Uncrystallised Funds Pension Lump Sum Form

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1 Uncrystallised Funds Pension Lump Sum Form SIPP form reference H199 Quick actions: ou should complete this form if you want to take an Uncrystallised Funds Pension Lump Sum. To convert a capped drawdown arrangement to flexi-access without taking any benefits please complete H198 Capped to Flexi-access Conversion Form. Please note that our terms & conditions can be found at This completed form must be sent to: Pension Access Team, Hornbuckle, Tyman House, Leicester LE1 6J. Section A - our contact details First name(s) Address Surname Hornbuckle plan number Postcode ate of birth aytime telephone number Section B - About your request Pensions are complex and there are important questions to consider when taking benefits. We always recommend that financial advice is taken. The Government s new service ( also provides guidance and options on how to use your pensions savings. Hornbuckle is not authorised to give financial advice, but as a trustee has a duty of care to the pension plan. The questions in this section help us establish whether your personal circumstances require special attention. We request that this section is completed by you, the member, or your adviser on your behalf. Please tick the box as most appropriate. our intent Taking benefits may deplete your ability to save for future income and may have tax consequences. Re-investing benefits may put your money at risk from additional charges, creditors and investment scams What is your primary reason for taking funds out of your pension? For income For debt repayment For investment For lifestyle o you plan to make further contributions to your pension plan? es Page 1

2 Section B cont d our knowledge We ask the following questions to gauge your understanding of the possible outcomes of your instruction. It may impact e.g. your tax status and entitlement to means-tested benefits, now and in the future. Taking benefits can have irreversible and costly consequences. How would you describe your own level of financial and investment awareness? When did you last receive any form of financial advice or guidance on your financial affairs from a qualified and Financial Conduct Authority (FCA)regulated individual? Have you taken guidance from Pension Wise through either the Citizens Advice Bureau or The Pensions Advisory Service? ne Basic Advanced Professionally qualified <12 onths <36 onths > 36 onths Never es - Was not aware this was available - I am equipped to make fully informed decisions When did you last receive any form of personal taxation advice or guidance on your financial affairs from a qualified individual? Why have you chosen not to take specific financial and/or tax advice on this occasion? our circumstances Personal circumstances are influenced and impacted by the financial decisions you take. Alternative income options may provide a higher level of income in the case of illness and you may need to consider the income needs of any dependants in the event of your death and you may live longer than you think. How would you value your financial status considering your income, debts, liquid investments and non-liquid investments excluding the value of your home? <12 onths I am equipped to make fully informed decisions Retail consumer <36 onths I can t afford such advice Affluent > 36 onths I am not willing to pay for such advice High net worth Never I am unable to find a suitable advisor o you have any pension assets other than your Hornbuckle plan(s)? es but not taking benefits es and taking benefits How would you describe your current income (excluding benefits from this pension) in relation to your current outgoings and lifestyle? aterially insufficient Constrained Generating savings potential aterially unconstrained Are you suffering from any diagnosed health condition that could lead to a reduced life expectency? es Please tell us about your dependants? dependants ependent spouse and/ or dependent child(ren) Are your pension benefits subject to, or do you expect them to be subject to, an Income Payments Order? es Are your pension benefits subject to, or do you expect them to be subject to, a Pension Sharing Order? es Are your pension benefits subject to, or do you expect them to be subject to, an Earmarking Order? es Page 2

3 Section C completing your request 1. our other benefits Have you started taking benefits from any other registered pension scheme? es If please proceed to Step 2. Please provide details of your other plans that are already in payment. Provider / scheme name ate payments commenced aximum annual pension Percentage of Lifetime Allowance used 2. our pension protection o you have Primary, Enhanced, Fixed or Individual Protection? es If please proceed to Step 3. Please select all of the following that apply to you: I have primary protection I have fixed protection 2014 I have enhanced protection I have individual protection 2014 I have fixed protection 2012 Please attach copies of any certificates you have received from HRC to verify your protection. 3. Enhancement factors Have you applied to HRC for an enhancement to your lifetime allowance? es If please proceed to Step 4. Please select all of the following that applies to you: I have a lifetime allowance enhancement factor in relation to pension credit rights I have a lifetime allowance enhancement factor in relation to a period during which I was a relevant overseas individual I have a lifetime allowance enhancement factor in relation to a transfer from a recognised overseas pension scheme Please attach copies of any certificates you have received from HRC to verify the enhancement to your lifetime allowance. Page 3

4 4. Benefit instruction Please select what proportion of your plan you wish to use for the purpose of paying benefits: our entire plan A defined percentage of your plan A defined amount of your plan % If you want to withdraw your entire plan, you need to let us know whether you want to keep your plan open. es, please keep my plan open, please close my plan te that fees and our minimum balance requirement will continue to apply. See the terms and conditions for further details. Please select the option below that applies to you: A: This is my first source of income since last 6 April and I have not been receiving taxable Jobseeker s Allowance, Employment and Support Allowance, taxable Incapacity Benefit, State Pension or Occupational Pension B: This is now my only income but since last 6 April I have had other income, or received taxable Jobseeker s Allowance, Employment and Support Allowance or taxable Incapacity Benefit. I do not receive a State Pension or Occupational Pension C: I have another source of income or receive a State Pension or Occupational Pension We will send you payslips, and a P60 at the end of each tax year by Tick here if you require this by post. Postal charges may apply. Tick here if you want us to a copy to your financial adviser. 4.1 Funding benefits Please indicate below how the payment of benefits is to be funded. Additional forms may be required to carry out these plans: 4.2 our Bank etails Please provide details of the account to which you would like us to pay your Uncrystallised Funds Pension Lump Sum: Bank / building society Sort code Account / roll number Account name For non-uk accounts: IBAN For non-uk accounts: Swift address/bic code If you are taking income from your Hornbuckle plan for the first time we will open a Bank of Scotland pension account for you within your scheme to pay your income. Any bank charges incurred in the conversion of a payment from Sterling to a different currency will be payable from your plan. Page 4

5 5. Cancellation rights ou can cancel your application to designate your plan for the payment of a drawdown pension at any time within 30 days of the date that we crystallise your benefits. ou can find full details of your cancellation rights in the Key Features ocument for the Scheme. If you would like to cancel the crystallisation of your benefits you can write to use at the address at the bottom of this form or us at 6. Next steps and your declaration Please accept this as my instruction to pay an Uncrystallised Funds Pension Lump Sum from my Hornbuckle plan. I acknowledge that if I take an Uncrystallised funds pension lump sum I will be subject to the oney Purchase Annual Allowance contribution limit. Important outcomes can arise from this instruction. We ask you to confirm that you are aware of the importance of being properly informed before taking pension benefits. We have recommended that you seek external advice from a qualified financial adviser. Hornbuckle cannot give financial advice nor assess the suitability of this transaction. I authorise Hornbuckle itchell Trustees Limited to close my scheme bank account and transfer the remaining balance to the Hornbuckle Payroll account in order to pay my benefits as requested. This payment will represent a full discharge of Hornbuckle itchell Trustees Ltd s liability in respect of the above plan. ate ember signature Print name 7. Adviser details (if advice received) Adviser name Firm name Firm FCA Number Have you provided a personal recommendation to the plan member in relation to the drawing of their benefits? es On which basis has recommendation been provided? Face to face At a distance Have you agreed with the plan member that we should pay you a fee from their Hornbuckle plan? es If yes, please make sure that you and the member have completed H108 Adviser Charging Form. ate Adviser signature Print name Page 5

6 Checklist Before submitting this form please make sure: ou have answered the questions in Section A and B plus completed steps 1-6 in Section C If you have received advice, that your financial adviser has completed and signed step 7 in Section C ou have attached copies of any certificates relating to protection of lifetime allowance enhancements you have Where to send Pension Access Team, Hornbuckle, 42 Regent Road, Leicester LE1 6J Get in touch Tel: Fax: Page 6 Hornbuckle is the trading name of The Hornbuckle itchell Group Limited, which is authorised and regulated by the Financial Conduct Authority. H APR15

7 Sending your form Use the label below to send your completed form to our Pension Access Team. Please cut around the dotted line and securely attach the label to an envelope so it does not come off during transit. Alternatively you can write this address on an envelope and send to us. Please cut along the dotted line Pension Access Team Hornbuckle Tyman House 42 Regent Road Leicester LE1 6J Page 7

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