1.5 Do you have a National Insurance number? You can find this on a payslip or a letter from HMRC or DWP. Mobile

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1 The FundsNetwork Pension Uncrystallised Funds Pension Lump Sum withdrawal form Please complete the form in BLOCK CAPITALS using black ink. You should use this form to take an Uncrystallised Funds Pension Lump Sum from your FundsNetwork Pension. Your adviser will advise you if you are eligible for this product and what options are most suitable for you. When completed please return to FundsNetwork, PO Box 80, Tonbridge, TN11 9YA 1 Your details 1.1 Title Mr Mrs Ms Other: 1.2 Surname 1.3 First and other names in full 1.4 Date of Birth 1.5 Do you have a National Insurance number? You can find this on a payslip or a letter from HMRC or DWP. No Yes 1.6 Phone numbers Home Mobile What is your FundsNetwork Pension account number? 2 2 Transitional protection entitlements If you have successfully applied for any of the following types of transitional protections, please provide details below and enclose a copy of the relevant certificate(s) with this form. 2.1 Protection details Enhanced protection Primary protection Fixed Protection 2012 Fixed Protection 2014 Individual Protection 2014 If you have applied for a lifetime allowance enhancement factor due to a pension credit or transfers from an overseas scheme, please supply a copy of the relevant certificate issued by HMRC confirming this entitlement. Issued by Financial Administration Services Limited, authorised and regulated by the Financial Conduct Authority (FCA). FundsNetwork and its logo are trademarks of FIL Limited. Page 1 of 5 G

2 3 Lifetime allowance Please complete this section fully in order to assess how much lifetime allowance you have available in relation to this flexi-access drawdown request. Any omissions or exclusions may result in you becoming liable to tax charges. 3.1 Prior to this request have you received any pension income from any other sources? (E.g. annuity, income drawdown, employer pension) Yes No go to section Did you start receiving any of these pension benefits on or after 6 April 2006? Yes complete section 3.3 ONLY No complete section 3.4 ONLY 3.3 Please provide the percentage of the lifetime allowance available. % 3.4 What is the total current value of all your pensions already in payment before 6 April 2006? The pension value for income drawdown plans will be 80% of the maximum annual gross pension multiplied by 25. The pension value for defined benefits plans will be the maximum annual gross pension multiplied by 25. Please refer to examples below: Example 1 Pension Drawdown in payment before 6 April 2006 Maximum annual pension X 8 0 % = X 2 5 = Example 2 Pension in payment from defined benefit scheme before 6 April 2006 Maximum annual pension X 2 5 = Benefit details 4.1 How much do you wish to withdraw from your uncrystallised pension account All of my remaining uncrystallised account Part of my uncrystallised account OR % 4.2 Please select one of the following disinvestment options I confirm I have made the necessary amount of cash available Please pay the lump sum by proportionately selling units from each of the funds I am invested in Important information: 25% of the amount being withdrawn will be tax free, with the balance being taxed as income If this is your first withdrawal we will apply an emergency tax code, unless you provide us with your original P45 for the current tax year. Subsequent withdrawals, if applicable, will be taxed using the tax code provided to us by HMRC. This payment will reduce your annual allowance for money purchase pensions from 40,000 to 10,000 (if this is your first withdrawal) If you exceed your lifetime allowance, the excess lump sum will be subject to a 55% tax charge Page 2 of 5 G

3 5 Your bank details 5.1 Name of the bank or building society 5.2 Branch address. Care of and PO Box are not acceptable. Building number/name Street, city, county and country Postcode 5.3 Account name 5.4 Account number Sort code Page 3 of 5 G

4 6 Adviser details (this section should be completed by your adviser) 6.1 Full name of the adviser 6.2 Unique adviser number Consultant ID 6.3 FCA firm reference number FCA individual reference number I confirm that I am authorised to conduct this type of business I confirm that I have formally recommended my client to take an Uncrystallised Funds Pension Lump Sum. I confirm and consent to your reliance upon the fact, that I have verified the identity of the client named in section 1 in accordance with the Money Laundering Regulations and standards set in Guidance issued by the JMLSG. I confirm that I have provided my client with the FundsNetwork Pension Key Features Document, Terms & Conditions and the relevant Key Investor Information Documents and Fund Specific Information. 6.4 Adviser remuneration Initial fee Deducting Adviser Charges: All fees will be deducted from your client's FundsNetwork Pension cash account. If there is an insufficient balance, we will sell units from a nominated fund (if chosen) or the largest fund holding. Company Stamp Page 4 of 5 G

5 7 Declaration In relation to my application for the FundsNetwork Pension, I declare that: If applicable, I authorise you to deduct the lifetime allowance charge, if applicable, from my pension account on the date that the funds are designated. Where the sale of a fund with a Fund Manager s Sell Charge is required, I authorise you to sell enough of this fund to generate the amount required after those charges. Where a pension commencement lump sum is payable, that I will not be recycling the lump sum (as defined in Schedule 29 of the Finance Act 2004). I agree to pay my adviser an Initial Fee and/or an Ongoing Fee, if applicable, as stated on this application form and in accordance with the FundsNetwork Pension Terms & Conditions. For all fees I instruct FundsNetwork to deduct monies from the FundsNetwork Pension cash account or unit/shares from either a nominated fund or my largest fund holding to pay the fees. I understand that these fees will become irrevocably due and payable immediately on receipt of the monies by FundsNetwork and that FundsNetwork will then hold this money as agent of my adviser. I confirm that I have received a personalised illustration that shows the effect of the fees agreed on my investment. The details given on the application are correct and complete to the best of my knowledge and belief. I have received advice from an intermediary qualified to advise an Uncrystallised Funds Pension Lump Sum products. Your signature By signing here I confirm that I have read and completed all relevant sections as per the instructions on this form. Signature Date Page 5 of 5 G