CanRetire. Application new plan(s) (for single contributions and transfers only) Pension Investment Plan. Flexible Drawdown Plan

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1 CanRetire Application new plan(s) (for single contributions and transfers only) Please enter the Personal Example reference number for your chosen product choice(s) FTIP Pension Investment Plan Flexible Drawdown Plan Fixed Term Income Plan Lifetime Annuity (including Enhanced) P I P F D P F T I Example: E D 2 2 Your plan(s) will be set up on the basis outlined in the Personal Example(s) referenced above or any subsequent Personal Example(s) issued by. Important notice Please answer all questions honestly and take reasonable care to make sure that those answers are correct. Failure to answer the questions honestly or correctly, could mean your plan may be cancelled from the start or, if applicable, your claim rejected or not fully paid.

2 Contents Please ensure you read/complete the pages/sections relevant to your application. + Part Enhance Lifetime Page Pension Investment Plan () Flexible Drawdown Plan () Fixed Term Income Plan (FTIP) Lifetime Annuity () Part 1. Important notes for completing this form Part 1a. Personal details Part 1b. Payment details for UK bank accounts Part 1c. Your death benefit preferences Part 1d. Your allowances Part 1e. Source of funds single contributions Part 1f. Source of funds for transfers Part 2. Payments for arranging your plan(s) Part 3. Lifetime Annuity or Enhanced Lifetime Annuity application Part 4. Data protection notice and Scheme Administrator s statement Part 5. Declarations For adviser use only Part 6. Professional adviser details Part 7. Anti-money laundering verification of identity private individual

3 Part 1 Important notes for completing this form FTIP Court orders Divorce/Dissolution of a civil partnership Please note that we cannot accept: Funds that are subject to existing or proposed pension sharing orders, or attachment (earmarking) orders and other receiving orders Pension credits (or such funds) arising/derived from pension sharing orders A transfer-in payment from a qualifying recognised overseas pension scheme Notes In this application form, references to, we, us, our shall mean Limited. Basis of your purchase Your decision to purchase your CanRetire plan(s) will have a long-term impact on your lifestyle for the foreseeable future and probably the rest of your lifetime. We strongly believe that such decisions should only be made after discussing your options with an authorised professional adviser to ensure that you have made the most suitable choice. You can also take advantage of the government s free guidance guarantee service, Pension wise. Your money. Your choice. although this is no substitute for independent professional advice. Please tick this box to confirm you have used the Pension wise service. Please tick this box to confirm you have received advice from an authorised professional adviser We do not accept applications for the Pension Investment Plan or Flexible Drawdown Plan unless you have received advice from a professional adviser. Now that you have chosen to buy a CanRetire plan(s) with Limited, please complete this application form. Please see below a list of everything we need for us to set up your plan(s). We will only accept applications with original signatures. We cannot accept photocopies, certified copies or applications via fax/ . will only start your plan(s) once all our requirements have been met. Please complete this form in BLACK INK ONLY using BLOCK CAPITALS and INITIAL AND DATE ANY ALTERATIONS. Please do not use correction fluid. If you are using this application to take retirement benefits from your pension savings, you will need to read our guide entitled Calculating your lifetime allowance (form 8388) to make sure you can make the declarations under My lifetime allowance in the Declarations section before signing this application form. HM Revenue & Customs Statement It is a serious offence to make a false statement. The penalties are severe and could lead to prosecution. Please complete this application where indicated and return with the following: Proof of date of birth and change of name (including marriage, divorce, civil partnership, deed poll) for each applicant and annuitant. P45 (original parts 2 and 3 for the current tax year) If not available, we will apply the emergency tax code and request the correct tax code from HM Revenue & Customs. Lifetime Allowance Protection Certificate (if applicable) Identity verification requirements If you are making any single contributions to a Pension Investment Plan, please note that in order to comply with our regulatory obligations we may require documents to verify the identity and residential address of individual planholder. In the absence of such documents, we may use credit reference agency searches to verify the identity and address. Please note this will not affect anyone s credit rating. We reserve the right to ask for further documentation to confirm your identity. Enclosed Please return all correspondence to: New Business, Limited, Place, Potters Bar, Hertfordshire EN6 5BA. 3

4 Part 1a Personal details FTIP Title (Mr, Mrs, Miss, Ms, other) Applicant Surname Forename(s) in full Permanent residential address Telephone numbers (including STD codes) Daytime Evening Mobile address Date of birth (DD/MM/YYYY) Gender Male Female National Insurance Number Marital status Single Married/ Civil partner Divorced/ Dissolved Widowed Occupation Your yearly income before taxation Please indicate which income band applies to you. Under 10,000 10,000 to 19,999 20,000 to 39,999 40,000 to 49,999 50,000 or more Status Please indicate from the categories listed, which applies to you. If more than one could apply, select the one that is your main source of income: 1. Employed A person chargeable to tax in the tax year of assessment under Chapter 2 of Part 2 of the Income Tax (Earnings and Pensions) Act 2003 in respect of employment. 2. Pensioner A person chargeable to tax in the tax year of assessment under Part 9 of the Income Tax (Earnings and Pensions) Act 2003 in respect of a pension. 3. Self-Employed A person chargeable to tax in the tax year of assessment under Chapter 2 of Part 2 of the Income Tax (Trading and Other Income) Act 2005 in respect of annual profits or gains arising or accruing from any trade, profession or vocation carried on by that person. 4. Child under age 16 not applicable for this application: 5. Caring for one or more children aged under Caring for a person aged 16 or over 7. In full time education 8. Unemployed 9. Other 4

5 Part 1a Personal details (continued) Second annuitant (only applicable for Lifetime Annuity or Enhanced Lifetime Annuity applications) Title (Mr, Mrs, Miss, Ms, other) Surname Forename(s) in full Permanent residential address Telephone numbers (including STD codes) Daytime Evening Mobile address Date of birth (DD/MM/YYYY) Gender Male Female National Insurance Number Please indicate relationship to applicant Relationship to applicant Spouse Civil partner Other 5

6 Part 1b Payment details for UK bank accounts Please complete in BLOCK CAPITALS FTIP Please complete this section if you want to take regular payments from your plan(s) FTIP Payments from your plan(s) We will set up the amount and frequency of your payments on the basis laid out in your Personal Example, including any pension commencement lump sum payments. If you require a different amount or a different frequency, please contact our New Business Team (see details on page 3). can only make payments to a bank/building society account held in your name or where you are a joint account holder. Payments cannot commence until funds are received. For FTIP or, payments cannot commence until all funds are received. Where we are expecting funds from more than one source, we will set up the plan on receipt of the first source of funds. Please advise the day of the month you would like your withdrawals to be paid (only available 1st to 28th). Your first payment will be made at the next available date. This must be at least two weeks after receipt of your funds FTIP Name of bank/building society you want us to send the payments to Account name Account number (must be 8 digits, including any leading zeros) Sort code Roll number (for building society accounts) FTIP Pension Commencement Lump Sum (PCLS) Any pension commencement lump sum will be paid by direct credit into your account shown above. Should you require payment of the pension commencement lump sum to be made into any other account on which you are a named account holder, please complete the section below. Name of bank/building society to which pension commencement lump sum is to be paid Account name Account number (must be 8 digits, including any leading zeros) Sort code Roll number (for building society accounts) will only pay monies to a bank/building society account held in your name. 6

7 Part 1c Your death benefit preferences FTIP FTIP has full discretion as to the type of benefit paid on your death from your, or FTIP. This can be as a lump sum death benefit or a pension death benefit (by means of a flexi-access drawdown plan): If we decide to pay a lump sum death benefit, we also have full discretion as to who will receive that benefit but we will take your wishes into consideration when making our decision. If we decide to pay a pension death benefit, we will pay the person(s) you have nominated. Only you can change this so it is very important for you to amend your nomination if circumstances change. Please complete the table This will give us an indication of how you would like us to pay any death benefits from your, or FTIP and who you would like us to pay. Insert plan from which the benefit is to be paid, or FTIP Select the type of death benefit you would like us to pay and insert the share to be paid in that way to the beneficiary. Beneficiary name (Please also provide full details in the separate Beneficiary boxes on page 8) Benefits from each plan must total 100 of Lump sum death benefit of fund for Pension death benefit If you have selected guaranteed income payments or an annuity protection lump sum has full discretion as to who will receive the death benefit from your lifetime annuity plan but we will take your wishes into consideration when making our decision. Please complete the table This will give us an indication of who you would like us to pay any death benefits to from your lifetime annuity plan. Type of death benefit Beneficiary name (Please also provide full details in the separate Beneficiary boxes on page 8) Insert the share to be paid to the beneficiary Guaranteed income payments Annuity protection lump sum Note: Joint life cases Do not insert the second annuitant here as the lump sum is payable after both annuitants have died.) Each benefit must total

8 Part 1c Your death benefit preferences (continued) FTIP If you require more than four beneficiaries please use a copy of this page Please provide details of each beneficiary shown in the tables Beneficiary 1 Beneficiary 2 Title (Mr, Mrs, Miss, Ms, other) Surname Forename(s) in full Permanent residential address Relationship to you Date of birth (DD/MM/YYYY) Beneficiary 3 Beneficiary 4 Title (Mr, Mrs, Miss, Ms, other) Surname Forename(s) in full Permanent residential address Relationship to you Date of birth (DD/MM/YYYY) Please insert any additional information you would like us to consider. Where has discretion as to who will receive payment of the death benefits, we will take your preferences into account but are not bound by them. This record of your preferences is confidential during your lifetime and it will not be made known to the person(s) you have named. You can change your preferences at any time. Please contact us for a CanRetire, Your death benefit preferences form. 8

9 Part 1d Your allowances FTIP Depending on how you are using your CanRetire plan(s), you may be subject to one or both of the following limits. Money Purchase Annual Allowance Applies if you are/your employer is making a personal contribution to the Pension Investment Plan From 6 April 2015 there are new, flexible ways of accessing money purchase pension savings, called flexi-access. If you flexi-access those savings, you will be subject to a reduced annual allowance of 10,000, on the future contributions paid by or in respect of you, to all the money purchase pension schemes you belong to. This is called the money purchase annual allowance (MPAA). The reduced 10,000 limit usually only applies from the date you take your first flexi-access payment. How you will know when the MPAA rules apply to you and what you must do Your pension scheme administrator must notify you within 31 days of taking a benefit in such a way that triggers the MPAA, that the MPAA applies to you and the date from which it applies. You must then pass this information on to every money purchase pension scheme in which you are an accruing member, within 91 days of being notified. (You are classed as an accruing member at any time on or after triggering the MPAA, that you or someone else including your employer, is already paying or pays a contribution to a money purchase pension scheme for your benefit.) Are you already subject to the 10,000 Money Purchase Annual Allowance? Yes No If yes, please insert the date the MPAA first applied to you, as notified to you by the scheme administrator. (DD/MM/YYYY) FTIP Lifetime Allowance Applies if you are taking any new benefits now from your plan(s), including: Annuity income, with or without a tax-free Pension Commencement Lump Sum (PCLS) New designation to income drawdown in or FTIP, with or without receiving an income or a tax-free PCLS Taxable lump sum withdrawal(s), each called an Uncrystallised Funds Pension Lump Sum (UFPLS) from You will be asked to make a declaration in Part 5 of this application (see About my lifetime allowance ) confirming that together with the benefits you are taking now, the total value of benefits you have taken so far from UK registered pension schemes is within the standard lifetime allowance of 1,000,000, or your personal allowance if this is higher (or lower) than the standard. Our leaflet, Calculating your lifetime allowance (form 8388) explains what the lifetime allowance is, how it could affect you (tax charges) and what you should do to make sure that you can make the declaration in this form. If you have protection from the lifetime allowance charge, please indicate the type of protection you currently hold and send us a copy of the certificate issued to you by HMRC: Enhanced protection Primary protection Lifetime allowance factor Fixed (2012) protection Fixed (2014) protection Individual protection Applies if you are taking regular taxable lump sums withdrawals (UFPLS) from the Pension Investment Plan We can only pay regular UFPLS withdrawals to you if (and for as long as), you have enough personal lifetime allowance remaining. So, before we begin paying you we will need to know how much of your personal allowance you have used up. Our leaflet, Calculating your lifetime allowance (form 8388) will help you to work this out. Insert the total percentage of your lifetime allowance that you have used to date. Do not include the benefits you are taking now with. Each time we pay a regular UFPLS to you, we will tell you the percentage of lifetime allowance you have used. We will tell you if it appears that you are close to using up your allowance and will stop the payments whilst we check this with you. Whilst we are paying regular UFPLS withdrawals to you, you must tell us as soon as you take/intend to take benefits in any other registered pension schemes you belong to, or if you think you are close to using up all your lifetime allowance. You will be required to make additional declarations in Part 5 of this application (see, I am taking regular lump sum withdrawals from the Pension Investment Plan ), confirming that you will do this. Failure to tell us could result in one or more UFPLS being an unauthorised payment and you will be liable to pay the tax charges that apply. Please note that you cannot take an UFPLS if, immediately before the payment is made, you have: (a) protected lump sum rights of more than 375,000 under primary or enhanced protection; or (b) a lifetime allowance enhancement factor where the amount of your remaining lump sum allowance is less than 25 of the amount of the proposed payment. 9

10 Part 1e Source of funds single contributions For single contributions into Pension Investment Plan only Gross single contribution before deduction of basic rate income tax From you From your employer Total Your employer s contribution If your employer is contributing, please insert their name and address Employer s contact name/department Please indicate how payment will be made: Bankers draft Bank/Building society cheque Electronic transfer Employer s telephone number Source of your contribution Please indicate the source of your contribution. Salary/Bonus Divorce settlement Gift * Inheritance * Lottery/Betting win Policy claim/maturity * Compensation payment Sale of company * Sale of investments Savings * * Sale of property Other (please give details below) * * * Please provide more information on how the funds are made up Name of bank/building society Please provide details of the bank/building society account from where the contribution originated if paying by electronic transfer. Account name Account number (must be 8 digits, including any leading zeros) Sort code Roll number (for building society accounts) Please ensure any building society cheque or bankers draft is made payable to Limited and includes the name of the client or we will require further proof of where funds have originated. 10

11 Part 1f Source of funds Transfers FTIP If purchase money is coming from multiple sources please use a copy of this page For transfers from your existing pension arrangements (including existing pension plans) Full name of pension scheme Existing providers address (including postcode) Full name of current provider Existing policy/plan number(s) Approximate fund value to be paid to Does this represent the full value of your existing policy/plan? Yes No Are these funds? Crystallised Uncrystallised Combination of both If uncrystallised, please indicate how much (if any) PCLS, you want to pay Please indicate which plan you would like us to allocate these funds to Pension Investment Plan Flexible Drawdown Plan or (maximum 25) Please note that can only accept uncrystallised funds where no PCLS has been taken Fixed Term Income Plan Lifetime Annuity/ Enhanced Lifetime annuity Please note that can only accept uncrystallised funds where no PCLS has been taken For transfers from your existing pension arrangements (including existing pension plans) Full name of pension scheme Existing providers address (including postcode) Full name of current provider Existing policy plan number(s) Approximate fund value to be paid to Does this represent the full value of your existing policy/plan? Yes No Are these funds? Crystallised Uncrystallised Combination of both If uncrystallised, please indicate how much (if any) PCLS, you want to pay Please indicate which plan you would like us to allocate these funds to Pension Investment Plan Flexible Drawdown Plan or (maximum 25) Please note that can only accept uncrystallised funds where no PCLS has been taken Fixed Term Income Plan Lifetime Annuity/ Enhanced Lifetime Annuity Please note that can only accept uncrystallised funds where no PCLS has been taken 11

12 Part 2 Payments for arranging your plan(s) FTIP Please confirm you have received advice from a professional adviser regarding the purchase of your Pension Investment Plan or Flexible Drawdown Plan. Do you want to deduct the payment of an adviser charge to pay your professional adviser for advice in respect of this application? If Yes, please complete the section below. Yes Yes No Initial adviser charge is only able to deduct and pay an adviser charge for advice or services given to you by your professional adviser if it is wholly connected to the purchase of this plan and is appropriate to the advice and service the adviser has provided you with in relation to this purchase. Adviser charges can be paid when you start your plan and on an ongoing basis. We can only facilitate these payments if you instruct us to do so by completing this form. Please note: Whether deduct and pay any adviser charge is at our discretion and we will notify you in the event we decide not to. There may be instances where need to query the level of adviser charge with your adviser, in which case we may notify and get further instructions from you. If you cancel your plan during your cancellation period then the money returned will include any adviser charge you have asked us to pay. Ongoing adviser charge How often will ongoing adviser charges be taken? Monthly Quarterly Half-yearly Annually When would you like the ongoing adviser charge deductions to start from? Please enter a month and year. How often will ongoing adviser charges be taken? Monthly Quarterly Half-yearly Annually When would you like the ongoing adviser charge deductions to start from? Please enter a month and year. Commission payments If advice has not been given in respect of this purchase your intermediary may have agreed with you to receive commission for the services provided. Adviser remuneration summary Initial adviser charge based on Percentage Percentage of Annual Monetary of purchase money purchase money Monetary Percentage amount Percentage (before PCLS, (after PCLS, amount of fund of each of purchase if applicable) if applicable) value, payment money, OR OR OR OR Ongoing adviser charge based on Initial commission based on Monetary amount FTIP Please indicate from where should the Initial Adviser Charge be taken The total purchase money (before PCLS) From the PCLS itself Total purchase money (after PCLS) How would you like the initial adviser charge deducted? Before setting-up your plan (not available if there are any net contributions into ) After setting-up your plan 12

13 Part 3 3a Basis of annuity What type of annuity is required? Lifetime Annuity or Enhanced Lifetime Annuity application Lifetime Annuity OR Enhanced Lifetime Annuity* * Before completing this application for an Enhanced Lifetime Annuity, you should have been accepted for an enhancement. A Personal Example would have been sent to you, the quote number will start with a G or M. If a Personal Example has not been sent to you and you would like to consider this, please contact us. Notes: The Personal Example reference number shown on the front of the document will form the basis of the annuity. This number can be found on the top left hand side of the Personal Example (quote). If you require a Personal Example on a different basis, please contact us. Further details about the different options can be found in the information we have sent to you. 3b Benefit start date will only pay benefits once all requirements have been satisfied, and the transfer payment(s) received, and we will assume this is the date you wish benefits to commence unless a different date is specified below. Should you wish to select the date for taking the benefits, please insert your selected date (must be a future date). Date (DD/MM/YYYY) 13

14 Part 3 Lifetime Annuity or Enhanced Lifetime Annuity application (continued) Please only complete this page if you are applying for an Enhanced Lifetime Annuity. 3c Your health Doctor s details Name, address (including postcode) of your personal or regular doctor who holds your medical records First annuitant (applicant) Second annuitant (For joint life cases) Telephone number Name, address (including postcode) of your previous doctor, if you have changed doctors in the last 6 months Telephone number Other enhanced annuity details Do you or the second annuitant have or are you currently applying for any other Enhanced Lifetime Annuity or Enhanced Scheme Pension with Canada Life in your name(s)? If Yes, please give details Yes First annuitant No Yes Second annuitant No Access to medical records " Procedures for access to reports (Your rights) Under the Access to Medical Reports Act 1988 and the Access to Personal Files and Medical Reports (Northern Ireland) Order 1991 and the Access to Health Records and Reports (Isle of Man) Act 1993 reserves the right to apply for a medical report from any doctor who has at any time attended you. The declaration gives us your consent to apply for such a report if we need to. Your rights: You do not have to give your consent but, without it, will not be prepared to accept your request. If you do give your consent, you can indicate whether or not you wish to see any report before it is sent to us. If you indicate that you do wish to see any report we will notify you if we apply for one, and will inform the doctor of your wishes. You will then have 21 days to contact the doctor to arrange to see the report. If you do see the report, the doctor must obtain your consent before sending it to us. You have the right to request that the doctor amends any part of a report you consider incorrect or misleading, and can attach your written views on any part the doctor refuses to amend. The doctor does not have to let you see any part of a report that he/she considers would be likely to cause serious harm to the physical or mental health of yourself or If you indicate that you do not wish to see any report: The doctor can forward it to us immediately and we should be able to process without delay. You can, however, still change your mind at any time within six months and notify the doctor that you wish to see the report. If the doctor has already forwarded the report to us, he/she will send you a copy and, if not, he/she will give you 21 days to arrange to see it. If you indicated that you do wish to see any report: This may delay the processing. The doctor is allowed to charge you a fee to cover the cost of supplying you with the report. You should follow the procedures outlined below. others, or that would indicate his/her intentions towards you. He/she also does not have to let you see any part that would be likely to disclose information about, or the identity of, another person who has supplied information about you, unless that person has consented or the information relates to, or has been supplied by, a health professional caring for you. If the doctor does not let you see any part of the report he/she must notify you of that fact. If you have any questions about your rights under the act referred to above or questions relating to the process of getting, assessing or storing medical information, please write to the Chief Underwriter at. 14

15 Part 4 Data protection notice and Scheme Administrator s statement FTIP Data protection notice Any personal information provided to as data controller will be treated in accordance with the Data Protection Act By signing this form you consent to using and sharing your personal information as set out in this notice including, without limitation, the processing of sensitive personal data. If submitting personal information about another person, by signing this form you confirm that you have their consent to provide such information to and for their information to be used as set out in this notice. Using personal information uses personal information to undertake any activity relating to its policies, products and services and, where relevant, to process applications, set up and administer policies, products and services and handle any claims. Given the global nature of s business, it may be necessary to transfer information to countries outside the European Economic Area EEA in order to provide s services. Sharing personal information may share personal information: with other group companies including those outside the EEA; with any of its or their service providers, reinsurers and regulators; with other insurers and government agencies, including without limitation Her Majesty s Revenue and Customs HMRC ; with other companies, organisations and associations and credit reference agencies in order to prevent, detect or investigate crime; for employer-related products and services, with the employer, the trustee(s) and their agents; for insurance related products, with your own doctor or relevant medical professionals; and/or in any circumstances if permitted or required to do so by law or if has consent to do so. Accessing personal information A person whose personal information is held by has various rights including the right to: have any incorrect personal information corrected; and/or access the personal information holds for which a fee may be charged. To do so and/or if you need more information, please contact at: Limited Place Potters Bar Hertfordshire EN6 5BA. Telephone Scheme Administrator s statement is the Scheme Administrator of the CanRetire Personal Pension Scheme (the Scheme). will administer the Scheme in accordance with the Scheme rules which may change from time to time to meet the terms of UK tax and social security laws. You can ask for a copy of the current rules of the Scheme. 15

16 Part 5 Declarations FTIP Declarations that all applicants must make to FTIP Joining the CanRetire Personal Pension Scheme I confirm that I am resident in the United Kingdom (UK). If I am not a member already, I apply to become a member of the CanRetire Personal Pension Scheme (the Scheme) and agree to be bound by the rules of the Scheme. I have read the Scheme Administrator s statement on page 15 and I understand that I can ask for a copy of the rules of the Scheme. My application I am applying for the plan(s) indicated on the front page of this application. I confirm that in the period before the acceptance of this application, I will inform of any matter or fact that would make the answers to the questions in this application incorrect or untrue. I confirm that I have read the Data protection notice on page 15 and I am satisfied that my personal information will be handled appropriately, in accordance with the notice. I accept that in order to comply with regulatory obligations, may require documents to verify my identity and residential address. In the absence of such documents, may use credit reference agency searches to verify my identity and address. I understand that this will not affect my credit rating and that reserves the right to ask for further documentation to confirm my identity and address. Entitlement, bankruptcy and court/receiving orders I confirm: I am entitled to the proceeds of the funds listed in the Source of Funds section of this application. I have not been declared bankrupt prior to 29 May 2000; and No court or receiving orders currently apply or are about to be made against the funds (including on divorce or the dissolution of a civil partnership). About the plan(s) I have applied for I understand that the following shall constitute the contract between me and : (a) this application form; (b) the provisions of each policy (plan) issued, the policy (plan) schedules and any endorsements; (c) the Personal Example(s) referenced above or any subsequent Personal Example(s) issued after has processed this application. (d) in the case of an enhanced lifetime annuity, the confirmation schedule where one has been issued or any other medical information relied upon by Canada Life in any circumstances. The contract(s) will be subject to and governed by the laws of England and Wales. My death benefit preferences (section 1c) I understand that the payment of the type of benefit I have indicated under my, and/or FTIP is at the complete discretion of and that if a lump sum death benefit is payable, also has discretion as to who will receive payment. I understand that has discretion as to who will receive payment of the death benefit provided by my lifetime annuity plan. On exercising discretion as to who will receive payment of a death benefit, I accept that does not have to pay the person(s) I have named, but I would like to take my preferences in section 1c into consideration when making the decision. Declarations for making payments to CanRetire Plan(s) I am transferring in funds from external provider(s) To external (current) provider(s) I would like to take benefits from the plan(s) listed in the Source of Funds section of this application. I will be solely responsible for any additional tax charges or any penalties which arise if the information provided in this application is incorrect or if I have failed to comply with any aspect of this application. FTIP I authorise and instruct you to transfer the funds from the plan(s) as listed in the Source of Funds section of this application directly to. 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 losses and/or expenses which are the result and which a reasonable person would consider to be the foreseeable 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 any plan. I authorise you to release all necessary information to to enable the transfer of funds to. I authorise you to obtain and release to the professional (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, s responsibility is limited to the return of the total payment(s) to the current provider(s). Where the payment(s) made to represent(s) all of the funds under the plan(s) listed in the Source of Funds section 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. Where the payment(s) made to represent(s) part of the funds under the plan(s) listed in the Source of Funds section of this application, then payment made as requested will mean that I shall no longer be entitled to receive pension or other benefits from that part of the plan(s) represented by the payment(s). In addition, I accept responsibility in respect of any claims, losses and expenses that and the current provider(s) 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. FTIP If an employer is paying contributions to any of the plans as listed in the Source of Funds section of this application, I authorise you to release to that employer any relevant information in connection with the transfer of funds from the relevant plan(s). To FTIP I would like to transfer the funds held on my behalf in the plan(s) listed in the Source of Funds section of this application to the Scheme. I authorise to obtain from and release to, the professional adviser, the external provider(s) and any employer named in this application, all necessary information to enable the transfer of funds to. Please place all funds that you receive from the sources listed in the Source of Funds section of this application into a Pension Holding Bond under the Scheme, as appropriate, to be applied to the plan(s) in the way shown in my accepted Personal Example(s), or If I am transferring a capped drawdown arrangement(s) to a flexi-access drawdown arrangement(s), I will be subject to the Money Purchase Annual Allowance (MPAA) from the date of my first flexi-access payment. I am/my employer is making a contribution to the Pension Investment Plan I understand that I will only receive tax relief on personal contributions to all the registered pension schemes I belong to in each tax year, on total contributions up to the greater of 3,600 gross and 100 of my relevant UK earnings. I confirm that I am entitled to tax relief on my personal contribution to the Scheme and I will notify if, and as soon as I become aware that I am not entitled. I accept that will have to refund any amount that does not qualify for tax relief. I confirm that I have sufficient Annual Allowance or Money Purchase Annual Allowance, to support the contribution(s) being made by me, my employer or both, as shown in Part 1d of this application. I confirm that the contribution(s) shown in Part 1e (whether paid by me, my employer or both), are not being made directly or indirectly from any pension commencement lump sum (PCLS) I have taken, nor in anticipation of any PCLS I intend to take. 16

17 Part 5 Declarations (continued) FTIP Declarations if taking payment(s) from CanRetire plan(s) now and/or investing in drawdown for the first time FTIP My request for payment and discharge to Once all funds have been received or any selected benefit start date has been reached (whichever is the later), please provide me with the benefits on the basis shown in my accepted Personal Example(s). I understand that once this application has been processed, will provide a subsequent Personal Example setting out the actual amount(s) of money that I will receive or has been invested in drawdown, as appropriate to my application. I am taking a pension commencement lump sum I confirm that it is not my intention to (directly or indirectly) use my pension commencement lump sum to pay a contribution to any UK registered pension scheme, whether the contribution is paid by me, my employer or both. Access to medical reports declaration may obtain medical information from any Doctor who, at any time, has attended me/us, about anything that affects my/our physical or mental health and I/we authorise the giving of such information. This information can also be used to maintain management information for business analysis. By signing this declaration I am/we are allowing to process my/our application using the information that I/we have given. The applicant and any Second Annuitant must tick one of these boxes: First annuitant (tick one) I do not want to see the report before it is sent to. I do want to see the report before it is sent to. Second annuitant (tick one) I do not want to see the report before it is sent to. My lifetime allowance I confirm that when combined with the benefits I am taking or designating to drawdown now, the value of all the benefits I have already taken from UK registered pension schemes (including any transferred to a qualifying recognised overseas pension scheme) is below the current standard Lifetime Allowance limit of 1,000,000, or my personal lifetime allowance if this is higher (or lower) than the standard.** **If you do not know how to calculate the value of your benefits, for lifetime allowance purposes, please refer to your professional adviser or contact us. I do want to see the report before it is sent to. Fund switch authority I give permission to the professional adviser named in this application to undertake unit fund switches on my behalf until further notice. Yes No I am taking regular lump sum withdrawals from the Pension Investment Plan I will inform immediately if, at any time during a period that I am receiving regular payments of uncrystallised funds pension lump sums from my Pension Investment Plan: (a) I receive payment of any new benefits or designate funds to income drawdown for the first time (known as benefit crystallisation events ), under any other registered pension scheme(s); (b) I have reason to believe that receipt of a further regular lump sum payment from would take me over my remaining lifetime allowance; or (c) I lose or obtain lifetime allowance protection. If I am unable to inform in time to stop a further regular lump sum payment from being made, I accept that I will be responsible for paying the amount of any tax charges that apply. I am applying for an Enhanced Lifetime Annuity (Applicant & any Second Annuitant to read & complete) Where I/we have not completed this application myself/ourselves, I/we have checked the answers that have been completed on my/our behalf. Where has requested confirmation of any relevant information from my/our doctor(s) and this has not been received within three months from the date of the request, this could result in reducing the amount of income payable to me or the second annuitant. The total purchase money for all Enhanced Lifetime Annuities and Enhanced Scheme Pensions in my/our names does not exceed 1,000,000. If this limit is exceeded this could result in reducing the amount of income payable to me or the second annuitant. By signing this declaration, I/we give my/our explicit informed consent for to use my/our sensitive personal data. A copy of this consent can be treated as the original. FTIP All applicants Adviser charges and advice I consent to any adviser charge deductions as set out in Part 2 of this application. I confirm that any adviser charges paid on my behalf by on the initial set up of the plan(s): are wholly connected to the purchase of the plan(s); and appropriate to the advice and service my adviser provided me in relation to the plan(s). If this is not the case I understand that some or all of the adviser charges and any pension commencement lump sum may become liable to a tax charge, which I may be responsible for. I confirm that I have not sought or received any advice from as to the merits or suitability of the choices I have made. Sign and date the application I have answered the questions and made the statements in this application honestly. I have taken reasonable care to make sure those answers are correct. I accept responsibility for any additional tax charges, penalties, claims, losses and expenses that 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. Applicant s signature (this box must be signed by the applicant) Date (DD/MM/YYYY) Enhanced annuity only Second annuitant s signature (if applicable) Date (DD/MM/YYYY) 17

18 For adviser use only Part 6 Professional adviser details FTIP Agency number, if known (You will find this on your statement. If you do not supply this information it may delay your payments) L Please make sure we have the correct address as we will confirm stages of our process via . address Professional adviser firm Name of person submitting the application Address (including postcode) Telephone number Fax number Regulatory body number For regulatory body reporting requirements please indicate, by ticking the box Advised independent restricted simplified basic Execution only Non-advised Tick the box if this is the first time you have placed business with. If you have ticked the box, to obtain our terms of business application form either phone us on or How would you like to be contacted for general correspondence? /Phone/Fax 18

19 For adviser use only Part 7 Details of individual (see explanatory notes) Full name of customer Anti-money laundering verification of identity private individual Current address Previous address if individual has changed address in the last three months Date of birth (DD/MM/YYYY) Confirmation I/We confirm that: (a) the information in the section above was obtained by me/us in relation to the customer; (b) the evidence I/we have obtained to verify the identity of the customer: meets the standard evidence set out within the guidance for the UK Financial Sector issued by Joint Money-Laundering Steering Group; or exceeds the standard evidence (written details of the further verification evidence taken are attached to this confirmation) (Tick only one) Signed Name Position Date (DD/MM/YYYY) Details of introducing firm (or sole trader) if different from Part 8 Full name of regulated firm (or sole trader) Regulatory body reference number Explanatory notes 1. A separate confirmation must be completed for each customer (such as joint holders, trustee cases and joint life cases). Where a third party is involved, such as a payer of contributions who is different from the customer, the identity of that person must also be verified, and a confirmation provided. 2. This form cannot be used to verify the identity of any customer that falls into one of the following categories: Those who are exempt from verification as being an existing client of the introducing firm prior to the introduction of the requirement for such verification. Those whose identity has not been verified by virtue of the application of a permitted exemption under the Money Laundering Regulations. Those whose identity has been verified using the source of funds as evidence. 3. This confirmation must carry an original signature, or an electronic equivalent. 19

20 Limited, registered in England no Registered office: Place, Potters Bar, Hertfordshire EN6 5BA. Telephone: Fax: Member of the Association of British Insurers. Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. This paper is made from recycled materials ID R

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