INCOME INSTRUCTION– Collective Retirement Account (CRA)– For use by financial advisers only

*SFIWA0100F*

Full name

Collective Retirement Account number

1 YOUR DETAILS

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Address

National Insurance Number

/ /

Date of birth (ddmmyyyy)

Telephone number Email address

Postcode

• Income payments will normally be paid on the 25th of the month. Where it falls on a non-working day, the payment will be made on the previous working day. Provided we have received all of our requirements by the cut-off dates below, payments will start in the month we receive your request (or the month you have specified, if different). Where the request is received after the specified cut-off date, payment will be made in the following month.

• Cut-off dates: For income requests from existing crystallised accounts, the cut-off date is the 9th of the month. For any other requests, including taking the full crystallised fund, the cut-off date is the 7th of the month. Where these dates fall on a non-working day, the cut-off day will be the previous working day.

• We can only hold your completed instruction for a maximum of 3 months.

• Additional documents we might need – Proof of age – If this is the first time money has been taken from this account.

– Proof of residential address – If your address is different from the one we have on our records or it has changed within the last 12 months.

– Proof of bank account ownership – If we have not already seen it.

• Tax – You will have to pay tax on the income you receive in the same way as you would on a salary. How much you pay depends on

your total income. Generally the provider will not know your overall income and will use an emergency tax code to start with. This means you may pay too much tax initially and have to claim the money back. Alternatively you may owe more tax if you have other sources of income.

– Non UK Tax – If you are subject to tax in any country outside the UK, please contact your tax specialist, to understand whether you will be liable for tax in that country.

• Our minimum income payments are £25 each month, £300 for annual payments or £125 for one-off payments.

• Please tick/complete this form using BLOCK CAPITALS only and blue or black ink.

WITH THIS FORM YOU CAN: • change the level of regular income you’re withdrawing, take a one-off withdrawal or withdraw the full crystallised* value from your CRA.

* Crystallised refers to that part of your pension that has been set aside to provide income.

This form cannot be used for: • full withdrawals - if you want to withdraw the entire account value, please use the ‘Taking a full withdrawal’ form which you can get by calling us

on 0808 171 2626.

We regularly update our forms; your financial adviser can confirm that this October 2019 version is the latest by checking the literature library on our website www.oldmutualwealth.co.uk

Client reference number u If known

NOTE

Proof of address – We will require proof of your residential address if it is different from the one we have on our records or has changed in the last 12 months, for example an original household bill dated within the last 6 months (mobile phone bills are not acceptable).

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3 CHANGE AMOUNT OF INCOME WITHDRAWAL u Crystallised funds only

Capped drawdown• If you started capped drawdown before 6 April 2015 and have not since converted to flexi-access drawdown, you are still

in capped drawdown. Income withdrawals can be changed up to the maximum limits set at your last review. Reviews will be conducted every three years until age 75. After age 75 these reviews will be annual. Certain events will also trigger a review and you have the option to recalculate your maximum income each year.

• If you are in capped drawdown and select a specified regular income amount of more than the maximum amount permitted, your account will immediately convert to flexi-access drawdown. It cannot be reversed even if you subsequently reduce the income level back down to within the maximum for that year.

• If you are in capped drawdown and select a one-off withdrawal that exceeds the remaining maximum amount permitted, your account will immediately convert to flexi-access drawdown.

Flexi-access drawdown• There is no cap on the amount of income you can take using flexi-access drawdown. However, once you take income in this

way, the amount you can pay into ‘money purchase’ (also known as ‘defined contribution’) schemes in any tax year without being liable to a tax charge is subject to a limit called the ‘Money Purchase Annual Allowance’ (MPAA). This is currently £4,000. You have the option to convert to flexi-access at any time. You can do this by ticking option i) below. For more information please contact your financial adviser.

How is income taxed?• You will have to pay tax on the income you receive in the same way as you would on a salary. How much you pay depends on

your total income. If this is the first time that you will be taking an income withdrawal from your account, generally the provider will not know your overall income and will use an emergency tax code to start with. This means you may pay too much tax initially and have to claim the overpaid tax back from HM Revenue & Customs back. Alternatively you may owe more tax if you have other sources of income. If you have taken income previously tax will be deducted based on the tax code that has been provided by HM Revenue & Customs. Please see our Guide to Income Tax and Your Pension for further information.

Complete as required i) Convert to flexi-access

ii) One-off withdrawal

I would like to immediately change from capped drawdown to flexi-access drawdown.I confirm I understand that there is no cap on the amount of income I can take under flexi-access drawdown, and once I take income this way I will be subject to the Money Purchase Annual Allowance (MPAA).I understand that once the account has been converted, it cannot be changed back.

Any regular income you currently receive will continue unless you complete the regular income section belowu If we make an income payment to you in good faith, based on your instruction, we are not able to accept it back at a later date and this may affect your tax position.

I want to take the following amount

I want to take my full crystallised holding leaving the uncrystallised amount invested (if you wish to take both crystallised and uncrystallised holdings you will need to complete the full withdrawal form)

Please confirm the month you want to receive your one-off paymentIf left blank, income will be paid in the next available month

(before tax)£

I confirm:a) I have provided my client with advice and discussed the appropriate risks in relation to this transaction

b) I have seen evidence of age and my client is over age 55, or over the applicable protected age

c) I have provided my client with an illustration in relation to this withdrawal, in line with my regulatory responsibilities as financial adviser, as detailed in FCA Sourcebook COBS 14.

2 FINANCIAL ADVISER DECLARATION

Signature Date

Financial Adviser Name

Adviser Firm Name

This statement must be completed in order for Old Mutual Wealth to carry out the instruction on behalf on the client

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! Please refer to the important information notes above before completing this section.

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5 BANK DETAILS

Name of bank account holder u The account must be in your name or with you as a joint holder

Name and address of bank/building society u This must be a UK bank/building society

Account number Sort code

− −Building society roll number u If applicable.

If you are not currently taking income withdrawals, or you want to change the bank account we pay your income to, please complete this section. We cannot make payments to third parties or business accounts except for sole trader.

We will meet your income payments by selling units proportionally across all funds.

If you are not invested in the Managed Portfolio Service (MPS), and you do not hold a mixture of uncrystallised and crystallised funds, you can instead choose to sell proportionally from specific funds by selecting an alternative fund choice below or you can write ‘largest fund’ if preferred.

Fund name

4 FUND CHOICE FOR INCOME PAYMENTS

Postcode

3 CHANGE AMOUNT OF INCOME WITHDRAWAL u Crystallised funds only (continued)

• We will need to see proof that you are the owner (or joint owner) of the bank account detailed below, if you have not used this account with us before. The proof and bank account details provided below must match exactly.

• The proof can be an original or certified* copy of a voided cheque or bank account statement dated within the last six months. If you have online bank account statements a printed copy certified* by your adviser as a true copy will suffice.

• Failure to provide acceptable proof of ownership will delay your application. * Copies must be certified on each page in ink by a UK-based professional such as your financial adviser, solicitor, accountant, GP or bank manager

(including the bank’s stamp). We cannot accept photographs of documents or debit cards. Emails of certified copies must confirm that the original documents have been witnessed.

iii) Regular income withdrawals

a) I want to stop taking regular income until further notice

c) Capped maximum amount required u Only available if you have a capped drawdown account

Monthly basis Yearly basis

Please confirm the month you want your capped income to startIf left blank, income will be paid in the next available month

I want the maximum income permitted paid to me on a

OR

b) I want my regular income paid to me on a

and the amount I want paid monthly is u (before tax)£

Monthly basis

£and the amount I want paid Yearly is u (before tax)

Please confirm the month you want your regular income to startIf left blank, income will be paid in the next available month

Yearly basis

If you request monthly payments, the maximum amount will be divided by the number of months left in the scheme year. This will change to the maximum amount divided by 12 when you start a new scheme year. For example: If your maximum income amount is £12,000 each year and you select this option with 6 months remaining, we will pay £2,000 each month for 6 months until the start of the new scheme year. We will then pay £1,000 each month.

NOTE

Please refer to the important information notes on the previous page before completing this section.

Please refer to the important information notes above before completing this section.

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www.oldmutualwealth.co.uk Please be aware that calls and electronic communications may be recorded for monitoring, regulatory and training purposes and records are available for at least five years.

Old Mutual Wealth is the trading name of Old Mutual Wealth Limited which provides an Individual Savings Account (ISA) and Collective Investment Account (CIA) and Old Mutual Wealth Life & Pensions Limited which provides a Collective Retirement Account (CRA) and Collective Investment Bond (CIB).

Old Mutual Wealth Limited and Old Mutual Wealth Life & Pensions Limited are registered in England and Wales under numbers 1680071 and 4163431 respectively. Registered Office at Old Mutual House, Portland Terrace, Southampton SO14 7EJ, United Kingdom. Old Mutual Wealth Limited is authorised and regulated by the Financial Conduct Authority. Old Mutual Wealth Life & Pensions Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Their Financial Services register numbers are 165359 and 207977 respectively. VAT number 386 1301 59.

PDF8789/219-0290/October 2019 Income Instruction CRA (Adviser version)

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6 YOUR DECLARATION

(a) I authorise and request Old Mutual Wealth to carry out the instructions detailed in this form.

(b) I understand that these changes will take effect in accordance with the CRA Terms and Conditions.

(c) I understand that, if I am subject to capped drawdown, my account will immediately convert to flexi-access drawdown if: i) I select a regular income amount above the maximum amount permitted, or ii) I select a one-off withdrawal that exceeds the remaining maximum amount permitted. I also understand that once converted to flexi-access drawdown this cannot be reversed.

(d) I declare that this form has been completed correctly to the best of my knowledge and belief.

(e) I understand that the taxable part of any payment made will be subject to income tax deducted by Old Mutual Wealth and paid to HM Revenue & Customs. Old Mutual Wealth will submit my personal and income details to HM Revenue & Customs.

(f) I declare that any full payment of the value of the benefits under this CRA shall constitute a full discharge of entitlement to receive benefit from this CRA.

(g) I have read and understood the contents of Old Mutual Wealth’s leaflet: ‘A guide to income tax and your pension’, and the accompanying documents related to taking income from my account.

Send the completed form to:

Old Mutual Wealth, Old Mutual House, Portland Terrace, Southampton SO14 7AY

Customer Service Centre Tel: 0808 171 2626

Signature

Date (ddmmyyyy)