transfer - oldmutualwealth.co.uk€¢ free standing pension (fs1-4) ... • any portfolio...

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Transfer into your Old Mutual Wealth Pension

Please tick/complete this form using BLOCK CAPITALS only and blue or black ink, ensuring that any amendments are initialled by the applicant.

We try not to use technical jargon but where this is unavoidable we have explained the meanings in a glossary at the end of the form.

fInanCIaL aDVIser’s DeCLaraTIOnThis section must be completed by your financial adviser for the application to be accepted.

1. Is the transfer from an occupational pension scheme, or any other registered pension scheme that holds safeguarded benefits?

2. If YES, does your firm have the FCA’s permission to advise on pension transfers and opt-outs? If no, provide details below of the firm with the pension transfer and opt out authorisation

that has provided advice with regard to the transfer:

Name and address of firm:

FCA registration number

Yes - Go to 2 No

Yes No

WITh ThIS FOrM YOu CAN:

– transfer a pension into any of the following: • Personal Pension (PP1-4 & PPS) • Executive Pension (EP1-4 & EPS) • Free Standing Pension (FS1-4) u�Free Standing Pensions can only accept transfers from other free standing pensions.

There are separate forms for amending regular contributions and paying additional single contributions.

• Wecannotaccept: a) any transfer of benefits from a final salary scheme (unless the application is made through a financial adviser who has appropriate

FCA authorisation, or where the advice has been provided to that adviser by a firm who has the necessary FCA permission) b) any transfer from unfunded final salary schemes c) any transfer that includes funds in capped or flexi-access drawdown. Those funds can be transferred to a Collective Retirement

Account (CRA) if required d) any block transfers that may protect tax-free cash entitlements and/or a protected early retirement age

• The minimum transfer payment is £500.

• All references to Old Mutual Wealth in this form mean Old Mutual Wealth Life Assurance Limited.

NOTE

Pleaseenterthenumberoftheplanyouwanttotransferinto:

Plan Number

A YOUR DETAILS

Full name

Permanent residential address(c/o addresses are not acceptable)

Postcode

u If you are under 16 or between 16 and 18 and not in employment, this application must be completed by your legal guardian.

u your plan number will begin with PP, EP or FS

u If your address is different from the one we have on our records or it has changed within the last 12 months, we will need proof of the new address, for instance a recent original bill showing the new address, eg phone, electricity, gas, water, etc but not a mobile phone bill.

Contact details Tel: Email:

Date of birth(ddmmyyyy)

National Insurance Number

–

Please complete the table below to provide details of the pension plans you want to transfer from other providers. If you have more than four transfers please provide the same information for each one by using a copy of this page and attach it to this application.

1. Amount of transfer payment

Does this represent the full value of the plan you wish to transfer?

If No, we will request a partial transfer for the amount above.

2. Transferring scheme provider’s name

3. Plan number

4. Is the transfer from an occupational pension scheme?

£

1

TrANSFEr NuMBEr

£

2

Yes No Yes No

Yes No Yes No

C Transfer paymenTs

B LeGaL GUarDIan’s DeTaILs (if applicable)

Full name

Permanent residential address(c/o addresses are not acceptable)

Postcode

• Please complete a transfer authority for each transfer; transfer authorities are at the end of this form.• Before we can accept the transfer, we will need confirmation of the transfer payment details from the Transferring Scheme Administrator.

NOTE

1. Amount of transfer payment

Does this represent the full value of the plan you wish to transfer?

If No, we will request a partial transfer for the amount above.

2. Transferring scheme provider’s name

3. Plan number

4. Is the transfer from an occupational pension scheme?

£

3

TrANSFEr NuMBEr

£

4

Yes No Yes No

Yes No Yes No

PDF9162/218-1007/June 2018 (Transfer PP/EP/FS1-4, PPS/EPS)

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Contact details Tel: Email:

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Complete the table below to select your fund(s) for your transfer payment(s)

e fUnD CHOICe

• If your fund choice is incomplete or otherwise invalid, we will allocate part or all of the investment as appropriate to the OmW Deposit fund.

• We are not authorised to provide advice; your financial adviser will be able to help you choose the funds most suitable for you.

• You can choose up to 99 funds – if there is insufficient space for you to list all of your chosen funds below, continue on a separate sheet and attach it to this application.

• Any portfolio rebalancing currently in place will be cancelled as a result of this application; we will need a new Portfolio rebalancing instruction if you want this service to continue.

NOTE

fund manager full fund name

100%Total

Whole %(minimum 1%)


you do not need to complete this section if you have already provided the information to Old mutual Wealth.

have you taken any benefits from any pension arrangements with Old Mutual Wealth or any other pension provider, in a way that means you are subject to the Money Purchase Annual Allowance (MPAA) which limits the total contributions that can be paid to money purchase registered pension schemes to £4,000 a year?

D mOney pUrCHase annUaL aLLOWanCe DeCLaraTIOn

If Yes please confirm the date on which the MPAA first applied to you

NoYes

f paymenTs TO yOUr fInanCIaL aDVIser

• If you HAVE been given advice about this application by your financial adviser: – Go to section G u�No commission or fees will be paid from your plan for this transaction. Any fees you agree to pay your financial adviser for the advice received

will need to be arranged separately.

• If you HAVE NOT been given advice about this application by your financial adviser: – Do you wish commission to be paid to your financial adviser for this transaction?

• The rates of commission shown are the maximum rates payable (and exclude any Marketing Allowance that may be payable).

• If you do not require maximum initial commission, please state the rate or amount required.

• We do not pay remuneration to financial advisers for plans opened in their own names. Financial advisers should refer to our Terms of Business for further information.

NOTE

Please complete ONE of the following:

orOption 1

Option 2

%. £

or%. £

Option 3 %. or £

plan numbers startingwith:

Option 1 Option 2 Option 3

pp1, pps, ep1, eps, fs1

Up to 4% initial commission (no fund-based commission)

N/A N/A

pp2, pp3, pp4ep2, ep3, ep4fs2, fs3, fs4

Up to 3.10% initial commission + 0.25% pa fund-based commission

Up to 2.25% initial commission + 0.50% pa fund-based commission


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– Go to section G

– Using the table below complete the commission option required

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Any omission or misstatement of a material fact in this application form could affect the payment of benefits under the arrangements comprising the pension plan. A material fact is one which is likely to influence the assessment and acceptance of this application. If you are uncertain whether a fact is material, you should give full details so that we can assess its possible significance. If you become aware of such a fact while we are considering your application, you should notify us immediately.

1. DeclarationI request that the changes detailed in this application are made to my plan.a) I declare that to the best of my knowledge and belief the statements made in this application and declaration and any related documents are correct

and complete and that I have not concealed any material fact.b) I agree to supply information relevant to the pension plan as shall be required by Old Mutual Wealth from time to time.c) If Portfolio Rebalancing applies to my plan, I understand that: i) my instructions will automatically be cancelled as a result of this application. ii) a new set of Portfolio Rebalancing instructions will be required should I wish to reinstate the instructions.

2. Transfer paymentsI authorise and instruct you to transfer sums and assets from the plan(s) listed in this application directly to Old Mutual Wealth and to provide any instructions and/ or discharge required by any relevant third party to do so.

I authorise Old Mutual Wealth, the current provider and any financial intermediary named in this application to obtain from each other, and release to each other, any information that may be required to enable the transfer of sums and assets to Old Mutual Wealth.

I authorise Old Mutual Wealth, the current provider and any employer paying contributions to any of the plan(s) listed in the application to obtain from each other, and to release to each other, any information that may be required to enable the transfer of sums and assets to Old Mutual Wealth.

Until this application is accepted and complete Old Mutual Wealth’s responsibility is limited to the return of the total payment(s) to the current provider(s).

When the payment is made to Old Mutual Wealth as requested, this means that I shall no longer be entitled to receive pension benefits from the whole of the plan(s) listed in the application where the whole of the plan(s) is/are transferring, or that part of the plan(s) represented by the payments if only part of the plan(s) is/are transferring.

I accept responsibility in respect of any claims, losses, expenses, additional tax charges or any penalties that Old Mutual Wealth and the current provider may incur as a result of any incorrect, untrue, misleading or inaccurate information in this application or given by me, or on my behalf, or any failure on my part to comply with any aspect of this application. This includes where I have been asked to provide any original policy document(s) in return for the transfer of funds and I am unable to do so.

3. personal Data statement I agree that you may keep and use my personal data to process my application and to service my plan.I confirm that the beneficiary/each beneficiary and/or my spouse or civil partner or dependant referred to in this application (or parent where parental consent is required if a beneficiary is a dependant) consents and agrees to my acting as their agent for the purposes of the personal data provided within the application being returned to you for the administration of my plan.I understand that you may provide my personal data, by electronic or other means, to:• other companies within Quilter plc if you regard this as necessary to service my plan• my financial adviser including via a secure restricted access internet service• my employer/Trustee/Administrators of the scheme (where applicable)• a third party to verify my identity in line with money laundering or other requirements• re-insurers and other third parties who perform tasks for you to help you to service my plan. These third parties may be based in countries outside the

EEA. These countries may not have laws to protect data equivalent to those in the UK. However, you will ensure that any such third parties agree to treat my data with the same level of protection as if you were dealing with it.

• investigate or prevent fraud. I understand that to prevent and detect fraud you may:• share my personal data with other organisations including the police• check and/or file my personal data with fraud prevention agencies and databases and if I give you false or inaccurate information and you suspect

fraud you will record this.I understand that:• Quilter plc may use my data for assessment and statistical analysis purposes and without identifying me make results available to third parties.• my personal data may be made available to third parties where required by law, court order or regulation.• on payment of a small fee I am entitled to receive a copy of the personal data that you hold on me and that I have the right to require you to correct

any inaccuracies.I confirm that I have received a Key Features Document and my financial adviser has explained the basis of their remuneration, where relevant.

G yOUr DeCLaraTIOn

Date(ddmmyyyy)Legal guardian’s

signatureu this is required if the applicant is under 18, even if he or she has signed above

D D M M 2 0 Y Y

Date(ddmmyyyy)

Your signature D D M M 2 0 Y Y

u if 16 or over

The Scheme Administrator undertakes on behalf of Old Mutual Wealth Life Assurance Limited to administer the relevant Scheme in accordance with the rules.A copy of this completed application form and the relevant Member’s Guide are available on request.


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 Life Assurance Limited is registered in England & Wales under number 1363932. Registered Office at Old Mutual House, Portland Terrace, Southampton SO14 7EJ, United Kingdom. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services register number 110462. VAT number 386 1301 59.


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GLOssary

Send the completed form to:Old Mutual WealthOld Mutual HousePortland TerraceSouthampton SO14 7AY

Customer Contact Centre Tel: 0808 171 2600

Fund-based commission This is ongoing commission we pay to your financial adviser, payable monthly, quarterly or half-yearly. It is calculated as a percentage of the encashment value of your plan each year.

Initial commission This is commission we pay your financial adviser at the start of your plan, or when contributions are made. You can agree a different level each time you make a single contribution.

Marketing allowance This is an enhancement to the initial commission we pay to your adviser. Different advisers have different rates of Marketing Allowance.

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Please use a copy of this page if you require more authority forms.

Dear Sir or Madam

Name of Transferring Scheme

Transferring Scheme address

Policy number (if applicable) Please accept this letter as my authority to pay the transfer value to Old Mutual Wealth. This is to provide me with added benefits in the receiving scheme instead of under your scheme. I authorise you to provide Old Mutual Wealth with all the information it needs to accept the transfer value.You have confirmed to me that you have calculated the transfer value based on equal benefits for men and women since 17 May 1990. This is in line with the European Court of Justice’s rulings on equal treatment. I understand that I have no further claim against the trustees, administrators or managers of the transferring scheme.

Yours faithfully

Signature

Full name

Postcode

(this should normally be the Head Office address)

Dear Sir or Madam

Name of Transferring Scheme

Transferring Scheme address

Policy number (if applicable) Please accept this letter as my authority to pay the transfer value to Old Mutual Wealth. This is to provide me with added benefits in the receiving scheme instead of under your scheme. I authorise you to provide Old Mutual Wealth with all the information it needs to accept the transfer value.You have confirmed to me that you have calculated the transfer value based on equal benefits for men and women since 17 May 1990. This is in line with the European Court of Justice’s rulings on equal treatment. I understand that I have no further claim against the trustees, administrators or managers of the transferring scheme.

Yours faithfully

Signature

Full name

Postcode

(this should normally be the Head Office address)







Transfer aUTHOrITy

D D M M 2 0 Y YDate(ddmmyyyy)

D D M M 2 0 Y YDate(ddmmyyyy)

Transfer aUTHOrITy

transfer - oldmutualwealth.co.uk€¢ free standing pension (fs1-4) ... • any portfolio...

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