Application Form The Primetime Retirement Fixed Term Annuity The Primetime Retirement Fixed Term Annuity (the ‘Plan’) is held within a registered pension scheme, the Pointon York SIPP, administered by Pointon York SIPP Solutions Limited, which is authorised and regulated by the Financial Conduct Authority, authorisation number 309975
Please return this completed application form and supporting documents to: Primetime Retirement Support Team Pointon York House Welland Business Park Valley Way, Market Harborough Leicestershire, LE16 7PS
Primetime Retirement Support Team t: 01858 419301 f: 01858 419400 e:
[email protected] Flexibility, Flexibility, Choice, Choice, Independence Independence
pointon york
Administering Administering SIPPs SIPPs Since Since 1990 1990
helping customers succeed
Please complete the Application Form as fully as possible using BLOCK CAPITALS throughout; boxes should be ticked where indicated. Should you have any queries, please contact the Primetime Retirement Support Team on 01858 419301. All information provided will be treated in confidence and will be subject to the Data Protection Act 1988.
1 Financial Adviser Details Financial Adviser Name
Firm Name and FCA Register Number
Address Postcode Email Telephone Number Is the above Financial Adviser connected to the member in any way? (e.g. relative, business partner, etc)
Yes
No
I hereby understand and declare: 1. I confirm that I have given advice in respect of transferring the benefits of the existing client’s pension plan. 2. Fee payment as specified in Section 3 will be made when the client’s Plan is in force and the funds invested. 3. The Adviser fee will be paid to the bank account details provided in the signed Terms of Business Agreement. 4. I will not rebate any of this fee direct to the member. Financial Adviser’s Name Adviser’s Signature Date
PLEASE NOTE: If you are new to Pointon York, in order to set the application up and pay Adviser fees we will require a fully completed ‘Terms of Business’ (TOBA) Form to be submitted with this Application.
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CHECKLIST Pointon York is committed to ensuring that your application is processed as quickly and as efficiently as possible. The following checklist will ensure we have all the information we need to do this. • Personal Details: Members Bank Details completed for the income payments? • Investment Strategy: Have you included the Primetime Retirement Quote Reference Number? • Benefit Crystallisation: Have you completed all sections? If you have answered ‘Yes’ to any of the Lifetime Allowance Questions have you completed the additional ‘Benefit Crystallisation Event Member Declaration’ form? - Benefit Crystallisation Event Member Declaration: Have you completed all sections and included all Lifetime Allowance Statements for any other drawdown pensions vested Post A day? • Member Declaration: Is this signed and dated by the member? • Proof of Age: have you enclosed an acceptable document as detailed on Page 3? • Have you enclosed a fully completed and signed Transfer In Instruction page for EACH ceding scheme transfer? Please note for Pension Transfer Instructions: • For additional pension transfers please copy the Pension Transfer Instruction page as many times as required • We use the Origo Options Transfer system to facilitate the transfer process for pension plans which are eligible, however in case it is necessary to instruct by post it would be helpful and would speed up the postal process if we receive the the signed provider discharge forms at the application stage
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2 Member Personal Details Title (please circle)
Mr / Mrs / Miss / Doctor / Other (please state)
Forename(s) Surname
D
Y
Y
Y
Y
D M M Date of Birth
Sex:
Male / Female
Marital Status Single Separated Married Divorced National Insurance Number Nationality
Permanent Residential Address House Number
House Name
Street Name
Town County Post Code Mobile Daytime Tel Email
Your Bank Account details to receive income and Pension Commencement Lump Sum (PCLS) (if applicable): Note - a joint individual account is acceptable, but payment cannot be made to a business account Name of Account Holder Name of Bank Account Number
Sort Code
Spouse/Partners Name (if applicable) Spouse/Partner Date of Birth
D
D
M
M
Y
Y
Y
Y
Proof of Age If the funds are being crystallised we will require Proof of Age before any benefits can be paid. Please submit one of the following documents (please tick the document(s) you are submitting).
Certified Copy of Passport
Certified Copy of Driving Licence
Original Birth Certificate*
*
If there has been a name change through marriage we will also need an original Marriage Certificate.
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3 Investment Option Selected 100% of my fund is to be invested as directed in the Primetime Plan indicated below: Primetime Retirement Plan Five year Plan Term* Capital+ Plan Income+ Plan *Only available under the Primetime Retirement Plan
Six year Plan Term Accumulation+ Plan
Primetime Retirement Quote reference Please specify whether the adviser charge is to be calculated before
or after
PCLS is taken.
% If a specific Adviser charge has been agreed please state this here: £ It is normal for the final transfer funds received from the ceding provider(s) to vary from the amounts illustrated in the quotation. Please indicate your requirements for Fixed Investment Withdrawals so that we may manage any such variance. I require Fixed Investment Withdrawals based upon 100% of my current Government Actuary’s Department (GAD) allowance I require Fixed Investment Withdrawals based upon 120% of my current Government Actuary’s Department (GAD) allowance I require Fixed Investment Withdrawals based upon 150% of my current Government Actuary’s Department (GAD) allowance I require a specific monetary amount of Fixed Investment Withdrawals per annum
£
% I require a specific % of Fixed Investment Withdrawals per annum Please note that in all cases, the maximum income that may be paid to you will be restricted by GAD. Where Fixed Investment Withdrawals above current GAD are requested the excess will be retained within the scheme bank account and may be payable on a future GAD review. Any income not withdrawn from the SIPP bank account is added to your Protected Maturity Amount. We aim to pay any Pension Commencement Lump Sum within 5 working days of receipt of your transfer value from the ceding provider (or if more than one transfer is being managed, within 5 workings days of receipt of the final transfer). If there is a specific reason why you would like Benefit Crystallisation to be delayed (for example a birthday triggering a higher GAD limit) please indicate the specific date, before which benefits should not be crystallised. I wish to ensure benefits are not crystallised before the following date
Expression of Wish Nomination Pointon York SIPP Solutions Limited will determine the recipients of the benefits available under your Plan. In order to assist and speed up the payment of these benefits in the way that you wish, you are strongly encouraged to complete the following section. You should indicate who you wish any remaining funds on your death to be paid to and any split of distribution, as a % of funds. If you want to nominate more than two beneficiaries please continue on a separate piece of paper, which should be signed and dated. Beneficiary 1 name
Relationship to you
% Fund
Relationship to you
% Fund
Address
Beneficiary 2 name Address
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4 Benefit Crystallisation ‘Benefit Crystallisation Event’ is the name given to the calculation that needs to be done when you take benefits from your pension, in order to record how much of your Lifetime Allowance is to be used up. Please accept this as my written request to take benefits from the above scheme and confirmation of information in respect of this benefit crystallisation event: Country of Residence Will your residency change before you draw your first drawdown payment?
Yes
No
If ‘Yes’ please confirm the country you will be resident in? Required Pension Commencement Lump Sum (PCLS) Maximum Fixed Amount
Nil
£
Where no PCLS is elected then the option will be lost permanently on segments being vested now.
Income
£
Please specify income amount per annum as per quotation provided:
Payment will be monthly via Faster Payment. The regular date will be the first available date from our weekly payroll dates of 8th, 15th, 22nd or 28th monthly following the strike date.
Lifetime Allowance Lifetime allowance details for those under age 75 For most people, their personal lifetime allowance is the same as the standard lifetime allowance (£1.5 million in the 2013/2014 tax year reducing to £1.25million from 6th April 2014). This is the equivalent fund value used to buy your pensions and annuities rather than the yearly pension or annuity amount you can receive. If this plan does take you over this limit you may have to pay an additional tax charge. Lifetime allowance details for those over 75 If you are 75 or over and are taking a lump sum is the amount that you are taking within 25% of your remaining personal Lifetime Allowance?
Yes
No
Have you any other pensions in drawdown, or about to put any in drawdown?
Yes*
No
Is the total value of all your pensions and annuity benefits you’ve already taken, including any tax-free cash, when added to the benefits you are transferring here, more than the standard lifetime allowance?
Yes*
No
If you are unsure how to calculate the value of your benefits, please speak to your financial adviser. Do you have a personal lifetime allowance different from the standard lifetime allowance, individual protection, enhanced protection, fixed protection or a protected early retirement age? Yes*
No
*If you have answered ‘Yes’ to any of these questions then you will need to complete the supplementary Benefit Crystallisation Event Declaration Form and submit along with this application.
Lump Sum I confirm the lump sum I am due to take from my Plan is not being taken with the intention of significantly increasing contributions to one or more registered pension scheme(s).
Drawdown 1. 2.. 3.
I accept figures as calculated for Pension Commencement Lump Sum and maximum income based upon my fund values at point of calculation. I understand that Income Drawdown payments may need to decrease on recalculation at my next review and every review thereafter – for example due to a change in rates by the Government Actuary’s Department (GAD) tables I understand that any income payment will be subject to income tax through PAYE.
Indemnity 1. 2. V0.5 03.14
I understand that if tax becomes payable because the information provided is proven to be incorrect, then I will be wholly and personally liable for the tax due and any resultant penalty as may be imposed by HM Revenue and Customs. In addition, I hereby indemnify Pointon York SIPP Solutions Limited in respect of any liability that they may incur as a result of any incorrect information I provide either on this Application or otherwise.
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5 Member’s Declaration Please read all of the following carefully before signing at the end. By applying for a Primetime Retirement Fixed Term Annuity you are applying for membership of The Pointon York SIPP. As a Plan member you accept a relatively limited range of options within a Pointon York SIPP. The Pointon York SIPP is registered with HM Revenue & Customs as a registered pension scheme under the terms of Part 4 of Finance Act 2004 (as amended). It has been registered for the purpose of providing benefits to members and their dependants by way of lump sums and pension income. At the time of establishment of your Plan, the “Trustee” is Crescent Trustees Limited of Pointon York House, Welland Business Park, Valley Way, Market Harborough, Leicestershire LE16 7PS. 1. To the best of my knowledge and belief, the particulars given in this application are true and complete. 2. I have read the Primetime Retirement Plan Policy Conditions and agree to these. 3. I consent to Pointon York SIPP Solutions Limited using the information supplied in this application form in order to administer my membership of The Pointon York SIPP and acknowledge that the information will be held on Pointon York SIPP Solutions Limited’s computer records. Such information may be disclosed in confidence to regulatory bodies, the bank operating the bank account, Crescent Trustees Limited as Trustee of The Pointon York SIPP, and to any associate and/or agent appointed to assist Pointon York SIPP Solutions Limited in administering my membership and any person providing professional services to Pointon York SIPP Solutions Limited. 4. I consent to the transfer of my existing pension via the Origo Options Transfer System if the policy is eligible for such transfer. 5. I confirm that to the best of my knowledge and belief the particulars and declarations given in this application are correct and complete. 6. I confirm that I have received financial advice from the Financial Adviser named in part 1 of this Application. 7. I confirm that Crescent Trustees Limited and/or Pointon York SIPP Solutions Limited have not provided me with advice with regard to the establishment of my SIPP or its suitability for my circumstances. 8. I understand that any sums in respect of an adviser charge will be deducted from my investment amount.
Data Protection Statement I hereby consent to Pointon York SIPP Solutions Limited and related companies within the Group, to: 1. Set-up and administer my plan and send me details relating to it. 2. Share my details with other companies within the Pointon York Group Limited and their associated companies in order to provide administration services in respect of my plan. 3. Pass my details to market research organisations for purposes of confidential market research surveys. 4. If you do not want to receive marketing information, please tick this box. 5. If you do not wish for your details to be released to market research organisations, please tick this box. I confirm that I have read and understood the Key Features Document, the Policy Conditions and the Quote.
Member’s Signature
Date
Warning: It is a serious offence to make false statements; the penalties are severe and could invalidate your membership of The Pointon York SIPP and lead to prosecution. Pointon York SIPP Solutions Limited, the Scheme Administrator, agrees on behalf of the Scheme, to administer The Pointon York SIPP as required by the Rules. Pointon York SIPP Solutions Limited is authorised and regulated by the Financial Conduct Authority. The FCA Authorisation number is 309975 and the registration details can be viewed on the Financial Services Register at www.fca.org.uk.
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Pension Transfer Instruction IMPORTANT: We cannot accept open market option transfers as these are designated for lifetime annuities only. We must receive the full pension transfer. For additional transfers please copy this page as many times as required I wish to transfer my existing pension benefits to the Pointon York SIPP for the purchase of a Primetime Retirement Fixed Term Annuity. I authorise and instruct you to transfer the funds from the policy number(s) below directly to the receiving scheme in the form of a bank transfer cash payment, by cheque payable to Crescent Trustees Ltd or such other method agreed with Pointon York SIPP Solutions Limited (Pointon York). I authorise you to release all necessary information to Crescent Trustees Limited or Pointon York to facilitate the transfer of funds to the receiving scheme, I authorise you to provide them with any information they request about my benefits or the scheme. I agree that a copy of this authority should have the validity of the original.
Member and Pension Details Title
Forename(s)
Surname
Date of Birth
National Insurance Number Name of transferring scheme Trustee/Administrator’s address Your Scheme or Policy number(s) Is the transfer from a scheme already in drawdown?
Yes
No
Is the transferring scheme an occupational pension scheme? Yes If yes, is the scheme a defined benefit scheme? Yes IMPORTANT - If transferring from a defined benefit scheme we recommend you receive financial advice as there may be benefits which could be lost on transfer
No No
Right to Withdraw You have the right to withdraw from the transfer within 30 days of the date we inform you that we have received your transfer request. You may do this by writing to Pointon York SIPP Solutions Limited at the following address: Pointon York SIPP Solutions Limited, Pointon York House, Welland Business Park, Valley Way, Market Harborough, Leicestershire, LE16 7PS.
Member Declaration
I confirm that I have a retained benefit within the above named scheme and I wish to transfer benefits from the scheme to the Pointon York SIPP for a Primetime Retirement Fixed Term Annuity. If my benefits are already crystallised I understand that the ceding scheme will provide details of the maximum permitted benefits available until the next pension review date. I consent to the transfer of my existing pension via the Origo Options Transfer System if my policy is eligible. Where you have asked me to give you any original policy document(s) in return for the transfer of funds and I am unable to do so, I promise to accept responsibility for any claims losses and expenses of any nature which you may incur as a result of having made the transfer(s) in this form. Where payment(s) made to the receiving scheme represent all of the funds under the plan(s) listed, then payment made as requested will discharge the current provider of all claims and responsibilities in respect of the plan(s) listed. Where payment(s) made to the receiving scheme represents part of the funds under the plan(s) listed, then the current provider will be discharged of all claims and responsibilities only in respect of the part of the plan(s) represented by the payment. I promise to accept responsibility in respect of any claims, losses and expenses that Crescent Trustees Limited or Pointon York and the current provider(s) may incur as a result of any incorrect information I provided in this application, or of any failure on my part to comply with any aspect of this application. I understand that: - if I exercise my right to withdraw from the above transfer it may not be possible for the transfer to go back to the transferring scheme, - if I exercise my right to withdraw from the above transfer any legal and related costs borne by Crescent Trustees Limited in relation to any investment instruction already carried out will be paid from funds in my SIPP not attributable to the transfer, and - I will lose this right to withdraw after the date Pointon York SIPP Solutions Limited inform me my 30-day right to withdraw expires and that if I subsequently wish to transfer to another pension scheme I will be charged for doing this. Member Signature
Date
Pointon York House Welland Business Park Valley Way, Market Harborough Leicestershire LE16 7PS t: 01858 419301 e:
[email protected] V0.5 03.14
pointon york
helping customers succeed
Primetime Retirement Support Team Pointon York House Welland Business Park Valley Way, Market Harborough Leicestershire, LE16 7PS t 01858 419301 f 01858 419400 e
[email protected] www.pointonyork.co.uk © Pointon York SIPP Solutions Limited 2014
Pointon York SIPP Solutions Limited. Registered in England, No. 4356056. Registered Office: Pointon York House, Welland Business Park, Valley Way,Market Harborough, Leicestershire, LE16 7PS
Pointon York SIPP Solutions Limited is authorised and regulated by the Financial Conduct Authority. V0.5 03.14
