ADDING OR AMENDING CONTRIBUTIONS - Old … OR AMENDING CONTRIBUTIONS ... FS1-4) Have you taken any...

ADDING OR AMENDING CONTRIBUTIONSto your Pension (PP1-4, PPS, FS1-4)

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.

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WITH THIS FORM YOU CAN:

– add or amend regular contributions– make an additional single contributioninto a Personal Pension (PP1-4 and PPS) or a Free Standing Pension (FS1-4).There is a separate form for making transfers in from other pension arrangements.

• All references to Old Mutual Wealth in this application mean Old Mutual Wealth Life Assurance Limited.• We recommend that you complete this form with help from your fi nancial adviser. – If you don’t have an adviser and would like to fi nd one in your area, you can fi nd a range of options by visiting

www.oldmutualwealth.co.uk/fi nd-an-adviser.

NOTE

A YOUR DETAILS

– Your plan number

Your full name

Please tick/complete this form using BLOCK CAPITALS and blue or black ink, initialling any amendments or corrections.If you are under 16 or between 16 and 18 and not in employment, this application must be completed by your legal guardian.

Yes NoHave you been given advice about this application by your fi nancial adviser?

Failure to answer the following question will delay your application

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

Postcode

your plan number will begin with PP or FS

B LEGAL GUARDIAN’S DETAILS (if applicable)

Full name

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

Postcode

Contact details Tel: Email:

Contact details Tel: Email:

Date of birth(ddmmyyyy)

National Insurance Number

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.

C CONTRIBUTIONS

Complete this section with details of the contributions for your pension.

• Please note you could suffer a tax liability if contributions are funded from a tax-free cash sum received from a registered pension scheme. • Employer contributions cannot be paid into free-standing (FS) pensions.NOTE

Employer’s contribution (gross)(including any contribution being made by salary sacrifi ce)

Your contribution (net)

Total

Minimum additional single contribution – £500 gross.

£ .

£ .

£ .

SINGLE CONTRIBUTION

Frequency of regular contributions Monthly Yearly

Employer’s contribution (gross)(including any contribution being made by salary sacrifi ce)

Your contribution (net)

Total

£ .

£ .

£ .

REGULAR CONTRIBUTION

0 1 M M 2 0 Y Y

this cannot be back-dated

The start date for your regular contribution, or for the amended regular contribution, will be the fi rst of the next available month.

If you would like a later start date, please state the month and year required here:

Your employer must complete section J

Your employer must complete section J

If being paid by a third party, complete section D

If being paid by a third party, complete section D

If you are adding regular contributions for the fi rst time and you want theamount to be automatically increased at each annual review, tick here

the increase will normally be the greater of 10% or the rate of infl ation.

The Direct Debit Instruction at the end of this form is required where a regular contribution is being added for the fi rst time, or where the payer’s bank details have changed.

D THIRD PARTY PAYER DETAILS (if applicable)

Full name(s) of the third partyPermanent UK residential address

Postcode

Complete this section with details of any third party (other than your employer) paying your contributions.

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

• Privacy information – a privacy notice is available on our website at www.oldmutualwealth.co.uk/privacy• In some circumstances the plan owner may be the only person permitted to pay premiums. Please contact Old Mutual Wealth if you

have any queries about this.

NOTE

Contact number

in case of query

Which contribution is being paid by this third party? Single Regular

Date of birth(ddmmyyyy)

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PDF9163/218-0572/May 2018/(Add/Amend PP1-4, PPS, FS1-4)

Have you taken any benefi ts 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?

E MONEY PURCHASE ANNUAL ALLOWANCE

If Yes please confi rm the date on which the MPAA fi rst applied to you

NoYes

No We will automatically increase your waiver of contribution benefi t in line with any increases to your regular contributions

Yes Tick one of the following to indicate how you want us to proceed: if neither is ticked it will delay your instruction while we contact you for clarifi cation

I have incapacity benefi t and want to increase it in line with increases to my regular contributions (up to a maximum of 10%)payment will be capped as detailed in your Member’s Guide

I have life cover and want to increase it in line with increases to my contributions (up to a maximum of 10%)

Tick here if your fund choice is the same as for your regular contributions Now go to section H

OR

F INCREASED PROTECTION BENEFITS (if applicable)

If you have incapacity benefi t and/or life cover

You can increase these benefi ts in line with any increases to your regular contributions (up to a maximum of 10% in any rolling 12-month period). If required, tick the following (as applicable):

continue with the increase and remove the waiver of contribution benefi t once the waiver of contribution benefi t is removed, we cannot reinstate it

limit your contribution increase to the maximum allowed, and keep the waiver of contribution benefi t on your plan

• Any protection benefi ts chosen are guaranteed to remain in force for one year between review dates, provided regular contributions continue at least at the level required.

NOTE

Tick here if your fund choice for the amended contribution is the same as your current regular contribution fund choice, Now go to section H

ORComplete the table below to select different fund(s) for your amended contributions

Complete the table below to select your fund(s) for your single/regular contributions

• Amended regular contributions

• Single/New regular contributions

G 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 fi nancial adviser will be able to help you choose the funds most suitable for you.

• You can choose up to 99 funds – if there is insuffi cient 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%)

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If you have ‘waiver of contribution’ benefi tHave contributions to your pension (including those in this form) increased by more than 10% in the last 12 months?

H PAYMENTS TO YOUR FINANCIAL ADVISER

• If you HAVE been given advice about this application by your fi nancial adviser:

– Go to section I No commission or fees will be paid from your plan for this transaction. Any fees you agree to pay your fi nancial adviser for the advice received

will need to be arranged separately.

• If you HAVE NOT been given advice about this application by your fi nancial adviser:

– Do you wish commission to be paid to your fi nancial 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 fi nancial advisers for plans opened in their own names. Financial advisers should refer to our Terms of Business for further information.

NOTE

Plan numbersstarting with:

Option 1 Option 2 Option 3 Option 4

PPS, PP1, PP2, FS1, FS2, PP3, FS3 (pre CMD)

Up to 25% initial commission(no fund-based commission) N/A N/A N/A

PP3, FS3 (post CMD*) N/A

Zero or 5.75% initial commission

(no fund-based commission)

Zero or 4.85% initial commission + 0.25% pa fund-based commission

Zero or 4% initial commission + 0.50% pa fund-based commission

PP4, FS4 (pre CMD*)

Up to 12.5% initial commission(no fund-based commission) N/A N/A N/A

PP4, FS4 (post CMD*) N/A

Zero or 3.6% initial commission

(no fund-based commission)

Zero or 2.25% initial commission + 0.50% pa fund-based commission

N/A

Please complete ONE of the following:

orOption 1

Option 2 Commission to be paid on the same basis as the existing level

%.. £

Option 3

Option 4

Commission to be paid on the same basis as the existing level (plus fund-based commission each year as stated)

Commission to be paid on the same basis as the existing level (plus fund-based commission each year as stated)

TABLE 1 – REGULAR CONTRIBUTIONS

* CMD is the Charge Maturity Date. It can be at any point between the commencement date of the plan and the selected retirement age. Call us if you want more information or to fi nd out your Charge Maturity Date.

NO – Go to section I


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Please complete ONE of the following:

TABLE 2 – SINGLE CONTRIBUTIONS

orOption 1

Option 2

%. £

or%. £

Option 3 %. or £

Plan numbersstarting with:

Option 1 Option 2 Option 3

PP1, PPS, FS1

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

N/A N/A

PP2, PP3, PP4FS2, 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

Any omission or misstatement of a material fact in this application form could affect the payment of benefi ts under the arrangements comprising the Personal/Free Standing Pension. A material fact is one which is likely to infl uence 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 signifi cance. If you become aware of such a fact while we are considering your application, you should notify us immediately.

Declarationa) I request that the changes detailed in this application are made to my existing plan.

b) I understand that the Personal Pension will comprise a single arrangement in respect of any regular or single contributions paid by me or on my behalf by my employer or a third party and any transfer payments.

c) 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.

d) I declare that the total contributions paid by me or on my behalf to any registered pension scheme on which I am entitled to tax relief, do not exceed any of the following: the higher of the basic amount (£3,600), or my relevant UK earnings for the tax year.

e) I agree to supply information relevant to the Personal Pension as shall be required by Old Mutual Wealth from time to time.

f) I undertake to notify the Scheme Administrator immediately if the total contributions paid by me or on my behalf to any UK-registered pension scheme on which I am entitled to tax relief do exceed the higher of the basic amount (£3,600) or my relevant UK earnings for the tax year or if I cease to be entitled to relief at source on my contributions.

I will give notice of this by the later of:

i) 5 April in the year of assessment in which the event occurs; and

ii) the date which is 30 days after the occurrence of that event.

g) I declare that contributions made to the Plan have not been and will not be funded from a tax-free cash sum from a registered pension scheme to the extent that either myself nor Old Mutual Wealth will suffer a tax liability.

h) I declare that any person paying contributions as a third party has been made aware and accepts that they have no claim to benefi ts arising from my membership of this pension scheme.

i) If Portfolio Rebalancing applies to my plan, I understand that: i) my instructions will automatically be cancelled as a result of this application. ii) new Portfolio Rebalancing instructions will be required should I wish to reinstate the service.

Legal guardian declarationa) I understand the contributions paid to the plan may only be returned to the member in the form of benefi ts payable under the rules of the personal

pension scheme (after age 55 except in the case of earlier incapacity).

b) I declare that I am responsible for the plan until the member reaches 18.

c) I declare that I will be responsible for ensuring that contribution limits in respect of the minor are not exceeded.

d) I agree to advise Old Mutual Wealth of the National Insurance number of the minor when they reach age 16.

Personal Data StatementI confi rm that I have been shown and read the privacy notice.

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I YOUR DECLARATION


Date(ddmmyyyy)

Legal guardian’s signature

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

if 16 or over

Your employer must complete section J overleaf if contributing to your pension

THIS FORM ACTS AS AN APPLICATION FOR TAX RELIEF AT SOURCE ON YOUR CONTRIBUTIONS. IT IS THEREFORE A SERIOUS OFFENCE TO MAKE A FALSE STATEMENT. THE PENALTIES ARE SEVERE AND COULD LEAD TO PROSECUTION.

J EMPLOYER’S DECLARATION – TO BE COMPLETED BY YOUR EMPLOYER

GLOSSARY

Signed

on behalf of the employer named above

D D M M 2 0 Y Y

Employer’s name

Capacity

The statements in this form are correct to the best of our knowledge and belief.

this must be an authorised offi cial

Fund-based commission This is ongoing commission we pay to your fi nancial 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 fi nancial 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 allowanceThis is an enhancement to the initial commission we pay to your adviser. Different advisers have

different rates of Marketing Allowance.

Salary Sacrifi ceIf your contributions are paid through ‘salary sacrifi ce’, it means you have given up part of your

paid salary and that amount is paid into your pension.

Date(ddmmyyyy)

please tell us if any of your details have changed

Employer’s address

Postcode

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Send the completed form and direct debit instruction (if applicable), to:

Old Mutual WealthOld Mutual HousePortland TerraceSouthamptonSO14 7AYCustomer Contact Centre Tel: 0808 171 2600

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Please complete the form and send to: Old Mutual Wealth Life Assurance Limited, Old Mutual House, Portland Terrace, Southampton SO14 7AY. Name and full postal address of bank/building society Reference

B

Name(s) of account holder(s)

Bank/building society account number

Branch sort code

To: The Manager

bank/building society

Address

Postcode

9 9 5 3 0 1

Service user number

- -

Instruction to your bank or building societyPlease pay Old Mutual Wealth Life Assurance Limited Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with Old Mutual Wealth Life Assurance Limited and, if so, details will be passed electronically to my bank/building society.

Signature(s) Date

/ /

/ /

INSTRUCTION TO YOUR BANK OR BUILDING SOCIETY TO PAY BY DIRECT DEBIT.

This Guarantee should be detached and retained by the payer.

The instruction below must be signed in accordance with the authorised signature(s) for the bank account.

Banks and building societies may not accept Direct Debit Instructions for some types of account.

The Direct Debit Guarantee.• This Guarantee is offered by all banks and building societies that accept Instructions to pay Direct Debits.

• If there are any changes to the amount, date or frequency of your Direct Debit Old Mutual Wealth Life Assurance Limited will notify you fi ve working days in advance of your account being debited or as otherwise agreed. If you request Old Mutual Wealth Life Assurance Limited to collect a payment, confi rmation of the amount and date will be given to you at the time of the request.

• If an error is made in the payment of your Direct Debit, by Old Mutual Wealth Life Assurance Limited or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society.

– If you receive a refund you are not entitled to, you must pay it back when Old Mutual Wealth Life Assurance Limited asks you to.

• You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confi rmation may be required. Please also notify us.

DIRECT DEBIT INSTRUCTIONPlease complete and return this form to authorise us to collect Direct Debits for your plan.

• We can only accept one Direct Debit instruction on a plan.• Direct Debit collections will be made on the fi rst working day of the month.• They will show on your bank statement as Old Mutual Wealth Life Assurance limited.• Please complete the details below in BLOCK CAPITALS with blue or black ink.• We will insert the ‘Reference’ on the Direct Debit instruction; please leave this blank.• Send the completed form to us at the address shown below; do not send it direct to your bank.• Privacy information – a privacy notice is available on our website at www.oldmutualwealth.co.uk/privacy

NOTE


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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 fi ve years.

Old Mutual Wealth Life Assurance Limited is registered in England & Wales under number 1363932. Registered Offi ce 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.

When printed by Old Mutual this item is produced on a mixed grade material, which uses a combination of recycled wood or paper fi bre from controlled sources and virgin fi bre sourced from well-managed, sustainable forests.


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 fi ve years.

Old Mutual Wealth Life Assurance Limited is registered in England & Wales under number 1363932. Registered Offi ce 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.

When printed by Old Mutual this item is produced on a mixed grade material, which uses a combination of recycled wood or paper fi bre from controlled sources and virgin fi bre sourced from well-managed, sustainable forests.


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