For customers Guaranteed Pension Annuity (tax-free cash) Transfer application form Illustration number Agent number / Agent phone number Agent fax number Agent email address Page 1 of 12
Application checklist Refer to this list to find out what you need to send us along with the completed application. If we get all the information listed here, we can set up the annuity much quicker. If any of this information is missing, it might delay payment of any tax-free cash and the annuity. Please tick what you ve enclosed. For all cases: n Fully complete the relevant parts of this application form including: bank details and National Insurance number full details in section 1 signature in section 6 n Provide evidence of age for everyone in section 1. This can be: identity verification certificate from a financial adviser If you don t have a financial adviser, please give us: the original birth certificate a copy of a UK photo driving licence signature in section 6 a copy of a passport Where people in section 1 are married or in a civil partnership: n provide evidence of the relationship. This can be an: original of the marriage certificate, or original of the civil partnership certificate Where no financial adviser is involved: provide a phone number in section 1 send us a signed copy of the No advice form in this pack Where protection exists a copy of either: Certificate for enhanced protection Certificate for fixed protection 2012 Certificate of fixed protection 2014 Certificate of individual protection 2014 Certificate for primary protection Other certificate (for example relating to a pension credit as the result of a divorce settlement or to a transfer from a recognised overseas pensions scheme) Please read these notes before filling in your application form You should only use this form if you want to set up a Guaranteed Pension Annuity with tax-free cash. This is where all pension funds are transferred to us and we pay any tax-free cash. This is also known as an Immediate Vesting Personal Pension. If there s more than one transfer, we ll wait until all the transfers and paperwork are received before we pay any tax-free cash and the annuity. This application, the illustration and the answers you give will form the basis of a contract of insurance with Aegon (a brand name of Scottish Equitable plc). n Please complete this form in BLOCK CAPITALS and ballpoint pen and refer to the checklist for help in completing this form. n This form is your application to transfer to a Guaranteed Pension Annuity within the Scottish Equitable Personal Pension Scheme (the Scheme ). n In this application, you re applying at the outset for more than one arrangement under the Scheme. You ll be given details of the number of arrangements and the transfer payment which applies to each separately. n Please note that, normally, no transfer can be made where benefits have come into payment under the transferring arrangement. n Don t leave out any information when you answer the questions even if you think something s not relevant, write it down anyway. Otherwise, we could reject your application. If you re unsure about anything, call us on 03456 015273. n If a financial adviser has already filled in any information on this form, based on what you ve told them, please check that it s all correct and complete. If anything s missing or wrong, correct it, initial your changes and get in touch with a financial adviser. n Once we ve received all transfer payments, we ll set up your annuity. n Words shown in bold are defined terms that are explained in notes at the end of this form. n Whenever you see this icon *, we re asking you to send us additional material with this form. Guaranteed Pension Annuity Transfer application form Page 2 of 12
1. Annuitant s details 1.1 Please give your details. Please note to take out this plan you must live in the UK. Title Mr / Mrs / Miss / Ms / Other (please specify) Full forename(s) Surname Date of birth (dd/mm/yyyy) Gender: male female Main permanent residence Are you: single? in a civil partnership? separated? married? divorced? widowed? 1.2 Please give details of your dependant. Please give your spouse s/civil partner s/ dependant s details if you want to provide an annuity for them on your death. Title Mr / Mrs / Miss / Ms / Other (please specify) Full forename(s) Surname Date of birth (dd/mm/yyyy) Postcode One of the factors we use to calculate your annuity is the postcode for your main permanent residence. This is because where you live gives an indication of what your life expectancy is likely to be. This helps us to calculate your annuity accurately. You can find more information about this in the notes section at the end of this form. Home phone number: Work phone number: Mobile phone number: Email address: We might use your email address and phone numbers to get in touch with you about your application and policy. If you don t want us to send you information about our products, please tick the appropriate box in section 6. Gender: male female Address National Insurance number Relationship to you Postcode Where the dependant is neither married nor in a civil partnership with the annuitant, we need evidence of financial dependency before we can start paying any dependant pension/ annuity. We only need this in the event of a death claim. This evidence can be one of: n copy of a utility bill in both names n copy of a joint bank statement n copy of a joint mortgage statement National Insurance number Guaranteed Pension Annuity Transfer application form Page 3 of 12
2. Payment details We ll pay the annuity payments to: Name of UK bank or building society Bank or building society sort code Bank or building society account number Building society roll number (if applicable) If you d like your tax-free cash paid to a different account, please tick this box and give the bank details below Name of UK bank or building society Bank or building society sort code Bank or building society account number Name of account holder(s) Building society roll number (if applicable) You ll be taxed at the current emergency rate of tax until HM Revenue & Customs (HMRC) tells us the right code to use. Name of account holder(s) 3. Source of each transfer payment Full name of current provider Full name of current provider Full name of pension scheme Full name of pension scheme HMRC registration number (if allocated) HMRC registration number (if allocated) Existing plan number Existing plan number Current provider/scheme administrator address Current provider/scheme administrator address Postcode Approximate fund value to be paid to Aegon Does this represent the full value of the existing plan? Yes No Postcode Approximate fund value to be paid to Aegon Does this represent the full value of the existing plan? Yes No Guaranteed Pension Annuity Transfer application form Page 4 of 12
3. Source of each transfer payment continued Full name of current provider Full name of current provider Full name of pension scheme Full name of pension scheme HMRC registration number (if allocated) HMRC registration number (if allocated) Existing plan number Existing plan number Current provider/scheme administrator address Current provider/scheme administrator address Postcode Approximate fund value to be paid to Aegon Does this represent the full value of the existing plan? Yes No Postcode Approximate fund value to be paid to Aegon Does this represent the full value of the existing plan? Yes No If there are more than four transfer payments, please give the necessary details on a separate sheet of paper, or a photocopy of this page, which you should sign, date and attach to this form *. 4. Lifetime allowance 4.1 We need to know what the total value of all your pensions is to comply with HMRC rules. Please answer all the questions below. 4.1.1 Is the total value of all your pensions (with Aegon or other providers) equal to or less than 1,250,000 Yes go to 4.1.2. No go to 4.2 and also complete the additional lifetime allowance form in your pack. 4.1.2 Is the total value of all the transfers shown in section 3 less than 500,000? Yes go to 4.2. No go to 4.2 and also complete the additional lifetime allowance form in your pack. Guaranteed Pension Annuity Transfer application form Page 5 of 12
4. Lifetime allowance continued 4.2 If you ve registered for protection with HMRC, please provide us with a copy of your protection certificate and indicate on right what kind of certificate you ve enclosed. Please tick what you ve enclosed *: Certificate for enhanced protection Certificate for fixed protection 2012 Certificate of fixed protection 2014 Certificate of individual protection 2014 Certificate for primary protection Other certificate (for example relating to a pension credit as the result of a divorce settlement or to a transfer from a recognised overseas pensions scheme) If you have enhanced protection, fixed protection 2012 or fixed protection 2014, the transfer(s) you re making need to be permitted transfers otherwise you ll lose your protection. You should tick one box. Yes, the transfer(s) I m making are permitted transfers. No, the transfer(s) I m making aren t permitted transfers. 4.3 The declaration below applies to you if the purchase price shown on the quote set out in section 6 is less than 500,000 to confirm that you won t be subject to a lifetime allowance charge. a I declare that the retirement value shown on the illustration numbered in 6.2, when added to the total value of all my pension benefits that have crystallised or will crystallise under any and all registered pension schemes before the benefits on the quote crystallise, when taken with any pension or income withdrawal in payment on 5 April 2006 is less than the standard lifetime allowance. The current standard lifetime allowance is 1,250,000 except where Fixed Protection 2012, Fixed Protection 2014 or Individual Protection 2014 is held. This may change from time to time. If that is not the case, I ll inform the scheme administrator immediately in writing. b I note that you ll rely on the declaration I ve given in a above. c I agree that if, for any reason, all or part of the retirement value shown on this quote is more than my available lifetime allowance and this results in the scheme administrator being liable for a lifetime allowance charge (or an increase in the lifetime allowance charge) and penalties and/or interest to HMRC, that I ll be liable to pay to the scheme administrator, a sum equal to the amount of that lifetime allowance charge (or any increase in the lifetime allowance charge) and any penalties and interest charged by HMRC and any interest charged by the scheme administrator. d I declare that I or any person acting on my behalf will not use any of the tax-free cash that I receive from the Scheme in a way that would breach the recycling rule. However, I note and agree that in the event of any arrangement or action by me, or any other person, which constitutes or results in such a breach and consequently the scheme administrator becoming liable for a scheme sanction charge and penalties and/or interest to HMRC, that I ll be liable to pay to them a sum equal to the amount of that scheme sanction charge, any penalties and interest charged by HMRC and any interest charged by the scheme administrator. e I agree that any sum due may be deducted from any arrangements for or in respect of me under the Scheme. Guaranteed Pension Annuity Transfer application form Page 6 of 12
5. How we use your information Aegon uses your information to administer your policy, process claims and deal with complaints. We won t disclose your data to a third party unless: n it s part of our administration process n it s a legal requirement n it s necessary to prevent and detect fraud, or n you ve authorised this disclosure, for example to your financial adviser As part of the administration process, we might use third parties who are based outside the European Economic Area (EEA), for example the USA. If we do, we make sure appropriate controls are in place so we protect your information. We might use UK and European credit reference agency (CRA) and fraud prevention agency (FPA) records about you to prevent crime, fraud and money laundering. We might also use CRA records about you and those financially linked to you to check your identity if you, or someone financially linked with you, applies for services. If you give false or inaccurate information and we identify fraud, we ll pass details to the FPA to prevent fraud and money laundering. We might share your information with other members of the Aegon UK Group (which means Aegon UK and its subsidiary companies) and would like to keep you informed about our products and services that might interest you. We won t pass your information to other companies outside of the Aegon UK Group for marketing purposes. You can find more information on how we use and protect your personal data, and how information held by the FPA might be used, in the Protecting your personal information leaflet. Please ask if you d like a copy, or you can find one at aegon.co.uk/usefulforms 6. Annuitant s declaration In this declaration, I means the person applying for the Guaranteed Pension Annuity (with tax-free cash) and you means Aegon (except in clauses 6.13 and 6.14 of this declaration where you means the trustees and/or scheme administrators of each of the transferring scheme(s) listed in section 3). This declaration includes both the clauses set out in this section 6 and in section 4.3. 6.1 I apply to become a member of the Scottish Equitable Personal Pension Scheme (the Scheme). 6.2 I apply to you for a Guaranteed Pension Annuity. It is to be set up as in the illustration: Illustration number Dated (dd/mm/yyyy) / I want you to issue me with a plan or plans that set out your standard conditions amended to include any special terms and conditions you believe reasonably apply (based on the information and documentation that has been given in relation to my application). Any special terms and conditions will be in your current style or, where you do not have a current style, in the format you think best reflects them. You ll set up the annuity on the basis set out in the illustration referenced above unless you are told otherwise by me or my financial adviser before the first instalment of annuity is paid. The actual annuity will depend on the payment received. The actual basis and amount of the annuity will be set out in a final quotation which you ll issue to me and/ or my financial adviser. Guaranteed Pension Annuity Transfer application form Page 7 of 12
6. Annuitant s declaration continued 6.3 I, declare that the address and postcode that I have given in section 1 is my main permanent residence at the date I sign the form. I note that you will use the address and postcode that I ve given to calculate the annuity rate you offer. I note that if the address and postcode I ve given is not my main permanent residence on the date I sign the form, you have the right to change the terms of the contract (including the amount of annuity that is paid) to the terms that would have applied had I given you the correct address and postcode for my main permanent residence. In that event, I ll be liable to repay to you any overpayment of annuity made as a result of the change to the terms of the contract. 6.4 I agree to be bound by the documents and rules of the Scheme. 6.5 I agree to the transfer payment(s) from the transferring scheme(s) being paid to the Scheme to provide benefits for me. Where the transferring scheme is an Aegon contract, I note that the actual amount to be transferred will be worked out on the date you receive all the forms. 6.6 Where the transfer payment applied for is subject to a divorce order, and you agree to accept the application: a I note that you envisage that carrying out the work will result in you having to undertake further administrative work, and this will mean further administrative expenses b I agree that the terms of the plan can be amended (from the standard or other terms) to take account of the charges 6.7 Where I ve indicated in section 4 that enhanced protection, fixed protection 2012 or fixed protection 2014 applies to the funds being transferred, I note that for protection to continue, each transfer must be a permitted transfer. 6.8 I note that if there is any failure to provide information needed by the Scheme Administrator in order to administer my benefits in an accurate manner, the Scheme Administrator has the right to make further charges. 6.9 I note that no benefits can be commuted, surrendered or assigned, except in accordance with the Finance Act 2004. 6.10 Whether or not the information on this form is in my handwriting, I declare it is correct and complete, to the best of my knowledge and belief. 6.11 I agree that you or your representative can get in touch with any of the other providers or insurers of any other registered pension scheme that I am contributing to or have contributed to in the past, to get any information you feel necessary to administer my arrangements under the Scheme. 6.12 I note that if I deliberately or carelessly fail to answer any questions correctly and completely to the best of my knowledge and belief, benefits might not be paid. 6.13 To the trustees and/or scheme administrator of each of the transferring scheme(s), I declare; a I would like to take benefits from the plan(s) listed in section 3. b I authorise you to release all necessary information to Aegon to enable the transfer of funds to the Scheme. c I authorise and instruct you to transfer the funds from the plan(s) as listed in section 3 directly to the Scheme. d I authorise you to obtain from and release to the financial adviser named in this application any additional information that may be required to enable the transfer of funds. e Please transfer the fund(s) listed in section 3 to the Scheme. Where you ve asked me to give you the original policy document(s) in return for the transfer of funds and I m unable to do so, I promise that I ll be responsible for any losses and/or expenses which are the result, and which a responsible person would consider to be the probable result, of any untrue, misleading or inaccurate information deliberately or carelessly given by me, or on my behalf, either in this form or with respect to benefits from the plan. Guaranteed Pension Annuity Transfer application form Page 8 of 12
6. Annuitant s declaration continued f Until this application is accepted and complete, Aegon s responsibility is limited to the return of the total payment(s) to you. g Where the payment(s) made to the Scheme represent(s) all of the funds under the plan(s) listed in section 3, then payment made as requested will discharge you of all claims and responsibilities in respect of the plan(s) listed. h Where the payments made to the Scheme represent(s) part of the funds under the plan(s) listed in section 3, 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). 6.14 To the trustees and/or scheme administrator of the transferring scheme(s) and Aegon, I declare: a I ll 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 ve failed to comply with any aspect of this application. b In addition, I promise to accept responsibility in respect of any claims, losses and expenses that Aegon and you may incur as a result of any incorrect information provided by me in this application or of any failure on my part to comply with any aspect of this application. 6.15 Consent to processing your information Unless I ve ticked the appropriate box below to object, by signing this form I am consenting to receive marketing messages from the Aegon UK group of companies by post. I don t want you to contact me by post with marketing communications I would like you to send me marketing communications in the following ways (please tick the relevant boxes): email SMS phone I consent to you processing and using my information as explained in section 5. Date (dd/mm/yyyy) Signature of annuitant 7 7 The information you give in this application is needed for income tax purposes. If you include false information, the tax authorities may prosecute you, with severe penalties. If you want to see an example of the standard policy conditions and a copy of the completed application form, please ask us. We, the provider and administrator of the Scheme, agree to administer the Scheme in accordance with the rules and arrangements of the Scheme. 7. For financial adviser use only Financial adviser case number This is for the purposes of Financial Conduct Authority reporting: Did you give this applicant advice when choosing to set up this pension? Yes No Notes on money laundering Politically exposed persons If you re aware that the individual named in section 1 is a politically exposed person (as defined in the Money Laundering Regulations 2007), please contact us and we ll confirm what additional information we require from you. Guaranteed Pension Annuity Transfer application form Page 9 of 12
8. Notes Definitions Enhanced protection This provides full protection from the lifetime allowance charge for the value of the whole of your pension rights built up as a 5 April 2006, regardless of subsequent growth. Fixed protection 2012 At 6 April 2012 the standard lifetime allowance reduced from 1.8 million to 1.5 million. Fixed protection 2012 maintains the standard lifetime allowance at 1.8 million and provides protection against the lifetime allowance charge for benefits up to this level. If the standard lifetime allowance rises above 1.8 million in the future the higher standard lifetime allowance will apply. Fixed protection 2014 At 6 April 2014 the standard lifetime allowance reduced from 1.5 million to 1.25 million. Fixed protection 2014 maintains the standard lifetime allowance at 1.5 million and provides protection against the lifetime allowance charge for benefits up to this level. If the standard lifetime allowance rises above 1.5 million in the future the higher standard lifetime allowance will apply. Individual protection 2014 At 6 April 2014 the standard lifetime allowance reduced from 1.5 million to 1.25 million. Individual protection 2014 maintains the standard lifetime allowance at whichever is the lower of the value of the individual s pensions savings as at 5 April 2014 and 1.5 million, and provides protection against the lifetime allowance charge for benefits up to this level. If the standard lifetime allowance rises above the individual protection 2014 level in the future, the higher standard lifetime allowance will apply. Interest Interest shall be added on a daily basis to any amount due to the Scheme Administrator for any lifetime allowance charge and/or scheme sanction charge. It will be calculated on a daily basis from the date on which the first payment was due at the Royal Bank of Scotland plc base rate plus 5%. Lifetime allowance This is the limit that applies to the total value of tax privileged pensions savings you can have under all approved or registered pension schemes. Unless you have enhanced protection, when benefits are taken, savings above that level may attract a lifetime allowance charge. If you don t have enhanced protection, you ll have either a personal lifetime allowance or a standard lifetime allowance. Lifetime allowance charge When you take benefits, if your pensions savings are more than your lifetime allowance, the excess is subject to this charge. This tax is 55% on lump sums and 25% on funds used to buy a pension. The pension income is also taxed under the Pay As You Earn (PAYE) system. Main permanent residence Your main permanent residence is: n where you only have one address, it s the address at which you live on the date you sign the application form, or n where you have more than one address, it s the address at which you ve lived for most of the 12-month period immediately before the date you sign the application form. Unless we re given your full address, and postcode which is listed on our database of UK postcodes, we ll be unable to take postcode information into account in calculating your annuity and this could result in the final quote showing lower figures than shown on your initial quote. We reserve the right to ask for additional evidence of your address and to electronically verify that the postcode is for your main permanent residence. We may use a third party company who provides identity verification services in order to do this. Such companies may check the details you ve given us against details held on public databases or any database to which they have access. We will keep a record of the search. Guaranteed Pension Annuity Transfer application form Page 10 of 12
8. Notes continued If at any time we find that the postcode set out in section 1 of this application form is not your main permanent residence, we reserve the right to change the terms of the contract (including the amount of annuity that is paid) to the terms that would have applied had we been given the correct postcode for your main permanent residence. That may include seeking the repayment of any additional annuity that we have paid but was not due. Permitted transfer For the purposes of retaining enhanced protection, fixed protection 2012 or fixed protection 2014 for this transfer, this means: n all or part of the sums and assets or pension rights are transferred to form all or part of the assets of one or more money purchase registered pension schemes (to avoid doubt the Scottish Equitable Personal Pension Scheme is a money purchase registered pension scheme), and n where defined benefit or cash balance pension rights are transferred to a money purchase arrangement, the value of the sums and assets received by the money purchase arrangement are actuarially equivalent to the rights being transferred. Personal lifetime allowance Where you ve registered with HMRC for certain types of protection, you ll have an enhancement to the standard lifetime allowance. This increased amount is your personal lifetime allowance. Primary protection If you d built up pension rights of more than 1.5 million at 5 April 2006, primary protection offers a means of protecting the excess benefits. Your 5 April 2006 value registered with HMRC is increased in line with the rise in the standard lifetime allowance up until you take your benefits. The calculation of enhanced lifetime allowance for primary protection isn t affected by the reductions of the standard lifetime allowance that took place from 6 April 2012 and 6 April 2014. Recognised overseas pension scheme A pension scheme which is established in a country or territory listed in the Pension Schemes (Categories of Country and Requirements for Overseas Pension Schemes and Recognised Overseas Pension Schemes) Regulations 2006. An overseas scheme may also be a recognised overseas pension scheme if it is a description prescribed in those regulations, or if it satisfies any requirements in those regulations. Registered pension scheme A pension scheme which is registered with HMRC under Chapter 2 Part 4 of the Finance Act 2004. Recycling rule The Finance Act 2004 includes a rule (known as the recycling rule) to prevent people using all or part of a lump sum as a direct or indirect way of paying significantly greater pension contributions. You can find out more about this in the relevant HMRC guidance note, available on its website at http://www.hmrc.gov.uk/ manuals/rpsmmanual, or from your financial adviser. Standard lifetime allowance The current standard lifetime allowance is: n 1.8 million if you have fixed protection 2012 n 1.5 million if you have fixed protection 2014 n the protected amount (being more than 1.25 million and not more than 1.5 million) if you have individual protection 2014 n 1.25 million if you don t have fixed protection 2012, fixed protection 2014 or individual protection 2014 Guaranteed Pension Annuity Transfer application form Page 11 of 12
Aegon is a brand name of Scottish Equitable plc. Scottish Equitable plc, registered office: Edinburgh Park, Edinburgh EH12 9SE. Registered in Scotland (No. 144517). Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services Register number 165548. An Aegon company. www.aegon.co.uk 2015 Aegon UK plc We re proud to be the C 289821 RET 00252160 07/15 Lead Partner of British Tennis.