FutureProof Individual Stakeholder Plan - Clerical …

1 1 FutureProof Individual Stakeholder PlanRequest to change contributions and/or add a transfer payment Add or change a regular contribution Monthly/Yearly/Applicant/Third party/EmployerPlease complete sections 1, , , 4, 5, and where appropriate, section 2, the Employer s contribution record and the direct debit(s). Add one or more single contribution(s) Applicant/Third party/EmployerPlease complete sections 1, , , 4, 5, and where appropriate, section 2 and the Employer s contribution record. Add one or more transfer payment(s) Transfers from previous pensionsYou need only complete sections 1, , , 4 and all cases, your adviser should complete the section below, and section 6 where plan number plan holder s full name Did your adviser give you advice in respect of this application?

2 Advice given Advice not givenTo be completed by the financial adviserFinancial adviser s reference Illustrations attached Regular contribution Single contribution Transfer 1 Reference number Transfer 2 Reference number Transfer 3 Reference number Please note: For transfers we won t be able to service this request unless you submit a copy of the correct pre-sales illustration(s).Financial adviser s detailsName of regulated firm (sole trader)Address Postcode Contact name Please write in CAPITAL LETTERS, with black ink and where reference is for financial adviser use, as transfers please tick to confirm the relevant illustration is attached and that it matches the quoted reference be completed by the financial adviser (continued)Contact telephone number Financial adviser email addressFCA reference number Agency number Sales consultant s full name Unless stated below you, the financial adviser, will be sent all the documents.

3 You will always be sent a copy of the policy certificate. Your client will be sent yearly policy certificates Send to applicant Send to financial adviserFilling in this formPlease return the completed form, along with your personal illustration(s) to: Clerical Medical, PO Box 28121, 15 Dalkeith Road, Edinburgh EH16 9 ASImportant notes about completing this form You or your financial adviser must ensure all the relevant sections are completed. You must read the key features document and your personal illustration before completing this contributions guidance notesHow much will you contribute?You should note that we will only accept personal contributions that are eligible for tax relief.

4 It is your responsibility to monitor the amount you pay to all registered pension schemes of which you are a member. Your contributions are paid net of basic rate tax. We ll add basic rate tax relief automatically to the regular and single contributions you or other individuals (including legal guardians) make to your plan . You can claim additional tax relief from HMRC if you pay tax on some of your income at a rate higher than the amount we add automatically to your plan . You can do this by contacting HMRC or through your self-assessment tax completing the form you must enter the gross amount you want to pay. This includes the basic rate tax.

5 The basic rate of tax is currently 20% so 1. To work out the gross amount divide the net contributions by To work out the net amount multiply the gross amount by your employer is paying your contribution on your behalf, they ll be deducting the net contribution from your salary, unless it is being paid via salary sacrifice in which case it is paid contributions must be paid gross (before tax has been deducted).If your employer is going to either Pay a contribution for the first time, or Continue contributing, but a different amount, or Pay an increased amount on your behalf (by deducting the payment from your net pay and sending it to us) they ll need to complete the Employer s contribution record on page : sending personal information by email is not secure.

6 Only include your email address if you agree to Clerical Medical sending you confirm which sales consultant you work financial advisers are overseeing additional single contribution(s) they must ensure that money laundering requirements have been applicable they must also send us a confirmation of verification of identity for each person paying into the plan see page : If a legal guardian is a higher rate/additional rate taxpayer, and the applicant is a minor, HMRC will only allow higher rate tax relief if the minor is also a higher rate/additional rate we accept your request this form will be the basis of your contract with must be under age in this form (continued)How must payments be made?

7 Where regular contributions are being paid by Direct Debit, this will be adjusted to reflect the changes you re now payments must be made either by cheque or electronic transfer (BACS Account number 53865294, Sort Code 56-00-05).Transfer payments can be made by electronic transfer (BACS) or cheque in pounds sterling ( ).Paying by chequeCheques should be made payable to Scottish Widows Limited . To help prevent fraud please add your name. For example: Scottish Widows Limited AN Other .Please also add on the back of the cheque Clerical Medical-your name-policy number . If you, the payer(s), or the transferring organisation fails to do this, we may have to return the should also draw a line through any unused space on the cheque so that any unauthorised person(s) cannot add extra numbers or by Direct DebitIf you want to start paying regularly by Direct Debit you and/or your employer should complete the form at the back of this a pension transferWe don t accept transfers from non-registered schemes other than certain overseas plan can take transfer payments representing any Guaranteed Minimum Pension (GMP) or Section 9(2B)

8 Rights, however any previous guarantees they had will no longer apply and they will provide the same type of benefits as the rest of the pension you ve already taken the tax-free cash you cannot transfer your pension fund to this plan and may need to seek guidance from your financial you have enhanced or fixed protection: Any transfer of funds must be a permitted transfer , and Paying contributions to a new pension plan will normally mean you ll lose your you want to maintain your protection you and your adviser will need to satisfy yourselves that the requirements have been you are transferring from a defined benefit scheme, such as a final salary scheme, once we ve received your completed request we will assume that your cancellation period has already expired.

9 This means you cannot change your mind about making the transfer to this Personal detailsPlease complete this section in all circumstancesPlease note: If you are completing this on behalf of a minor (for example a child aged 16 or less, or 18 or less if not in full-time employment) please enter the minor s name Date of birth (DD MM YYYY) Permanent residential address Postcode Daytime telephone number 41. Personal details (continued)Mobile telephone number Email address Previous address Postcode Nationality Country of residence (if other than UK)Occupation 2. Third party s and/or legal guardian and/or employer s details when contributing for the first Third party or legal guardian I am paying contributions on behalf of the planholderTitle (Mr/Mrs/Miss/Ms/Dr/Other) Surname First and middle name(s) Date of birth (DD MM YYYY) Permanent residential address Postcode Daytime telephone number Mobile telephone number Email address Previous address Postcode Nationality Country of residence (if other than UK)Occupation If you hold more than one nationality, please list them employed, or self-employed, please state your usual : sending personal information by email is not secure.

10 Only include your email of you agree to us sending you emails. Where a sole trader is contributing from their business account they will need to provide us with their trading name and address. This must go in the Permanent residential address : sending personal information by email is not secure. Only include your email address if you agree to Clerical Medical sending you more than one nationality is held, please list them employed, or self-employed, please state your usual occupation.(only required if you have lived at the above address for less than three months)(only required if you have lived at the above address for less than three months)52.