Simple Investment SIPP Application Form

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1 Simple Investment SIPP Application Form

2 To London & Colonial Services Limited (London & Colonial): I hereby apply for a London & Colonial Simple Investment SIPP contract on the basis of the following information: Please answer all questions in full. 1. Your Personal Details Title Mr Mrs Miss Ms Other (please specify) First name Middle name(s) Surname Gender Address line one Address line two Town County Postcode / Country Male Female Marital status Single Married Civil Partner Separated Divorced Widowed National Insurance Number Date of birth D D M M Y Y Y Y Are you resident in the US for tax purposes? Are you a US citizen? Intended retirement age* Contact telephone number address Yes Yes No No *We will assume a retirement age of 65 if field left blank 2. Employment Status Employed Pensioner Self-employed Child (under 16) Caring for one or more person under 16 Caring for a person aged 16 or over In full-time education Unemployed Other

3 3. Adviser Details Please complete or ask your adviser to complete this section Full name of firm Name of Adviser Main business address Telephone Stamp if available Authorisation Body (eg FCA) Authorisation No. Advice given at point of sale to client that takes account of the intended underlying investment strategy and the advice has been followed. Advice not given at point of sale to client. Please state why in the following box. I/We certify that the evidence obtained to verify the identity of the customer meets the standard evidence set out within the guidance issued by the Joint Money Laundering Steering Group. Upon request I/we will supply evidence of the same to London & Colonial. Signed Print Name (on behalf of the Financial Adviser) Please Note: If you do not already have an agency with London & Colonial you will need to register on our website at

4 4. Adviser Charges Please only complete this section if you wish to pay your adviser charge from your Simple Investment SIPP funds. I wish to pay my adviser as detailed below. I confirm my Adviser has provided me with their schedule of fees and I understand that the following fee(s) will be payable: From my SIPP Initial: % OR (Based on the payments initially received and payable at outset) Annual: % OR (Payable annually in advance on each anniversary based on the fund value at the time) Additional Transfers: % OR (if applicable) Additional Single Contributions: % OR (if applicable) From my Investments - Where fees are facilitated by Investment Provider please refer to their terms and conditions Initial: Ongoing: % OR % OR 5. Components Please select your additional components for your SIPP Core Component - your SIPP investments are wholly held with one of our panel of investment providers. This is the default component and provides you with the services you need to set up and administer your SIPP. Your SIPP investments are wholly held with one of our panel of investment providers. Additional Investment Component (Annual component fee will apply) If you wish to invest with a nonpanel investment company - Please complete Section 7 Specialist Investment Component (Annual component fee will apply) Provides access to Peer-2-Peer Lending - Please complete Section 8 Benefits and Income Component (Annual component fee will apply) - Please complete Section 11

5 6. Core Component Investment 6.1 Platform Provider Panel Ascentric Cofunds Platform One UK Skandia AXA Elevate James Brearley Succession Transact True Potential Please enter your Account number if already set up 6.2 Execution Only Stockbroker Panel Stocktrade SVS Securities Please enter your Account number if already set up 6.3 Offshore Bond Skandia International Prudential International Please enter your Account number if already set up 6.4 Discretionary Fund Manager Brewin Dolphin (please complete Section 6.5.2) TAM Asset Management Rowan Dartington Signature Whitechurch Securities Please enter your Account number if already set up 6.5 Investment Trader Please confirm who will make investment decisions and do the trading for your chosen Investment Partner Financial Adviser Member Investment Manager/DFM (please complete section 6.5.2) Please confirm Investment Manager/DFM information Investment Manager Individual Name Company Name Authorisation Body (e.g. FCA)/Authorisation Number Correspondence Address Postcode/Country Contact Address Contact Telephone Number The appointment of the Investment Manager / DFM will be subject to the agreement of London & Colonial.

6 7. Additional Investment Component 7.1 If you wish to invest with a non Investment Partner please complete the following details: Where would you like us to place your initial investment Non Partner Investment Platform Provider Non Partner Execution Only Stockbroker Non Partner Discretionary Fund Manager (please complete section 7.2.2) Non Partner Offshore Bond Provider Directly with the Fund Provider or Unit Trust/ OEIC Companies Investment Provider Name Correspondence Address Postcode/Country 7.2 Investment Trader Please confirm who will make the investment decisions and do the trading for your chosen investment partner Financial Adviser Member Investment Manager/DFM (please complete section 7.2.2) We will invest the maximum available (subject to liquidity requirements) with your chosen Investment Provider. Please contact us if you wish to amend amount to be invested. All investment payments to UK Investment Providers will be made by BACS transfer. If you require same day payment by CHAPS, please tick the following box. All payments by CHAPS or to Non UK Investment Providers will incur an additional bank payment charge, please refer to our current Schedule of Fees for current banking charges. Please complete as much of the application form as you can and send it to us, together with a copy of the Investment Manager s or Investment Provider s terms of business and application form(s), at London & Colonial, Perrymount Road, Haywards Heath, West Sussex, RH16 3DN. We will fully complete the application form and return it to your chosen investment provider Please confirm Investment Manager/DFM information Investment Manager Individual Name Company Name Authorisation Body (e.g. FCA)/Authorisation Number Correspondence Address Postcode/Country Contact Address Contact Telephone Number The appointment of the Investment Manager / DFM will be subject to the agreement of London & Colonial.

7 8. Additional Investment Component Please open an account with Peer-to-Peer lender RateSetter on my behalf We will invest the maximum available (subject to liquidity requirements) with your chosen Investment Provider. Please contact us if you wish to amend the amount to be invested. All investment payments to UK Investment Providers will be made by BACS transfer. If you require same day payment by CHAPS, please tick the following box. All payments by CHAPS will incur an additional bank charge. Please refer to our current Schedule of Fees for current banking charges. 9. Disinvestment Instruction In order to process automatic payment of your Simple Investment SIPP income, or to take automatic payment to cover the scheme fees, please select one of the following options for how you would like us to proceed. Additional Investment Provider charges may apply for some or all of these options below. Full details are available directly from your chosen Investment Provider. We will automatically carry out disinvestment instructions on your behalf based upon your choice below. Disinvest proportionally from each fund held with the Investment Provider (i.e. 1 fund makes up 35% of portfolio then 35% of amount required taken from that fund). Take from the largest fund held with the Investment Provider (i.e. 1 fund makes up 35% of portfolio then 100% of amount required will be taken from that fund). Take from the Investment Provider s cash account first, then any remainder equally across all funds. Take from the Investment Provider s cash account first, then any remainder proportionally from each fund. Request funds directly from DFM.

8 10. Declarations If my application is accepted, I undertake to be bound in all respects by the rules of the SIPP in force from time to time. I hereby request London & Colonial to accept investment instructions from my Financial Adviser indicated in Section 3 or from the Investment Manager indicated in Section 6 or Section 7. I acknowledge that the total contributions to all registered pension schemes to which I am entitled to tax relief will not exceed the higher of: 1. 3,600 Or 2. My Relevant UK Earnings for that tax year, but not exceeding the Annual Allowance for the tax year. (Your Relevant UK Earnings are generally your earnings subject to UK Income Tax). I agree that I will inform London & Colonial if an event occurs as a result of which I will no longer be entitled to relief for my contributions. I will inform London & Colonial of such an event no later than: 1. the 5 April in the tax year in which the event referred to occurs; and days after the occurrence of the relevant event. I agree that I will inform London & Colonial within 30 days in writing if: 1. There is a change in my residency status 2. There is any change in my name or permanent residential address I agree that I will inform London & Colonial within 91 days in writing if I become subject to HM Revenue & Customs Money Purchase Annual Allowance rules. I consent to London & Colonial using any personal information supplied on this application or obtained from any third party to be used for the administration of my SIPP. I authorise London & Colonial to pass my personal information to: 1. Any Professional Financial or Investment Adviser(s) which I have nominated on this application form or in any associated correspondence; and 2. Any necessary third party in connection with administering my SIPP 3. Any regulatory authorities or to any other third parties under pensions regulations and/or to comply with any other legal requirements.

9 I consent to London & Colonial providing any relevant information related to my SIPP to any other Pension Scheme Trustees, Administrators, Practitioners, Insurers or Pension Providers when required to do so. I consent to London & Colonial performing electronic searches on me to verify my identity for Anti Money Laundering purposes as and when may be required. I request and consent to the payment of the transfer value(s) from my previous scheme(s), as indicated in Section 14 to the SIPP. I understand that after such payment neither I nor my spouse, civil partner or dependants will have any entitlement to benefits under the scheme(s) indicated in section 14 to which the transfer payment relates. I hereby agree to be responsible for any, claims, losses, costs, charges or expenses which may be raised against London & Colonial or incurred by London & Colonial in consequence of London & Colonial acting on instructions received by facsimile or from the address stated on this application form and/or provided by me. is not a secure method of communication and confidential or sensitive information will not be transmitted in this format by London & Colonial unless you agree otherwise. These statements apply to the details contained in this form, to any other information provided in association with this Application and to any data which London & Colonial creates, receives or processes in the future in relation to my SIPP. Whether or not you become a Member of the Scheme, London & Colonial will store and process your personal information in accordance with the UK Data Protection Act We will ensure that your information is only used in accordance with your instructions and London & Colonial s strict internal policies. To the best of my knowledge, the particulars and declarations made in this application are correct and complete. To be signed by the Member or the Member s Attorney. (If being signed by an attorney please enclose the appropriate Power of Attorney): Signed Print Name Date D D M M Y Y Y Y

10 11. Request To Take Benefits I wish to take Benefits immediately Yes No If you have answered Yes, please complete the following Benefit Payment Form Once you have reached age 55 you can request that your fund be used to provide pension benefits to you. You may be able to access your pension before age 55, e.g: if you are in an occupation which permits early retirement such as professional sports person or if you are in ill health - please refer to your adviser if you think this may apply to you Protection If you have applied to HM Revenue & Customs (HMRC) for any type of protection for your pension fund please tick here. Please enclose a copy of the relevant HMRC certificate(s) Lifetime Allowance We are required to test the value of your pension benefits against the Lifetime Allowance. Any benefit payments paid to you that exceed your available Lifetime Allowance may be subject to a Lifetime Allowance tax charge. Please confirm if the value of all the pensions you have already taken is below the Lifetime Allowance (please tick the appropriate box). The total value of all benefits taken is less than the Lifetime Allowance (currently 1.25m). The total value of all benefits taken is more than the Lifetime Allowance, or is within 20% of that amount. I have a personal Lifetime Allowance, enhanced protection or a protected early retirement age. Benefits Required If your SIPP was already in Capped Drawdown prior to 6 April 2015 and you wish to allocate additional funds into Capped Drawdown please complete Section If you wish to allocate some or all of your pension fund as Flexi-Access Drawdown please complete Section If you wish to allocate some or all of your pension fund as an Uncrystallised Funds Pension Lump Sum please complete Section Capped Drawdown Additional Designation Only available if your SIPP was already in Capped Drawdown prior to 6 April Please state your Pension Commencement Lump Sum (tax free lump sum) requirement Maximum Available Specified Amount (Please State) Please state your Income Requirement Maximum Available Nil Income Specified Amount (Please State) Gross p.a Frequency Monthly Quarterly Six Monthly Annually One Off payment

11 11.4 Flexi-Access Drawdown Please state your Pension Commencement Lump Sum (tax free lump sum) requirement Maximum Available Specified Amount (Please State) Please state your Income Requirement * Specified Amount (Please State) Gross p.a Nil Income Entire Fund Frequency Monthly Quarterly Six Monthly Annually One Off payment 11.5 Uncrystallised Funds Pension Lump Sum * Please state your lump sum requirement from the uncrystallised part of your pension fund Entire Pension Fund OR Specify the gross amount of the lump sum(s) you require from your uncrystallised pension fund Gross Frequency Monthly Quarterly Six Monthly Annually One Off payment Of the amount(s) stated above, 25% will be paid as a tax free lump sum and the remaining balance will paid as a lump sum after the deduction of income tax. The income tax will be deducted using the current HMRC emergency tax code or deducted in accordance to any tax coding notice HMRC have provided us. * Taking income from your Flexi-Access Drawdown fund or receiving an Uncrystallised Funds Pension Lump Sum will restrict the amount that you are able to contribute into money purchase pension schemes, of which you are an active member from the date that you become subject to the Money Purchase Annual Allowance, to 10,000 per pension input period. Pension input periods run parallel to tax years unless you have requested a change to your pension input period Bank Details Please state your bank account details for payment of tax free lump sum and income. Bank Name Bank Account Name Sort Code Account Number IBAN Number (Non-UK Accounts) Payments to UK bank accounts are normally made by BACS at no additional charge. If you wish us to make the payment by same day CHAPS payment, please tick the following box. All CHAPS payments and payments to Non- UK bank accounts will incur an additional bank charge. Please refer to our current Schedule of Fees for current banking charges. Please state when you wish payments to commence. Immediately Specified date (please specify) D D M M Y Y Y Y

12 11.7 Financial Advice Have you received financial advice from an appropriately authorised firm in relation to taking benefits from your SIPP? Yes No (go to Section 11.8) Have you followed the advice given by your financial adviser in respect of taking benefits from your SIPP? Yes* No (go to Section 11.8) *Please ask your financial adviser to sign below, then go to Section To be completed by your financial adviser I have given my client financial advice in relation to taking benefits from their SIPP and that advice is being followed. Name Company Signed 11.8 Your Circumstances Your Health i. Are you a smoker? Yes No Examples of which may include: Cigarettes; Cigars; Pipe; Nicotine replacement products ii. Have you been diagnosed as suffering from any illness which may have an effect upon your health/life expectancy? Examples of which may include: Heart condition; Diabetes; Cancer (of any type); Stroke; Respiratory condition; Lung disease; Multiple sclerosis (MS); Neurological disease (Parkinson s; Alzheimer s; Senile Dementia etc) iii. Do you need help with activities associated with daily living? Examples of which may include: Dressing; Bathing; Feeding; Mobility (Wheelchair use etc) Your financial status i. Does the amount of cash you wish to withdraw from your pension fund represent more than 25% of your pension fund? ii. Will your standard of living (annual income) be adversely affected by taking your pension savings in cash? iii. Does the amount of cash you wish to withdraw from your pension fund represent more than 25% of your total net assets? Examples of which may include: UK Bank/Building Society savings; Shares; Investment Portfolio/Bonds; Mortgage free property (residential or investment) iv. Do you have a Spouse/Partner/Other Dependants whose financial standard of living would be adversely affected in the event of your early death? v. Is it your intention to use the money you are taking from your pension savings to create an income to support your lifestyle in retirement? Examples of which may include: UK Bank/Building Society savings/nsi Savings/Income Bonds; ISA; Investment portfolio; purchasing investment property

13 vi. Have you considered and taken action to counter the adverse effect inflation will have upon your savings/income? Examples of which may include: UK Bank/Building Society savings/nsi Savings/Income Bonds; ISA; Investment portfolio; purchasing investment property Yes Y No N vii. Have you consulted a tax expert and taken action to mitigate the effect accessing your pension savings may have upon your taxable income for this tax year? viii. Are you aware that taking your pension savings as a lump sum at this time may have an impact on any means-tested (or other) benefits you receive? ix. Currently pension savings are protected from Inheritance Tax (IHT). Taking cash from your pension may mean that your estate will be subject to IHT. Are you comfortable with this position? x. In the event that you have outstanding personal debts are you intending to pay off those debts from your pension savings? xi. In the event that you have outstanding personal debts are you aware that creditors could have a claim against the cash you withdraw from your pension savings? xii. Are you confident that by taking out your pension savings as a lump sum you have the financial knowledge to select a legitimate investment vehicle and do not become the victim of an investment scam? xiii. Have you satisfied yourself that the action you are proposing to take will not leave you in a financially vulnerable position in your older age? Please note that we are required by the Financial Conduct Authority to send you further information based on the answers you give to the questions about your circumstances. We will not be able to pay your pension benefits until you have confirmed to us that you have read the additional information and still wish to proceed to take benefits from your pension Declarations I confirm that the information I have provided above is correct. If further tax becomes payable because the information I have provided above is proven to be incorrect, then I understand that I will be wholly and personally liable for the tax charge due and any resultant penalty as may be imposed by HMRC I request and consent to the payment of benefits set out in this questionnaire and agree that: i. I will be able to change the amount of income within the limits set by the Scheme Rules but if I choose to do so at anytime other than the relevant review date an extra charge may be incurred on the fund to meet the administration costs. ii. The maximum Capped Drawdown income that can be paid in any year cannot exceed the maximum allowable in accordance with HMRC rules otherwise my Capped Drawdown fund will automatically convert to a Flexi-Access Drawdown fund and the Money Purchase Annual Allowance will apply. iii. The Scheme Trustee has the right to liquidate investments to pay the benefits at its sole discretion in the absence of adequate iv. instruction from myself or my appointed advisers. If appropriate, the Scheme Administrator has my authority to check with HMRC the details of any enhancement to benefits certificate in respect of my Lifetime Allowance. v. I understand that if I take a pension commencement lump sum as a means to increase contributions to my SIPP, or any other registered pension scheme, by a significant amount this will be treated as "recycling" in certain circumstances by HMRC, and therefore the lump sum will be an unauthorised member payment and attract the tax charges associated with this kind of payment. vi. vii. I understand that if I withdraw my entire pension fund in one payment London & Colonial shall be released of all liability in respect of my SIPP. I understand that if HMRC have not supplied the Scheme Administrator with the correct tax code to deduct income tax from my payment, I will need to contact HMRC to reclaim the overpayment and this may not be possible until the end of the tax year If I flexibly access my pension fund by taking income under Flexi-Access Drawdown or by taking an Uncrystallised Funds Pension Lump Sum, I will notify the Scheme Administrator of any other schemes of which I am an active member within 91 days of receipt of the statement from London & Colonial I hereby agree that this application shall be the basis of the proposed contract to provide benefits under the scheme. Signed Dated D D M M Y Y Y Y Y Y Y Y Y Y Y N N N N N N N

14 12. Contribution Form 12.1 Regular contributions (if applicable) - Please complete a standing order instruction (Section 13) Personal - Complete 12.3 (from your account) Personal - Complete 12.4 (deducted from salary) Name Amount Frequency (please circle) Monthly Quarterly Half-yearly Annually Monthly Quarterly Half-yearly Annually Employer - Complete 12.4 Monthly Quarterly Half-yearly Annually Third party - Complete 12.5 Monthly Quarterly Half-yearly Annually 12.2 Single Contribution Personal - Complete 12.3 (from your account) Personal - Complete 12.4 (deducted from salary) Name Amount Employer - Complete 12.4 Third party - Complete Source of Wealth Occupation / nature of business Annual earnings / net annual turnover Source of funds for the investments (e.g. a UK bank account) 12.4 Employer s Declaration I/We confirm that: I/We will deduct the necessary employee contributions from the Applicant's salary after tax and National Insurance have been deducted as they become due and send this to London & Colonial I/We understand that failure to provide information that prevents London & Colonial from monitoring the payment of contributions must be reported to The Pensions Regulator I/We agree to pay the contributions detailed above until further notice and will inform London & Colonial of any changes to the amounts due I/We agree to advise London & Colonial immediately if any member is to leave our employment. Unless otherwise agreed in writing, we confirm that employer contributions will only be paid in respect of people currently employed and will cease if the member leaves employment.

15 I/We understand that London & Colonial will aim to verify the identity of the company electronically to satisfy anti-money laundering regulations. In the event that London & Colonial are unable to do this, they will request documentary evidence as an alternative. London & Colonial will delay applications until sufficient identification has been provided. Signed Position Full Name Company Third party Declaration for Third party contributions ONLY I/We confirm that: I/We agree to pay the contributions detailed above until further notice and will inform London & Colonial of any changes to the amounts due I/We understand that London & Colonial will aim to verify the identity of the third party electronically to satisfy anti-money laundering regulations. In the event that London & Colonial are unable to do this, they will request documentary evidence as an alternative. London & Colonial will delay applications until sufficient identification has been provided. Signed Full name Capacity Date of birth (if individual) Name of company (if applicable) D D M M Y Y Y Y Address Post Code/Country 12.6 Payment Method Single contribution Electronic Transfer Cheque Contribution In Specie (please provide asset details separately) Regular contributions Electronic Transfer Standing Order (complete section 13) Start date for regular contributions ASAP OR Date D D M M Y Y Y Y Please complete a Standing Order Instruction Form for each regular payment.

16 13. Standing Order Instruction Form This form should be completed if you wish to make regular contributions to the Simple Investment SIPP. To The Manager Bank Name Address Account Name Sort Code / Account Number Please accept this as my formal instruction, until further notice, to make the following regular payments from my account to London & Colonial Services Limited: Amount Amount in words Frequency (monthly, quarterly, annually, etc.) Date(1st, 2nd, etc.) Please make a first payment of: On D D M M Y Y Y Y Account holder signature Date D D M M Y Y Y Y London & Colonial Services Limited account details (for internal use only). Name of Organisation London & Colonial Bank Name Address Sort Code / Swift Number Account Number / IBAN Reference (if any) Please photocopy this page for additional regular payments

17 14. Transfer Request Form To: The Administrator of the Transferring Scheme or Policy 14.1 Transferring Scheme or Policy details Scheme / Policy Name Policy number(s) Estimated Transfer Value Administrators name Address line one Address line two /Town Postcode/Country Telephone number 14.2 Scheme Type Occupational money purchase (defined contribution) Occupational money purchase (defined contribution including safeguarded benefits) Occupational final salary (defined benefits) Other registered pension scheme 14.3 Status of transfer value Recognised overseas pension scheme Uncrystallised Crystallised (please complete Section 11) Phased Drawdown (please complete Section 11) 14.4 Policyholder / Scheme Member Full name Address Country / Postcode Date of birth D D M M Y Y Y Y National Insurance No. Transfer In Specie? * Yes No * Please provide a list of assets separately I authorise London & Colonial to obtain information on my pension. I wish to transfer my entitlement under the above scheme to the Sunlight Account: A Personal Pension Plan (marketed as the Simple Investment SIPP ), which is registered by HM Revenue & Customs under reference RN and ASCN A C. I also understand that after such payment neither I nor my spouse, civil partner or dependants will have any entitlement to benefits under your scheme to which this transfer relates. Signed Date D D M M Y Y Y Y Please photocopy this page for additional transfer payments

18 15. Nomination Of Death Beneficiaries Form You may request that any of your pension fund remaining on your death is divided between two or more persons. Please state each person s name and address in the first column and the desired percentage proportion of your available fund in the third column. This nomination can be changed by submitting a replacement nomination form to us at any time. In the event of my death I would like any sums payable under my SIPP to be paid to the following person or persons in the manner shown below. I understand that in exercising your discretion in the disposal of the benefits you will not be bound by my nominations but you will bear them in mind. Full name and address of beneficiary Relationship to you % Total: (Must add up to 100%) Signed Date D D M M Y Y Y Y We recommend that you review your nomination(s) regularly, particularly if either your circumstances, or those of your beneficiaries, change. Upon notification of your death, we will refer to the most recent signed nomination received by us.

19 For more information about any of our products please scan the QR code or contact: t: f: w: e: London & Colonial Holdings Limited, London & Colonial Services Limited, London & Colonial Central Services Limited and London & Colonial Trustees Limited are registered in England and Wales. Registered numbers , , , respectively. Registered office at Perrymount Road, Haywards Heath, West Sussex RH16 3DN. London & Colonial Services Limited is authorised and regulated by the Financial Conduct Authority. London & Colonial Assurance plc and London & Colonial (Trustee Services) Limited are registered in Gibraltar. Registered numbers and respectively. Registered office PO Box 199, Line Wall Road, Gibraltar. London & Colonial Assurance plc and London & Colonial (Trustee Services) Limited are authorised by the Gibraltar Financial Services Commission.

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