INDIVIDUAL STAKEHOLDER PENSION PLAN APPLICATION FORM TO SET UP A NEW PLAN TO RECEIVE ADVISED TOP-UPS

INDIVIDUAL STAKEHOLDER PENSION PLAN APPLICATION FORM TO SET UP A NEW PLAN TO RECEIVE ADVISED TOP-UPS

WHEN TO USE THIS FORM This application form is to set up a new Individual Stakeholder Pension Plan into which you can make additional payments on the advice of your adviser. No adviser charges will be applied to this plan to pay for the advice given and any charges agreed with an adviser must be taken outside the plan. Your existing plan can continue to receive any ongoing retirement contributions you have already agreed to pay and any increases you wish to make on a non-advised basis. Existing Plan Number This form is to be used for single and/or regular payments from an individual, and/or an employer, or on behalf of a person who is under the age of 16, or under 18 years of age and not in employment. Such a person is referred to on this form as a minor. And/or transfers from other registered pension schemes. WHICH SECTION(S) SHOULD BE COMPLETED? If an individual is paying into the policy then complete sections: B, C, D, F, H and I If an employer is paying into the policy then complete sections: B, C, D, F, H, and I and arrange for section K to be completed by the employer If the policy is for a minor then complete sections: B, C, E, F, H and J Section G should be completed if transfers are included in any of the above. 1

Note for section Important Information 1) If the person for whom the plan is being arranged is under 16 years of age, or under 18 years of age and not in employment, the legal guardian (e.g. a parent) should complete the application. However, the details should be those for the person who will ultimately receive the pension, i.e. the minor. The contract will be in the name of the legal guardian for the benefit of the minor. IMPORTANT INFORMATION 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. Please read the illustration and key features document before completing this application. Please use BLOCK CAPITALS or tick relevant boxes. Is this application being made on behalf of a minor (see note 1) Yes No If you have applied to HM Revenue & Customs (HMRC) for Enhanced or Fixed Protection from any potential lifetime allowance tax charge, such protection will be lost if any regular or single payment is made to a pension plan on or after 6th April 2006. For further information, please speak to your adviser before making any payments to a pension plan. In certain circumstances, restrictions may apply to the benefits your plan can provide. Ask us for details. 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. 2

CHECKLIST TO BE COMPLETED BY YOUR FINANCIAL ADVISER ADVISER DETAILS Company details completed on page 4. Intermediary Introduction Certificate completed and enclosed. APPLICANT DETAILS Client s national insurance number provided. If they have a national insurance number, it is essential that this is provided. If making regular payments, payment start date for payments provided and the direct debit mandate completed and enclosed. If making a single payment by cheque, cheque enclosed, payable to Scottish Widows. If making a transfer payment(s) please ensure the correct HM Revenue & Customs (HMRC) form is completed. Fund(s) selection made by client. Declaration(s) signed by client. Has your client considered completing the nomination form? Yes No The details requested in this checklist will help ensure that a fully completed application is submitted. This will help speed up the processing of this application. Any relevant details that are omitted from the application form will delay processing. EMPLOYER DETAILS Employer application (section K) completed. If employer making regular payments, a direct debit mandate must be completed and enclosed. 3

A. FINANCIAL ADVISER COMPANY DETAILS Your Scottish Widows agency number A Company Name Address Postcode Contact Name Telephone (inc. code) Mobile Number Email address Warning: Sending personal information by email is not secure. Only include your email address if you agree to Scottish Widows sending you emails. Notes for section B 1) Habitual residence means your permanent residential address. We can only accept applications from a limited number of overseas countries. We will only accept applications for minors where their country of habitual residence is the United Kingdom. If you are not resident in the United Kingdom, please speak to your financial adviser or contact us to confirm your eligibility. 2) To be able to make personal contributions you must be resident in the United Kingdom or otherwise entitled to tax relief on your payments. B. ELIGIBILITY If this plan is for a minor then only complete the first two boxes. In order to determine if you are eligible to take out a Scottish Widows Stakeholder Pension Plan, please provide the following information: Country of habitual residence (see note 1) Nationality And, if you are not resident in the United Kingdom: (see note 2) I am a Crown employee, or the husband, wife or registered civil partner of a Crown employee, who has general earnings from overseas Crown employment. (please tick box if applicable) OR I have earnings which are chargeable to United Kingdom income tax. (please tick box if applicable) C. POLICYHOLDER DETAILS Notes for section C 1) This should be your permanent residential address. We will send all correspondence to this address. Please ensure the postcode is provided. For minors we will send all correspondence to this address or the legal guardian if different. 1. Title Mr Mrs Miss Ms Other (please specify) 2. Your surname 3. Your first name(s) 4. Your address (see note 1) Postcode 5. Your daytime phone number 4

Notes to section C (CONT D) 2) A birth certificate should be sent to us with your application. If you have changed your surname, for example, through marriage or a civil registered partnership, a copy of the appropriate certificate should also be sent. To be eligible for this plan you must be aged less than 75. 3) If you have income from more than one category, the category that is your main source of income will apply. 4) Your National Insurance Number can be found on a payslip or a P60, or on a tax return. For minors National Insurance Numbers are issued shortly before a child s 16th birthday. Please tick the box if the minor is too young to have received a National Insurance Number. If the minor has 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 General Enquiries 0300 200 3500. 5) This is the age from which you want your pension to be payable. This must be between the ages of 55 and 75. You may be able to choose an earlier age, if your type of work has a lower retirement age approved by HM Revenue & Customs. C. POLICYHOLDER DETAILS (CONTINUED) 6. Your date of birth (see note 2) (DD MM YYYY) 7. Are you Male Female 8. If over 16, marital status Single Married/in a registered civil partnership Separated Divorced/registered civil partnership dissolved Widowed/a surviving registered civil partner 9. Employment status (see note 3) Employed Self-Employed A pensioner Other If Other please indicate which of the following applies to you: Are you: Caring for one or more children under 16 Caring for a person aged 16 or over In full time education Unemployed 10. If you are employed, please give your employer s name and address Postcode 11. Please tick this box if you are eligible now or at the end of a specified waiting period to join your employer s pension scheme, but have declined to do so, or will decline to do so at the end of the specified waiting period. Please also tick this box if you have left your employer s pension scheme to take out this pension plan. 12. Your National Insurance Number (see note 4) If for a minor that does not yet have a National Insurance Number, please tick this box 13. Selected Pension Age (see note 5) Additional details of legal guardian for minor application Guardian s Name Address of legal guardian if different from minor (see note 1) Postcode Country of residence of legal guardian Nationality of legal guardian 5

Notes to section D 1) The Money Purchase Annual Allowance (MPAA) is currently 4000. The MPAA applies to you if you have flexibly accessed your pensions from us or any other provider and have received any of the payments listed below from 6th April 2015 onwards: a payment from a flexible access drawdown fund (also known as a flexi-access drawdown fund); a payment from a capped drawdown fund which would exceed existing capped drawdown limits; a pension encashment (also known as an uncrystallised funds pension lump sum); a payment under a flexible annuity contract; a pension payment from a money purchase scheme which has fewer than 11 other pensioner members; a stand-alone lump sum from a money purchase arrangement where you were entitled to primary protection with a right to take a lump sum of greater than 375,000. The MPAA applies to all contributions you pay (or that are paid on your behalf e.g. employer contributions and death-inservice premiums) each year to all money purchase pension schemes of which you are a member. If the MPAA applies to you and your contributions exceed it, you will be liable to pay a tax charge based on your highest rate of income tax. The MPAA does not apply if you have taken only income from a capped drawdown plan; tax-free cash (pension commencement lump sums) when using your plan to purchase an annuity or drawdown plan; or small pots taken as a cash lump sum. In these circumstances, the higher annual allowance applies to you. 2) Your payments are paid net of basic rate tax at 20%. Scottish Widows will collect the basic rate tax relief from the Revenue and add it to the payments. If you pay more than 20% tax on some of your income, you may be able to claim additional tax relief either by contacting HMRC or via your self-assessment tax return. The minimum regular contribution you can pay is 20 net. Your regular payments are payable by direct debit. However, if your employer is paying any part of your regular contribution, they must complete the Direct Debit Instruction. This will enable Scottish Widows to collect your, and your employer s, contributions. If you are making any contributions, your employer will deduct the amount from your salary. The minimum applies to the total of your, and your employer s, contributions. 3) Employer s payments are paid gross. The minimum your employer can pay is 20 gross. 4) Where payments are being collected and being paid via your employer s bank account, the amount and payment date will be set by them. To comply with the late payment rules governed by The Pensions Regulator, payments which are made through your employer s bank account must reach Scottish Widows by the 19th of the month following the deduction from salary. For all other cases please choose a payment date up to the 28th of the month. D. YOUR PENSION CONTRIBUTIONS (FOR MINOR PLEASE COMPLETE SECTION E) There is no maximum limit on how much can be paid to your plan, although we can only accept contributions from you that are eligible for tax relief. However, your tax relief depends on your main place of residence as advised by HMRC for the current tax year. If you are a Scottish taxpayer the tax relief you will be entitled to will be at the Scottish Rate of income tax, which may be different from the rest of the UK. Relief is available on contributions which don t exceed your UK relevant earnings, or 3,600 if higher. The Treasury sets an annual allowance on the amount that can be paid into all your registered pension schemes without incurring a tax charge. Higher earners will have a lower annual allowance limit, called the Tapered Annual Allowance. Your annual allowance may also be limited to the Money Purchase Annual Allowance if you have flexibly accessed a pension with us or any other provider. (see note 1) Please speak to your financial adviser if you are unsure about how much you can pay. 1. Have you flexibly accessed any pensions with us or any other provider? (see note 1) Yes No If Yes - Date of first payment 2. Regular Contributions By you (see note 2) net By your employer (if applicable) gross (see note 3) (DD MM YYYY) Regular payments must be made by Direct Debit. Please complete the attached Direct Debit mandate. Please note, if payments are being made from both the policyholder and employer s bank accounts then a separate policy will be set up for the Employer payments. Please complete a Direct Debit mandate for each payer s bank account. Payment start date (DD MM YYYY) (1 28) If the start date of this plan is less than 21 days after the date we receive your application, we may collect both the first and second premium on the due date of the second premium Payment frequency (see note 4) Monthly Annually 3. Would you like the regular payments to increase automatically each year? Yes No If Yes what level of increase do you want? (see note 5) Retail Prices Index Average Weekly Earnings Fixed Rate from 5% to 20% 4. Single Contributions (see note 6) You net Your employer (if applicable) gross Single payments must be made by cheque, payable to Scottish Widows. 5. Transfer Payments Total amount of expected transfer payment Please complete section G for each transfer payment. % (please specify) Actual transfer payment(s) processed by Scottish Widows will depend on the final value(s) paid by the transferring scheme(s). 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 by seeking advice from your financial adviser. 6

5) Fixed increases may be at any rate between 5% p.a. and 20% p.a., whole percentages only. 6) The single payment must be paid by cheque, payable to Scottish Widows. The minimum single payment you can make is 20 net or 20 if your employer is paying it. When writing a cheque, it will help to prevent fraud if you include additional information on the payee line, especially if you are not personally paying the cheque in, for example you may be sending the cheque by post. When writing a cheque to Scottish Widows you should include the applicants and policy number on the Payee line. For example Scottish Widows re: applicants name, your reference policy number XXXYYZ. Remember to draw a line through unused space on the cheque so extra numbers or names cannot be added. Notes to section E 1) The amount of tax relief the minor can receive is subject to an upper limit set by the Government. In each tax year, relief is only available on payments which do not exceed the higher of 100% of the minors relevant UK earnings, and 3,600 gross. If payments to this plan, and any other pension plans the minor has, when added to the basic rate tax relief received, exceed this limit, the excess will not be eligible for tax relief. 2) Payments are paid net of basic rate tax at 20%. Scottish Widows will collect the basic rate tax relief from the Revenue and add it to the payments. If the minor pays more than 20% tax on some of their income, they may be able to claim additional tax relief either by contacting HMRC or via their self-assessment tax return. The minimum regular contribution that can be made is 20 net. 3) Please choose a payment date up to the 28th of the month. 4) Fixed increases may be at any rate between 5% p.a and 20% p.a, whole percentages only. 5) The minimum single payment that can be made is 20 net. When writing a cheque, it will help to prevent fraud if you include additional information on the payee line, especially if you are not personally paying the cheque in, for example you may be sending the cheque by post. When writing a cheque to Scottish Widows you should include the minors name and policy number on the Payee line. For example Scottish Widows re: minors name, reference policy number XXXYYZ. Remember to draw a line through unused space on the cheque so extra numbers or names cannot be added. E. MINOR S CONTRIBUTIONS The total contributions into the plan can be up to 3,600 gross or 100% of the minor s relevant UK earnings in each tax year. A tax year runs from 6 April in one year to 5 April in the next year. (see note 1) Who is to make contributions? Minor Legal Guardian Other If Other, please provide the following Name Address Postcode Country Nationality Relationship to minor 1. Regular Contributions (see note 2) By Minor net By Legal Guardian net By Other net When are the regular contributions to start? (see note 3) (DD MM YYYY) Regular contributions must be made by Direct Debit. Please complete the attached Direct Debit mandate. 2. Would you like the regular payments to increase automatically each year? Yes No If Yes what level of increase do you want? (see note 4) Retail Prices Index Average Weekly Earnings Fixed Rate from 5% to 20% % (please specify) 3. Single Contribution (see note 5) Minor Legal Guardian Other net Single contributions must be made by cheque, payable to Scottish Widows. 7

DIRECT DEBIT INSTRUCTION INSTRUCTION TO YOUR BANK OR BUILDING SOCIETY TO PAY BY DIRECT DEBIT Please fill in the whole form using a ball point pen and send it to: Scottish Widows 15 Dalkeith Road Edinburgh EH16 5BU Name(s) of Account Holder(s) Bank/Building Society account number Branch Sort Code Name and full postal address of your Bank or Building Society: Originator s Identification Number 8 3 6 6 2 8 Reference Number INSTRUCTION TO YOUR BANK OR BUILDING SOCIETY Please pay Scottish Widows Limited Direct Debits from the account detailed in this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Scottish Widows Limited and, if so, details will be passed electronically to my Bank/Building Society. Signature(s) To the Manager Postcode Date (DD MM YYYY) Banks and Building Societies may not accept instructions for some types of account. This guarantee should be detached and retained by the Payer THE DIRECT DEBIT GUARANTEE This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits. If there are any changes to the amount, date or frequency of your Direct Debit Scottish Widows Limited will notify you 14 working days in advance of your account being debited or as otherwise agreed. If you request Scottish Widows Limited to collect a payment, confirmation of the amount and date will be given to you at the time of the request. If an error is made in the payment of your Direct Debit, by Scottish Widows Limited or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society. If you receive a refund you are not entitled to, you must pay it back when Scottish Widows Limited asks you to. You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

F. INVESTMENT CHOICE You can select one of the following options You can choose your own selection of funds (complete section a) or You can choose one of three Lifestyle Switching Options (complete section b) or You can choose one of nine Pension Investment Approaches (complete section c). Alternatively, if you don t complete one of these sections your payments will automatically be invested in our Consensus Fund. We may change the selection of funds that we make available. There may be restriction on the amount you can invest in certain funds. Please contact us for details of any restrictions that apply. If a Lifestyle Switching Option or Pension Investment Approach is selected, it will apply to the whole plan i.e. for all types of payment and all future contributions. Full details of all available funds can be found in our Stakeholder Funds Guide. You can also get details online at www.scottishwidows.co.uk a. Choice of funds (if you complete this section don t complete b. or c. below.) You can invest in up to 10 funds at any one time. Fund Regular Contributions Single Contributions Transfer Payments Total 100% 100% 100% Automatic Switching So long as you do not choose one of our three Lifestyle Switching Options or Pension Investment Approaches in sections b. or c. overleaf, your investments will be automatically switched over the 5 years before your selected pension age, with the aim that your plan is invested approximately 75% in the Pension Protector Fund, and 25% in the Cash Fund at your selected pension age. You can elect for this NOT to happen by ticking this box. 10

F. INVESTMENT CHOICE (CONTINUED) b. Lifestyle Switching Options (If you complete this section don t complete sections a. or c.) Please see Guide to Lifestyle Switching (reference 41426) for full details of these options. Please tick one box Cautious Lifestyle Balanced Lifestyle Opportunity Lifestyle c. Pension Investment Approaches (If you complete this section don t complete sections a. or b.) Please see Pension Investment Approaches Guide (reference 45770IG) for full details of these options. Please tick one box. Cautious Pension Investment Approach Targeting Annuity Cautious Pension Investment Approach Targeting Encashment Cautious Pension Investment Approach Targeting Flexible Access Balanced Pension Investment Approach Targeting Annuity Balanced Pension Investment Approach Targeting Encashment Balanced Pension Investment Approach Targeting Flexible Access Adventurous Pension Investment Approach Targeting Annuity Adventurous Pension Investment Approach Targeting Encashment Adventurous Pension Investment Approach Targeting Flexible Access Please tick one as appropriate 11

If there is more than one transferring scheme, please photocopy this section and complete a copy for each scheme. G. TRANSFERRING SCHEME S DETAILS Notes to section G 1) The Financial Conduct Authority (FCA) requires that certain transactions are reported by authorised persons. These include certain pension transfers, specifically those from A relevant statutory scheme; An occupational pension scheme; or An individual pension contract or buy out plan (e.g. Section 32 plan) which provides guaranteed or fixed benefits. Is the transfer coming from a: a) Registered Pension Scheme (as defined in part 4 of the Finance Act 2004) b) Recognised Overseas Pension Scheme (as defined in part 4 of the Finance Act 2004) c) Overseas Pension Scheme (as defined in Part 4 of the Finance Act 2004) d) Employer-Financed Retirement Benefits Scheme (As defined in Income Tax (Earnings and Pensions) Act 2003) Details of the transferring scheme Type of Scheme Full name of the scheme or scheme administrator or provider Address Postcode HM Revenue & Customs pension scheme tax reference number Policy number (transferring plan) For transfers from an occupational pension scheme, please indicate if the transferring scheme is: (see note 1) A money purchase scheme If so, please confirm if the scheme is: an Executive Pension Plan or a Small Self-Administered Scheme A defined benefits scheme Has the transferring member flexibly accessed any pension benefits? Yes No If Yes Date of first payment (DD MM YYYY) 12

H. NOMINATION FORM This form supersedes any earlier form completed in respect of this plan number. To: Scottish Widows PLEASE USE BLOCK CAPITALS Name Date of Birth (DD MM YYYY) National Insurance Number Pension plan number I wish to nominate the person/people listed below to receive any death benefits which become payable under my plan. I understand that, in exercising discretion in applying the benefits, Scottish Widows as Scheme Administrator will not be bound by this expression of my wishes. Please consider the following person/people to receive death benefits in the percentages shown. Full name Relationship (if any) Percentage of benefits If your circumstances change after submitting this form and you would like to change the nominated beneficiaries please send a new form, which is available from us on request. Your signature Date (DD MM YYYY) 13

I. DECLARATION IMPORTANT PLEASE COMPLETE (FOR MINOR APPLICATIONS PLEASE USE SECTION J. LEGAL GUARDIAN DECLARATION) SCOTTISH WIDOWS STAKEHOLDER PENSION SCHEME (the Scheme ) Declaration to Scottish Widows Scottish Widows has set up the above Scheme by Deed Poll. I apply to join the Scottish Widows Stakeholder Pension Scheme. On acceptance of my application, I understand a policy will be issued in my name. I agree that the information detailed on this application is correct and complete and that it, together with the Deed Poll that established the Scheme, the rules of the Scheme, the policy provisions, the policy schedule and any endorsement relating thereto, constitute the contractual terms of my policy with Scottish Widows. I agree that all payments will be invested in one Arrangement. I authorise Scottish Widows to collect the payments I, my employer(s) and any third party(ies) agree to make, including any transfer payments from other pension arrangements. I understand my payments will be collected net of basic rate tax. I agree that if the basic rate of tax changes, Scottish Widows will amend the amount collected, but only to the extent necessary to maintain the total payment. Total payments by me in any tax year will not exceed the higher of 3,600, and my relevant UK earnings. I will inform Scottish Widows within 30 days if I am no longer entitled to receive tax relief, or if I stop residing in the United Kingdom. I agree that my appointed financial adviser and Scottish Widows may exchange such information concerning me as is necessary to effect and administer the policy. Where necessary, I consent to Scottish Widows seeking further information from other pension arrangements. I have received and read the Key Features of the Stakeholder Pension Plan. I have received the Important Notes for Applications document. For your own benefit and protection, please read each of the statements in that document before you sign this application. Scottish Widows will rely on them when administering your contract. If you do not understand any point please let us know. If I am transferring benefits currently held as GMP or section 9(2B) rights in the transferring scheme, I confirm that I have acknowledged in writing to the transferring scheme that: I have received a statement from Scottish Widows showing the benefits to be awarded in respect of the transfer payment I accept that the benefits to be provided by Scottish Widows may be in a different form and of a different amount to those which would have been payable by the transferring scheme and I accept that there is no statutory requirement on Scottish Widows to provider for survivor s benefits out of the transfer payment. I also acknowledge that Scottish Widows is not accepting liability to provide benefits in the form of GMP or section 9(2B) rights. I promise to accept responsibility in respect of any claims, losses and expenses that Scottish Widows 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. 14

I. DECLARATION IMPORTANT PLEASE COMPLETE (FOR MINOR APPLICATIONS PLEASE USE SECTION J. LEGAL GUARDIAN DECLARATION) (CONTINUED) Declaration to the provider/administrator of the transferring scheme named in Section G. I authorise and instruct you to transfer funds from the plan(s) as listed in Section G of this application directly to Scottish Widows. Where you have asked me to give you any original policy document(s) in return for the transfer of funds and I am unable to do so, I promise that I will be responsible for any loses/expenses 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. I authorise you to release all necessary information to Scottish Widows to enable the transfer of funds to Scottish Widows. 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. Until this application is accepted and complete, Scottish Widows responsibility is limited to the return of the total payment(s) to the provider/administrator of the transferring scheme. Where the payment(s) made to Scottish Widows represent(s) part of the funds under the plan(s) listed in Section G of this application, then payment made as requested will mean that I shall no longer be entitled to receive pension or other benefits from the plan(s) listed or that part of the plan(s) represented by the payment(s). I promise to accept responsibility in respect of any claims, losses and expenses that you 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. Your signature Date (DD MM YYYY) A copy of the completed application, Scheme Rules and Policy Provisions is available from Scottish Widows. MARKETING PREFERENCES Our policy on Data Privacy is set out in the Important Notes for Applications document. 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. 15

J. LEGAL GUARDIAN DECLARATION IMPORTANT PLEASE COMPLETE SCOTTISH WIDOWS STAKEHOLDER PENSION SCHEME (the Scheme ) Scottish Widows has set up the above Scheme by Deed Poll. I apply on behalf of a minor, who is under the age of 16 or under 18 years of age and not in employment, to join the Scottish Widows Stakeholder Pension Scheme. On acceptance of the application, I understand I will receive a policy issued in the minor s name. I agree that the information detailed in this application is correct and complete and that it, together with the Deed Poll that established the Scheme, the rules of the Scheme, the policy provisions, the policy schedule and any endorsement relating thereto, constitute the contractual terms of the policy with Scottish Widows. I agree that the application will be treated as a separate application in respect of each of the Arrangements under the policy. I authorise Scottish Widows to collect the payments agreed to be made. I understand payments by or on behalf of the minor will be collected net of basic rate tax. I agree that if the basic rate of tax changes, Scottish Widows will amend the amount collected, but only to the extent necessary to maintain the total payment. Total payments by or on behalf of the minor in any tax year will not exceed the higher of 3,600, and the minor s relevant UK earnings. I will inform Scottish Widows within 30 days if the minor stops residing in the United Kingdom. I agree that the appointed financial adviser and Scottish Widows may exchange such information concerning the minor as is necessary to effect and administer the policy. I will be responsible for the contract as if it were my own until the minor reaches 18 years of age. I have received and read the Key Features of the Stakeholder Pension Plan. I have received the Important Notes for Applications document. For your own benefit and protection, please read each of the statements in that document before you sign this application. Scottish Widows will rely on them when administering your contract. If you do not understand any point please let us know. Your signature as Legal Guardian Date (DD MM YYYY) Your full Name A copy of the completed application, Scheme Rules and Policy Provisions is available from Scottish Widows. 16

J. LEGAL GUARDIAN DECLARATION IMPORTANT PLEASE COMPLETE (CONTINUED) MARKETING PREFERENCES 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. 17

K. EMPLOYER APPLICATION In order to enable us to process this application, please complete this form. WARNING: You must not make false statements on this form; it is a serious offence, the penalties are severe and you could be prosecuted. PERSONAL AND POLICY DETAILS Stakeholder Pension for: Title First Name Surname Employer details: Employer s name Employer s address Postcode Companies House registration number (if applicable) Country of residence/registration PAYMENT DETAILS Regular Payment Regular payments must be made by Direct Debit, please complete the attached Direct Debit mandate. If the start date of the plan is less than 21 days after the date we receive your application, we may collect both the first and second premium on the due date of the second premium. The payment start will be the same date as shown in Section D. Single Payment Single payments must be made by cheque. When writing a cheque to Scottish Widows, it will help prevent fraud if you include the applicant s name and reference/policy number on the Payee Line. For example Scottish Widows re: the applicant s name and reference/policy number xxxyyz. Remember to draw a line through the unused space on the cheque so extra numbers or names cannot be added. 18

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. 53424 08/18