(Buyout and occupational pension schemes)

For customers and scheme trustees Instruction to buy a pension from Aegon (Buyout and occupational pension schemes) About this form This is your instruction to buy a pension from Aegon. Aegon is a brand name of Scottish Equitable plc. To complete this instruction you ll need the letter we sent you that detailed the options. It contains information that you ll need to refer to and provide in this instruction. Completing this form This instruction is split into three parts. The part you complete will depend on the plan you have with us. Part A Your instruction Complete Part A if your existing plan with us is a: n Section 32 Buyout plan, n Group Buyout plan n Trustee proposed section 32 n policy assigned to you from your occupational scheme Part B Scheme trustees instruction Complete Part B if you are a scheme trustee of: n an Executive Pension plan n an Exsel Group scheme n a Nexus scheme n an Exsel scheme n an Exsel Fund scheme n a Contracted-in money purchase scheme (CIMP) Part C Definitions Additional information n Please check the spouse s details that we ve shown on your illustration are correct. If these aren t correct, please contact us for another illustration. For the purposes of this instruction the term spouse includes a civil partner or dependant. n In Part A of this instruction we ask you to provide a certified copy of certain documents. If you can t provide these, please contact us for potential alternatives. n Where you see this icon * we re asking you to send us additional material with this instruction. n Please complete this instruction in BLOCK CAPITALS and ballpoint pen. n Words in bold are defined terms that we explain in the Definitions section in Part C. n Return completed forms and documents to Aegon, Freepost EH218, Edinburgh EH12 0BR If you have any questions about how to complete the instruction you can contact us on 03456 10 00 10. Page 1 of 13

Part A Your instruction 1. Personal details 1.1 Please enter your details Title Mr / Mrs / Miss / Ms / other please specify Full forename(s) Please include a certified copy of your passport or driving licence with this completed instruction as evidence of your age and identity. If you chose an option with a spouse s pension please include a certified copy of their passport or driving licence. * Surname Marital status, please select Single / Married / Civil partnership Date of birth (dd/mm/yyyy) National insurance number Permanent home address Postcode We ll only use your phone numbers to contact you about this instruction to buy a pension from us. Home phone number Work phone number Mobile phone number You can find your policy number and illustration number in the letter we sent you. Policy Number Illustration number (if known) illustration date (dd/mm/yyyy) Instruction to buy a pension Page 2 of 13

1. Personal details continued 1.2 Please give us details of your bank account that you would like us to pay your benefits to. The bank details should be for a personal account in your name or one where you are a joint account holder. Please enclose a certified copy of a bank statement for this bank account with this instruction. * We can only pay benefits directly into a UK bank or building society account. If you live outside the UK and are unable to set up a UK bank or building society account, please contact us. Name of bank/building society Address Sort code Account number Name of account holder(s) Building society roll number (if applicable) Postcode 2. Pension option You ll need to refer to the illustration(s) that you received with your letter. Depending on the type of plan you have, you may have more than one illustration and this is usually because at one time you were contracted-out of the state second pension scheme. You can tell which section(s) to complete as the heading for each section will match the one in your illustration(s). Enter the letter for option you want to confirm the benefits that you want. The options displayed in your illustration(s) will be shown as A, B, C and so on. 2.1 Complete this section for an illustration headed Illustration for a pension with Aegon Retirement fund. benefits you want. Instruction to buy a pension Page 3 of 13

2. Pension option continued 2.2 Complete this section for an illustration headed Illustration for a pension with Aegon Non- Guaranteed Minimum Pension Funds. benefits you want. Pre-1985 Post-1985 2.3 Complete this section for an illustration headed Illustration for a pension with Aegon Non- Reserved Funds. benefits you want. 2.4 Complete this section for an illustration headed Illustration for a pension with Aegon Guaranteed Minimum Pension. benefits you want. Pre-6 April 1988 Post-5 April 1988 2.5 Complete this section for an illustration headed Illustration for a pension with Aegon Reference Scheme Test (Section 9, 2(b) Rights). benefits you want. Instruction to buy a pension Page 4 of 13

2. Pension option continued 2.6 Non-protected rights (Trustee proposed section 32 plans only where applicable) Complete this section for an illustration headed Illustration for a pension with Aegon Non-protected rights. benefits you want. 2.7 Former protected rights (Trustee proposed section 32 plans only where applicable) Complete this section for an illustration headed Illustration for a pension with Aegon former protected rights. benefits you want. If you re married or in a civil partnership at the date of signing this form, where you want to purchase an annuity with your former protected rights fund that does not mirror exactly the protected rights annuity set out in your policy conditions booklet, you and your spouse or civil partner must agree to change the policy conditions to allow a different annuity to be purchased and to the annuity purchase itself. Where this is the case, please sign the policyholder s declaration below and your spouse/civil partner should sign the spouse s/civil partner s declaration below. Policyholder s declaration I want you to set up the above annuity with my former protected rights fund and I agree to the change to the policy conditions so that the requirement to purchase a protected rights annuity with the former protected rights fund is removed. I am aware that this may result in a reduced annuity or no annuity being paid to my spouse or civil partner if they survive me. Policyholder s signature 7 7 Spouse s/civil partner s declaration I, being the spouse or civil partner of the member named above, agree to the purchase of the annuity set out above with the former protected rights fund and to the change to the policy conditions so that the requirement to purchase a protected rights annuity with the former protected rights fund is removed. I am aware that this may result in a reduced annuity or no annuity being paid to me if the member should die before me. I have taken any advice I feel is necessary before making this declaration. Spouse/Civil partner (print name) Spouse s/civil partner s signature 7 7 Instruction to buy a pension Page 5 of 13

3. Lifetime allowance If you ve registered for protection with HM Revenue & Customs (HMRC) and haven t already given us a copy of your certificate, please enclose it with this form and tick the box opposite to show which one you ve enclosed. Certificate for enhanced protection * Certificate for fixed protection 2012 * Certificate for fixed protection 2014 * Certificate for individual protection 2014 * Certificate for primary protection * Other certificate (for example relating to a pension credit as a result of a divorce settlement.) * If your pension fund value is 250,000 or more, then 4.4 of the declaration doesn t apply to you and you must complete the Lifetime allowance form available at https://www.aegon.co.uk/support/supportdocuments.html. Search in the documents section under your product type for the form. 4. Declaration In this declaration, I means the individual detailed in section 1 and you means Scottish Equitable plc as the scheme administrator of the section 32 Buyout policy and/or Trustee Proposed section 32 Buyout policy, Group Buyout plan and policies assigned to individuals from occupational pension schemes. 4.1 I ve been made aware of my pension options and tax implications. I ve also had: a regulated advice from a financial adviser Yes No b guidance from Pension Wise Yes No c retirement risk warnings specific to the option I ve selected Yes No we can t progress your claim until you ve received and reviewed the risk warnings specific to the option you ve selected. You can access this information at aegon. co.uk/retirement planner under the Make it Happen section or alternatively you can contact us directly. 4.2 I want to accept the options(s) I ve selected in section 2 and instruct you to set up and pay the benefits accordingly. I note that the actual figures (and the amount of any benefit) may vary. 4.3 I confirm that the information I ve given in section 1 and the statements in this declaration are true and complete. Instruction to buy a pension Page 6 of 13

4. Declaration continued 4.4 Lifetime allowance declaration Under HMRC rules, there are special tax charges for people with large pension pots. If your total funds from all your pensions are not more than your standard lifetime allowance, or your personal lifetime allowance, if you have one, you won t have to pay this special tax charge. By completing this declaration you re confirming that you will not be subject to the lifetime allowance charge. a I declare that the retirement fund value shown on the illustration, 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 illustration crystallise, when taken with any pension or income withdrawal in payment on 5 April 2006 is less than my available lifetime allowance. If that isn t the case, I ll inform the scheme administrator immediately, in writing. b I agree 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 benefits being crystallised under the policy detailed in section 1 are more than the standard lifetime allowance or my personal lifetime allowance and this results in the scheme administrator being liable for a lifetime allowance charge (or an increase in the lifetime allowance charge), penalties and/or interest to HMRC, that I ll be responsible for and 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), any penalties and interest charged by HMRC and any interest charged by the scheme administrator. d I declare that the tax-free cash payment won t be reinvested into any registered pension scheme beyond the limits imposed by HMRC from time to time, and should I decide to make such reinvestment I ll provide full details to the scheme administrator. I acknowledge 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 of the limits imposed by HMRC and consequently the scheme administrator becoming liable for a scheme sanction charge, penalties and/or interest to HMRC, that I ll be responsible for and liable to pay to the scheme administrator a sum equal to the amount of that scheme sanction charge, any penalties and interest charged by the 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. Date (dd/mm/yyyy) Planholder s signature 7 7 Instruction to buy a pension Page 7 of 13

Part B Scheme trustees instruction You ll need to refer to the letter and illustration(s) that you received relating to the scheme member. Depending on the benefits the scheme member is entitled to there may be more than one illustration, for example, if he/she was contracted-out of the state second pension scheme. You can tell which section(s) to complete as the heading for each section will match the one in the illustration(s) for the scheme member. Enter the letter for the option you want and confirm the benefits that they want. The options displayed in the illustration(s) be shown as A, B, C and so on. 5. Member s details 5.1 Please enter the member s details. Title Mr / Mrs / Miss / Ms / other please specify Full forename(s) Surname Marital status, please select Single / Married / Civil partnership Date of birth (dd/mm/yyyy) National insurance number Permanent home address Postcode Name of scheme You can find the plan number and illustration number in the letter we sent you. Plan number Illustration number (if known) Illustration date Instruction to buy a pension Page 8 of 13

6. Bank details Please give details of where the pension and tax-free cash (if applicable) are to be paid. We can only pay benefits directly into a UK bank account. Name of bank Address Sort code Postcode Account number Name of account holder(s) 7. Pension option 7.1 Complete this section for an illustration headed Illustration for a pension with Aegon Retirement fund benefits the scheme member wants. 7.2 Complete this section for an illustration headed Illustration for a pension with Aegon Nonprotected rights. benefits the scheme member wants. Instruction to buy a pension Page 9 of 13

7. Pension option continued 7.3 Complete this section for an illustration headed Illustration for a pension with Aegon Non- Guaranteed Minimum Pension Funds. benefits the scheme member wants. Pre-1985 Post-1985 7.4 Complete this section for an illustration headed Illustration for a pension with Aegon Non-Reserved Funds. benefits the scheme member wants. 7.5 Complete this section for an illustration headed Illustration for a pension with Aegon Guaranteed Minimum Pension. benefits the scheme member wants Pre-6 April 1988 Post-5 April 1988 Instruction to buy a pension Page 10 of 13

8. Declaration In this declaration, we means the scheme trustee(s) and you means Aegon. 8.1 We want to accept the options(s) we ve selected above and want you to set up the benefits for the scheme member accordingly. We note that the actual figures (and the amount of any benefit) may vary. 8.2 We confirm that the information in section 5, section 6 and the statements in this declaration are true and complete. Date (dd/mm/yyyy) Scheme trustee (print name) Scheme trustee signature 7 7 Scheme trustee (print name) Scheme trustee signature 7 7 Instruction to buy a pension Page 11 of 13

Part C Definitions Certified copy where we ve asked for certified copies of documents from you, these can be certified by a number of different people including: n a Financial adviser n a Post Office official (through the post office s certification service) n a bank/building society official n an accountant You can find the full list of people in the FAQ section of Your retirement planner at aegon.co.uk/ retirementplanner or by contacting us directly The person certifying your document should provide the following on the copy: n their name in block capitals n the name of the company they work for n the address of the company n their occupation and role within the company n the statement I certify this to be a true likeness of the original, and n their signature Enhanced protection provides full protection from the lifetime allowance charge for the value of the whole of the individual s pension rights built up as at 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 will be added on a daily basis to any amount due to the scheme administrator for any scheme sanction charge. It will be calculated on a daily basis from the date the first payment is due at the Royal Bank of Scotland plc base rate plus 5%. Lifetime allowance is the limit that applies to the total value of tax-privileged pensions savings an individual can have across all approved or registered pension schemes. Unless the individual has enhanced protection, when benefits are taken, savings above that level may attract a lifetime allowance charge. If they don t have enhanced protection, they ll have either a personal lifetime allowance or a standard lifetime allowance. Lifetime allowance charge when the individual decides to take benefits, if their pensions savings are more than their available lifetime allowance, the excess is subject to this charge. This tax is 55% if the excess is taken as a lump sum and 25% on the excess if used to buy a pension. The pension income is also taxed under the Pay As You Earn (PAYE) system. Occupational pension scheme is a trust based pension scheme, such as: n an Executive Pension plan n an Exsel Group scheme n a Nexus scheme n an Exsel scheme n an Exsel fund scheme n Contracted-in money purchase scheme (CIMP) Instruction to buy a pension Page 12 of 13

Personal lifetime allowance where the individual is 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. Registered pension scheme is a pension scheme that s registered with HMRC under Chapter 2 Part 4 of the Finance Act 2004. Standard lifetime allowance this is the value of pension benefits an individual can build up before a lifetime allowance charge is applied. The current standard lifetime allowance is: n 1.8 million if they have fixed protection 2012. n 1.5 million if they have fixed protection 2014. n The protected amount (being more than 1.25 million and not more than 1.5 million) if they have individual protection 2014. n 1.25 million if they don t have fixed protection 2012, fixed protection 2014 or individual protection 2014. 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 C 289816 GEN 00270358 07/15 We re proud to be the Lead Partner of British Tennis.

For customers Cancellation Form To be returned only if you have already agreed a particular pension and you wish to cancel that agreement. To: Aegon Edinburgh Park Edinburgh EH12 9SE I hereby give notice that I have decided not to proceed with this pension policy. I would like time to reconsider. Policy number Signed 7 7 Date (dd/mm/yyyy) Please complete the following in BLOCK capitals Name Address Postcode 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 C 286647 RET 00270377 02/14 We re proud to be the Lead Partner of British Tennis.