment of tax-free cash Tax-free cash will be paid at the earliest possible date. If you wish to specify a date below, we will endeavour to make payment as close as possible to this date. Please note: If the maximum tax-free cash available is not taken on the date of designation, the remainder cannot be taken subsequently. Amount of cash required either maximum available or a lesser specified amount Payment date/designation date (DD MM YYYY) OR Part B. Transferring funds already designated for drawdown pension under an existing Clerical Medical product (or that were in income drawdown before 6 April 2006 under a previous Clerical Medical income drawdown product) Product name and policy number of the contract from which you are transferring 2

2. Your transfer payments (continued) Part C. Transferring designated funds from another provider Amount of transfer payment Guarantee expiry date (DD MM YYYY) Full title of transferring scheme or contract Policy number of transferring scheme or contract Pension Scheme Tax Reference number (PSTR) Name of administrator of transferring scheme or contract Address of administrator of transferring scheme or contract Postcode Telephone number Please note: When making a transfer from another provider, section 1 of the Drawdown to drawdown transfer information form in this application must be completed and returned to Clerical Medical. We will then forward it on to the administrator of the transferring scheme for them to complete the rest of it. We will also need either a copy of the signed discharge form and confirmation that it has been sent to the transferring scheme, or the original discharge form. 3. Investment details You must complete this section in ALL circumstances. Please indicate the choice of investment funds below. Please show in whole percentages only. Percentage Percentage Fund amount Fund amount Please note: Total 100% If you want to change the funds your money is invested in, you ll need to complete and return a Fund switch form (reference G986). The Self-Invested Fund and With-Profits Fund are not available. We can change the range of funds available and restrictions may apply. For details of the funds available please see our website www.clericalmedical.co.uk/funds Each fund has its own aims and risks. Your financial adviser will be able to help you make your choice. 3

4. Income withdrawal details You must complete this section in ALL circumstances. Please provide details below of the level of income you wish to take and the bank account into which it is to be paid. Your application cannot be processed and withdrawals cannot commence until we receive evidence of your age (your birth certificate). Is income required? Yes No If Yes, please complete the following: Amount of income required per payment (minimum 20 per payment) (gross, before deduction of tax) OR Annual % of total fund value split across the required number of payments. Frequency of income withdrawal payments Monthly Quarterly Half-yearly Yearly (You can change the frequency on the plan anniversary date each year.) First income withdrawal payment date (DD MM YYYY) Please note: The date you choose must be within the next 12 months, and must be between the 1st and 28th of the month. It may take up to five days for the payment to clear into your account. Please specify where you wish the income withdrawals to be taken from by completing A or B below. Part A Part B I wish to take income proportionally across all funds. OR I wish to take income from the fund/s specified below. Percentage Percentage Fund name amount Fund name amount AND Your bank/building society details for payment of income withdrawals and tax-free cash Name of bank/building society Address of bank/building society Postcode Bank sort code Bank account number Account holder(s) name(s) Roll number (building society only) 4

4. Income withdrawal details (continued) Please note: Payments will be made net of tax based on the tax code provided to us by HM Revenue & Customs. Until we receive confirmation of your tax code, we ll deduct tax on a month 1 basis. Where the payment date falls on a bank holiday or weekend, payment will be made on the next available working day. We ll automatically produce a P60 for you each year, even if you re taking no income. 5. Nomination of beneficiaries Please complete Part A or Part B below. Part A nominating a dependant* or other beneficiary If you die, the value of your Plan can be used to provide one or more of the following benefits to one or more nominated dependants* or other beneficiaries: Lump sum any nominated dependant* or other beneficiary can receive the value of your Plan as a tax free lump sum. Drawdown pension any nominated dependant* or other beneficiary can use the remaining value for drawdown. Any subsequent payments they receive from the drawdown pension will be tax free. Annuity any nominated dependant* or other beneficiary can use the remaining value to buy an annuity. The income taken from that annuity will be tax free. Please complete the table below to indicate who you would like to benefit after your death. Proportion Full name of dependant* or other beneficiary Their address Total 100% % % % % % % Please continue on a separate sheet of paper if necessary. Part B nominating a charity You can nominate a charity to receive a lump sum death benefit from your plan, but payment can only be made to the charity if you have no dependants* at the time of your death. If your dependant* continues with a drawdown pension after your death, a payment to charity can only be made after their death. Currently, payments to charity are tax-free. Please complete the details below if you would like to nominate a charity to receive a lump sum in these circumstances. Name of charity Address of charity Charity Registered Number 5

5. Nomination of beneficiaries (continued) Please note: If you ve arranged your plan under trust, we ll pay any lump sum to the trustees. If it s not arranged under trust, we ll decide who to pay the lump sum to. We ll choose who to pay the benefits to, although we take full account of any nomination you make. Although the value of pension funds are generally not subject to Inheritance Tax, in certain circumstances the value of death benefits may be subject to tax charges. As this is a complex area you should contact your adviser or tax office for further guidance. If you want to change your nominations at any time, please complete and return a new nomination form. These are available on request. Unless you tell us otherwise, we ll assume that you wish us to treat any subsequent transfers into this plan in accordance with this nomination. Clerical Medical may not offer drawdown pensions or annuities to dependants* or other beneficiaries another provider may need to be used if these options are required. Payment may only be made to a charity which meets the conditions of Part 1 of Schedule 6 of the Finance Act 2010. Details of registered charities are available from the following websites: www.charity-commission.gov.uk (England & Wales) www.oscr.org.uk (Scotland) www.charitycommissionni.org.uk (Northern Ireland). Clerical Medical will need to be satisfied that the body nominated meets the requirements for a charity at the time of payment. Subject to that, your nomination will be binding on the Scheme Administrator unless you withdraw it in writing or make a subsequent nomination that overrides it. *A dependant is your wife, husband or civil partner, or a child of yours who is under 23, or who has reached age 23 but is dependent on you because of physical or mental impairment, or a person who is not married to you, nor your registered civil partner, but who is financially dependent on you (or you are mutually financially dependent) at the time of your death. Every care has been taken to make sure that the information given in this nomination form is correct and in accordance with our understanding of current legislation and HM Revenue & Customs practice. The law and HM Revenue & Customs practice are subject to change, which cannot be foreseen. 6. Lifetime allowance declaration You must complete this section if you intend to designate your Clerical Medical plan for drawdown pension and have completed section 2, part A. You do not need to complete this section if you have already designated your plan. Will the total benefits you are taking from this plan now exceed your remaining lifetime allowance? Yes No If Yes, you must complete and return a lifetime allowance questionnaire. You can request this from Clerical Medical or your financial adviser. Your lifetime allowance will be the standard lifetime allowance, unless you have applied for any type of protection, or an enhanced personal lifetime allowance. Please note: If you do not complete a lifetime allowance declaration then a tax charge will apply. HM Revenue & Customs can impose a fine of up to 3,000 if you make a false declaration about your remaining lifetime allowance. 6

7. Authorisation for designation of existing Clerical Medical plans You must read this section if you intend to designate your existing Clerical Medical plan for drawdown pension and have completed section 2, part A. Important notes On the date of designation, amounts invested in the With-Profits Fund will be switched into the Unit-Linked Cash Fund (or another fund specified). An MVR may apply to the amounts that are switched. The With-Profits Fund will not be available post-designation. If amounts are being disinvested from the With-Profits Fund, an MVR may apply. However, the payment will take account of terminal bonus (if any). There may be exit penalties if benefits are being taken early as described in the product literature provided when you joined the plan. In exceptional circumstances, when amounts are withdrawn from the plan, we may defer payment for up to a month. If the amounts that are being withdrawn are invested in the property fund, or any fund that invests partly in property, we may postpone encashment for up to six months. This is because these assets can be less easy to sell than stocks and shares. Property valuation is a matter of judgement by a valuer. If a lifestyle investment programme is in place, it will stop on the date the plan is first designated. The actual amount of tax-free cash payable will take account of terminal bonus (if any), a market value reduction (if any), and charges for taking benefits early (if any) as described in the product literature provided when you started your plan. The amount of tax-free cash payable will be calculated using the bid prices applicable on the designation date or, if the benefits are taken earlier, on the working day following the date on which Clerical Medical receives the fully completed application form if later. No tax-free cash is payable from guaranteed minimum pension (GMP) benefits. Any GMP must, on designation, be immediately secured as income via the purchase of a pension annuity. This application cannot be processed until we have evidence of your age. We will need your birth certificate and, if your name has changed, your marriage certificate (if applicable) or other evidence. We cannot accept a copy. The originals will be returned to you as soon as we have processed your application. I agree that following receipt of the completed application form, Clerical Medical will calculate the actual transfer value payable to the Income Drawdown Plan (Pre 75) as described in the important notes. Once the transfer value has been paid to the Income Drawdown Plan (Pre 75), my existing Clerical Medical plan will then end. By signing this application I authorise and request you to designate my plan as drawdown pension, release funds from my plan to purchase a Clerical Medical Income Drawdown Plan (Pre 75), purchase an immediate pension annuity to secure any GMP and pay me the full amount of tax-free cash I require. 8. Declaration and authority for Income Drawdown Plan (Pre 75) You must read and sign this section in ALL circumstances. Important notes You must give us any information which might be relevant and which could influence our decision. If you are unsure whether a particular fact is relevant, you should disclose it. Before any plan comes into force, any change in the facts contained in the answers given in this application must be notified to Clerical Medical in writing. Clerical Medical reserves the right to amend the terms on which your application may have been accepted or to withdraw acceptance in the event of any such change. No contract will come into existence until Clerical Medical has issued an acknowledgement of the acceptance of your application. Part or all of the Scheme benefits might be forfeited if relevant information were to be withheld. Copies of this completed application and the documents governing the Clerical Medical Personal Pension Scheme ( the Scheme ) are available on request. Clerical Medical agrees to administer the Scheme in accordance with the rules of the Scheme. You should be aware that no benefit payable from the Scheme shall be capable of being surrendered, assigned or commuted except as provided by the relevant legislation. You should be aware that income withdrawal is not suitable for everyone, especially but not only, if: i) they hold pension savings of less than 100,000, and ii) they have no other sources of income or savings apart from state benefits. 7

8. Declaration and authority for Income Drawdown Plan (Pre 75) (continued) For your own benefit and protection, it is important that you read the key features document and your personal illustration carefully before signing this application. You should also read the Important notes above and the other notes below. If you do not understand any point, please ask your financial adviser for further information. Money Laundering Regulations Under current regulations we are required to verify the identity of our customers. In order to meet this requirement and for the prevention and detection of fraud, we may access information from a credit reference agency* to confirm your identity. They will authenticate your name, address and date of birth, which involves checking the details you supply against those held on any databases that the company carrying out the checks on our behalf (or any similar company) has access to. This includes information from the Electoral Register. We may use scoring methods to authenticate your identity. Our search will not be used by lenders or insurers when assessing lending or insurance risks. We may also pass information to financial and other organisations involved in money laundering and fraud prevention to protect ourselves and our customers from theft and fraud. If you give us false or inaccurate information and we suspect fraud, we will record this and share this information with other organisations. If you provide us with information about another person, we will treat this as confirmation that they have appointed you to act for them to consent to the processing of their personal data. This means that you have informed them of our identity and the purpose for which their personal data will be processed, namely to verify their name, address and date of birth. Where Clerical Medical receives notification affecting the legal ownership of the plan, or the appointment of an attorney under a Power of Attorney or other circumstances where there are new parties associated with the contract, the same process as set out above will apply. Please note that if we cannot confirm your name, address and date of birth by using a credit reference agency we may contact you to ask you to supply certain documents to verify this information. If you ask, we will tell you which credit reference agency we have used so you can get a copy of your details from them. *Please note we only use this agency to verify identity to fulfil anti-money laundering regulations and not to check credit worthiness. Data Privacy Notice Your personal information will be held by Scottish Widows Ltd which is part of the Lloyds Banking Group. More information on the Group can be found at www.lloydsbankinggroup.com This privacy notice contains key information about how we will use and share your personal information and the rights you have in relation to this. If you want to know more please access our full privacy notice at www.scottishwidows.co.uk/legalprivacy or ask us for a copy. We will use your personal information: to provide products and services, manage your relationship with us and comply with any laws or regulations we are subject to (for example the laws that prevent financial crime or the regulatory requirements governing the products we offer). for other purposes including improving our services, exercising our rights in relation to agreements and contracts and identifying products and services that may be of interest. To support us with the above we analyse information we know about you and how you use our products and services, including some automated decision making. You can find out more about how we do this, and in what circumstances you can ask us to stop, in our full privacy notice. Your personal information will be shared within Lloyds Banking Group and other companies that provide services to you or us, so that we and any other companies in our Group can look after your relationship with us. By sharing this information it enables us to better understand our customer s needs, run accounts and policies, and provide products and services efficiently. This processing may include activities which take place outside of the European Economic Area. If this is the case we will ensure appropriate safeguards are in place to protect your personal information. You can find out more about how we share your personal information with credit reference agencies below and can access more information about how else we share your information in our full privacy notice. We will collect personal information about you from a number of sources including: information given to us on application forms, when you talk to us in branch, over the phone or through the device you use and when new services are requested. from analysis of how you operate our products and services, including the frequency, nature, location, origin and recipients of any payments. from or through other organisations (for example card associations, credit reference agencies, insurance companies, retailers, comparison websites, social media and fraud prevention agencies). in certain circumstances we may also use information about health or criminal convictions but we will only do this where allowed by law or if you give us your consent. You can find out more about where we collect personal information about you from in our full privacy notice. 8

8. Declaration and authority for Income Drawdown Plan (Pre 75) (continued) We may be required by law, or as a consequence of any contractual relationship we have, to collect certain personal information. Failure to provide this information may prevent or delay us fulfilling these obligations or performing services. The law gives you a number of rights in relation to your personal information including: the right to access the personal information we have about you. This includes information from application forms, statements, correspondence and call recordings. the right to get us to correct personal information that is wrong or incomplete. in certain circumstances, the right to ask us to stop using or delete your personal information. from 25th May 2018 you will have the right to receive any personal information we have collected from you in an easily re-usable format when it s processed on certain grounds, such as consent or for contractual reasons. You can also ask us to pass this information on to another organisation. You can find out more about these rights and how you can exercise them in our full privacy notice. We may also collect personal information about other individuals who you have a financial link with. This may include people who you have joint accounts or policies with such as your partner/spouse, dependents, beneficiaries or people you have commercial links to, for example other directors or officers of your company. We will collect this information to assess any applications, provide the services requested and to carry out credit reference and fraud prevention checks. You can find out more about how we process personal information about individuals with whom you have a financial link in our full privacy notice. In order to process your application we may supply your personal information to credit reference agencies (CRAs) including how you use our products and services and they will give us information about you, such as about your financial history. We do this to assess creditworthiness and product suitability, check your identity, manage your account, trace and recover debts and prevent criminal activity. We may also continue to exchange information about you with CRAs on an ongoing basis, including about your settled accounts and any debts not fully repaid on time, information on funds going into the account, the balance on the account and, if you borrow, details of your repayments or whether you repay in full and on time. CRAs will share your information with other organisations, for example other organisations you ask to provide you with products and services. Your data will also be linked to the data of any joint applicants or other financial associates as explained above. You can find out more about the identities of the CRAs, and the ways in which they use and share personal information, in our full privacy notice. The personal information we have collected from you and anyone you have a financial link with may be shared with fraud prevention agencies who will use it to prevent fraud and money laundering and to verify your identity. If fraud is detected, you could be refused certain services, finance or employment. Further details of how your information will be used by us and these fraud prevention agencies, and your data protection rights, can be found in our full privacy notice. If you apply to us for insurance, we may pass your details to the relevant insurer and their agents. If a claim is made, any personal information given to us, or to the insurer, may be put onto a register of claims and shared with other insurers to prevent fraudulent claims. It is important that you understand how the personal information you give us will be used. Therefore, we strongly advise that you read our full privacy notice, which you can find at www.scottishwidows.co.uk/legalprivacy or you can ask us for a copy. If you have any questions or require more information about how we use your personal information please contact us using https://www.scottishwidows.co.uk/secure/forms/contact_us/individual_customers/policy-enquiries You can also call us on 0345 300 2244. If you feel we have not answered your question Lloyds Banking Group has a Group Data Privacy Officer, who you can contact on 0345 300 2244 and tell us you want to speak to our Data Privacy Officer. 9

8. Declaration and authority for Income Drawdown Plan (Pre 75) (continued) Marketing Choices 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. I declare that: a) All statements made by me or in this application are correct and complete to the best of my knowledge and belief. b) I have read or have had read to me any answers completed other than in my own handwriting and confirm that they are correct. c) I am under 74 and apply to become a member of the Scheme if I am not already a member, and agree that if my application is accepted I will be bound by the rules. d) Where I am transferring funds from another provider, I consent to Clerical Medical or my financial adviser obtaining information from the administrator of the transferring scheme or the insurer of the contract and to the administrator or insurer providing such information. I confirm that (please tick one of the following): the signed discharge form has been sent to the transferring scheme and a copy is enclosed the original discharge form is enclosed. Once Clerical Medical has received your completed application form, your application is irrevocable. You will not receive a separate cancellation notice or other opportunity to change your mind. Signature Date (DD MM YYYY) Name in CAPITAL LETTERS 10

www.clericalmedical.co.uk Clerical Medical is a trading name of Scottish Widows Limited. Scottish Widows Limited is 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. G1287/0318

Income Drawdown Plan (Pre 75) Drawdown to drawdown transfer information Important notes You must complete this section if you are transferring from another provider (and therefore have completed section 2 part C). Section 1 should be completed by you (the member). Sections 2 and 3 should be completed by the administrator of the transferring scheme. We will contact them directly. Please complete in CAPITAL LETTERS and where appropriate. 1. Member s details Mr/Mrs/Miss/Ms or other title Date of birth (DD MM YYYY) Surname Full forename(s) Policy number of transferring scheme or contract 2. Details of transfer payment and transferring scheme or contract Name of transferring scheme or contract Policy number of transferring scheme or contract Address of administrator of transferring scheme or contract Postcode Daytime telephone number Pension Scheme Tax Reference number (PSTR) Total transfer value Guarantee expiry date (DD MM YYYY) To be completed by the member and administrator of the transferring scheme 12

2. Details of transfer payment and transferring scheme or contract (continued) Please provide the following information for each designation event resulting in the funds that are being transferred into the Income Drawdown Plan (Pre 75). Date of designation (DD MM YYYY) Amount of standard lifetime allowance crystallised (including any pension commencement lump sum taken at that time) % Date of last maximum income review (DD MM YYYY) Has the transferring member flexibly accessed any pension benefits? Yes No If Yes Date of first payment (DD MM YYYY) Has the member purchased a short-term annuity contract from this tranche of drawdown funds? Yes No If Yes, please provide the following: Name of provider Address of provider Postcode Start date (DD MM YYYY) Term (maximum five years) Amount of annuity payment per year Does this amount increase? Yes No If Yes, by how much? Increase in annuity % per year OR other (please specify) 3. Declaration and authority We declare that to the best of our knowledge and belief the information on this form is true and complete. We confirm that the member has agreed in writing to, or requested, payment of the transfer payment as detailed on this form. Signature Date (DD MM YYYY) Name in CAPITAL LETTERS Signed for and on behalf of the administrator of the transferring scheme or insurer of the contract. Please check that all relevant information is completed and return to: Income Drawdown Team, Pension Servicing Department, Clerical Medical, PO Box 28121, 15 Dalkeith Road, Edinburgh EH16 9AS. www.clericalmedical.co.uk Clerical Medical is a trading name of Scottish Widows Limited. Scottish Widows Limited is 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. G1287/0318

Income Drawdown Plan (Pre 75) Submission form The adviser must complete this form in full. Financial adviser details FCA reference of principal firm Name of principal firm Name of adviser/registered individual Network member firm name/appointed representative firm name (if applicable) Adviser telephone number Adviser fax number Correspondence address (optional) Postcode Returning this completed form and attachments Please check that all relevant information is attached: Return to: Fully completed application form with signed Declaration and completed Drawdown to drawdown transfer information form (if your client is making a transfer from another provider) Original signed discharge form for a transfer from another provider (or a copy of it) Client illustration Evidence of age Confirmation of verification of identity Income Drawdown Team Pension Servicing Department Clerical Medical PO Box 28121 15 Dalkeith Road Edinburgh EH16 9AS For help with completion of this form contact your usual sales contact. Once returned, your dedicated customer services team will be able to provide information about the progress of this application. To be completed by the financial adviser 14

Returning this completed form and attachments (continued) Please check that all relevant information is attached: Return to: Fully completed application form with signed Declaration and completed Drawdown to drawdown transfer information form (if your client is making a transfer from another provider) Original signed discharge form for a transfer from another provider (or a copy of it) Client illustration (including commission advice slip ) Evidence of age Confirmation of verification of identity Income Drawdown Team Pension Servicing Department Clerical Medical PO Box 28121 15 Dalkeith Road Edinburgh EH16 9AS For help with completion of this form contact your usual sales contact. Once returned, your dedicated customer services team will be able to provide information about the progress of this application. www.clericalmedical.co.uk Clerical Medical is a trading name of Scottish Widows Limited. Scottish Widows Limited is 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. G1287/0318