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WITHDRAWAL TO BUY AN ANNUITY– Collective Retirement Account (CRA)

*SFBCY0400F*

1 YOUR DETAILS

Collective Retirement Account number

Other u Please specifyMr Mrs MissTitle

Full forename(s)

Surname

Proof of address – 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, e.g. phone, electricity, gas, water, etc but not a mobile phone bill.

Postcode

National Insurance number Date of birth

Please quote your client reference number u If known

For use by financial advisers only

COMPLETING THIS FORM• Complete this form, as applicable, using BLOCK CAPITALS and blue or black ink. For dates, please use the format date/month/year.

• Ensure that all applicable sections are completed clearly, because missing or unclear information can result in a delay in processing, or even the return of this form. We are unable to correct errors or omissions by you or your financial adviser retrospectively.

SEND YOUR COMPLETED FORM AS FOLLOWS

• Post – Old Mutual Wealth, Old Mutual House, Portland Terrace, Southampton SO14 7AY.

TAX • Income Tax – You will have to pay tax on the income you receive from the annuity provider 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.

Telephone number E-mail address

• Guidance notes – It is important that you read the guidance notes at the back of this form. They explain how to complete each section and contain details of any additional documents we need.NOTE

WITH THIS FORM YOU CAN:

– make a withdrawal to buy an annuity– request tax free cash where the crystallised funds will buy an annuity.We regularly update our forms; you can confirm that this April 2020 version is the latest by checking the literature library on our website www.oldmutualwealth.co.uk

Address

OPTION B – PARTIAL CRYSTALLISED

Please confirm how much of your crystallised funds you would like to use

All of it

Specified amount

uYou can only use the full value of your crystallised fund if there are no uncrystallised funds in your CRA. u Now go to section 6

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4 PENSION COMMENCEMENT LUMP SUM (TAX-FREE CASH)

uOnly complete if you selected option A or C in section 3

Please indicate the amount of pension commencement lump sum (tax-free cash) you wish to receive.

Maximum u The normal maximum amount of tax-free cash available is 25% of the uncrystallised fund value being used

Specified amount

Nil

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

Signature

Financial adviser name

Adviser firm name

3 WITHDRAWAL OPTIONS

Date

• The amount of crystallised funds that you can use for annuity purchase is subject to certain conditions. If you are purchasing an annuity using only part of your crystallised funds, a minimum amount of the crystallised funds must remain in your CRA. The guidance notes at the back of this form for section 3 describe these conditions in more detail.

NOTE

OR

OR

OPTION A – FULL I wish to use all of my pension fund for annuity purchase (with pension commencement lump sum where applicable)

uIf you are purchasing an annuity using uncrystallised funds in your account you can choose to receive part of these as a tax-free lump sum (a Pension Commencement Lump Sum).

u Please complete sections 4 and 5, if applicable

£

OPTION C - PARTIAL UNCRYSTALLISED

Please confirm how much of your uncrystallised funds you would like to use.

All of it

Specified amount

uIf you are purchasing an annuity using uncrystallised funds in your account you can choose to receive part of these as a tax-free lump sum (a Pension Commencement Lump Sum). u Please complete sections 4 and 5

£

£

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5 BANK DETAILSu Only complete if you selected option A or C in section 3

Please state which bank account you wish the proceeds to be paid into. We cannot make payments to third parties.

Bank/Building society account number Branch sort code

– –

Building society roll number u If applicable

Branch address bank/building society u Must be in the UK

Postcode

Name of bank/building society account holder

Bank/building society name

6 ANNUITY PROVIDER DETAILS

Provider name

Annuity reference

Address of annuity provider

Postcode

Postcode

Name of bank account holder

Bank name

Branch address of bank

Bank/Building society account number Sort code

– –

Annuity provider bank details

Please tick here if the annuity provider will be applying for your funds via the Options service. They will be able to confirm this to you.

Proof of Bank Account - We need to see proof that this is the bank account of the payee, if we have not already seen it.*

Tick as applicable I have previously provided proof of ownership of this bank account

I enclose proof of ownership of this bank account

* The guidance notes at the end of this form explains what we can accept as proof of ownership – if we do not have the required proof, we willmake payment by cheque instead.

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Enhanced Protection

Fixed Protection 2016 Individual Protection 2014

Fixed Protection 2014

Lifetime Allowance Enhanced Factors Primary Protection1

Please tick below if you have any of the following. By ticking you confirm that your entitlement to these protection benefits has not been revoked.

Fixed Protection 2012

Individual Protection 2016

7A PENSION PROTECTION

1Primary Protection If you have Primary Protection and have previously taken tax-free cash, complete this section.

Tax-free cash paidDate

£ .

£ .

£ .

OR

HMRC reference number

Pension Scheme Administrator reference u E.g. PSA12345678A. This applies to online protections only.

Scheme Specific Protection(Block Protection)2

HMRC Certificate -

If you were issued a certificate for this protection by HMRC, please send us a copy of the certificate with this form.

NOTE 2 Block ProtectionIf you have protected tax free cash or an early retirement age, please be aware that:you must fully crystallise all funds you have in your CRA at the same time or you will lose these protections. This will mean you will be limited to a maximum of 25% of the uncrystallised value as a tax free lump sum, and a minimum retirement age of 55. This includes any uncrystallised funds you may have in other CRAs.if your right to draw benefits before age 55 is subject to certain conditions, then you will need to confirm to Old Mutual Wealth that those conditions have been met before any payment can be made.

If you are not applying for any form of protection go to section 7B.

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We cannot process this form if this section is not completed – the guidance notes at the end will help you.

Please tick/complete any/all of the following that apply to you. You must complete at least one.

Before and after 6 April 2006; you must complete both option C and D if you have previously taken benefits from one or more pension schemes before and after 6 April 2006.

When you crystallise all or part of your savings in any pension scheme, the provider will tell you what percentage of your Lifetime Allowance has been used up. We need the following information to ensure you do not exceed the Lifetime Allowance, which could lead to a tax charge.

NOTE

A I have never taken any benefits from a UK registered pension scheme

B I have only taken benefits from my Collective Retirement Account(s)

C I have taken benefits from one or more UK registered pension schemes on or after 6 April 2006.

The total percentage of the standard Lifetime Allowance I have used is:

The first time I took pension benefits after 5 April 2006 was:

%

uOnly required if both C and D are being completed

u Now go to option D

7B LIFETIME ALLOWANCE

D I have taken benefits from one of more UK registered pension schemes before 6 April 2006, these are not included in any Lifetime Allowance figure completed above in option C. (Please complete all that apply)

If you have also completed option C, please provide the figures that were applicable at the date you first took a pension benefit after 5 April 2006

I’m in capped drawdown and my gross maximum annual income limit is:

AND/OR

I’m in flexi-access drawdown and my previous gross maximum annual income was:

AND/OR

I’m paid a lifetime annuity/scheme pension and the gross amount I receive each year is:

£

£

£

7C BENEFITS IN EXCESS OF LIFETIME ALLOWANCE

% to be taken as cash lump sum u Only applicable before age 75

%

%001

to be taken as income

Total u These percentages must total 100%

If you are claiming Enhanced Protection in section 7A, you do not need to complete this section.If the amount being used to provide benefits is greater than your remaining Lifetime Allowance, a tax charge will be due on the excess amount. More information is in the guidance notes at the end of this form.

Please specify how the excess is to be paid:

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8 DECLARATION

I request and consent to the payment of benefits set out in this form. I declare that:

1. I have read the attached guidance notes and I understand the figures quoted in my valuation are subject to change.

2. The information supplied by me is true and complete to the best of my knowledge as at the date of this Declaration.

3. I will inform Old Mutual Wealth Life & Pensions Limited of any change to the information provided occurring after the date of this Declaration and before the Benefit Crystallisation Event takes place.

4. I understand that any false statement may result in HM Revenue & Customs imposing penalties on me.

5. I understand that a Lifetime Allowance Tax Charge, where applicable, will be deducted from my CRA and paid to HM Revenue & Customs.

6. I agree that I will indemnify Old Mutual Wealth Life & Pensions Limited against any liability to pay any tax or other charges which occur due to the provision of false or misleading information.

7. Any payment by Old Mutual Wealth Life & Pensions Limited of the benefits under this CRA shall constitute a full discharge from all liabilities and claims arising in respect of the pension monies applied in this Benefit Crystallisation Event request.

8. Any tax-free cash will not be used to fund further contributions to any registered pension scheme to the extent that either Old Mutual Wealth Life & Pensions Limited or I will suffer a tax liability.

9. If appropriate, Old Mutual Wealth has my authority to check with HM Revenue & Customs the details of any certificate I supply.

Signature

*SFBCY0400X*

Date

GUIDANCE NOTES

Section 1 – Your detailsEnter your details in this section.

Proof of addressWe 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).

Section 2 – Financial adviser statementThis statement must be completed by your financial adviser.

Section 3 – Withdrawal optionsYou must complete this section. Choose whether you wish your annuity to be purchased using money from the uncrystallised or crystallised funds in your CRA. You must have enough value available in your policy to cover the annuity purchase value.

Choose whether you’d like to use your whole policy value, or part of it.

• If using part of your policy value, the minimum amount of money you must retain in your account is the greater of:

– 20% of the entire fund value or,

– £1,000

• If using part of your crystallised policy value, the minimum amount of crystallised money you must retain in your account is the greater of:

– 20% of the crystallised fund value or,

– £1,000

You may only use the full value of your crystallised fund if there is no uncrystallised value in your policy, or if you are also using the full value of your uncrystallised fund.

Section 4 – Pension Commencement Lump Sum (Tax-Free Cash)If you are purchasing an annuity using all or part of the uncrystallised funds in your account, you may be able to take part of the uncrystallised value as a tax-free lump sum. The normal maximum lump sum value you can take is 25% of the uncrystallised fund value being used.

If you have protected tax-free cash or an early retirement age, you must use all of the uncrystallised value of your CRA, and of any other CRA you may have, at the same time or you will lose these protected benefits.

Section 5 – Bank detailsPlease provide your personal bank details if you have requested a lump sum payment. If not, you may leave this section blank.

Proof of bank accountThe proof can be an original 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. If we don’t have the required proof, payment will be made by cheque instead.* Copies must be certified on each page in ink by a professional such as your

financial adviser, solicitor, accountant, GP or bank manager (including the bank’s stamp). We cannot accept photographs of documents.

Section 6 – Annuity provider detailsPlease enter the details of the annuity provider that you would like us to send your funds to. We will need their bank details to make the payment to them electronically.

Section 7A – Pension ProtectionThis section is applicable if you have lifetime allowance protection. If so, please complete this section and enclose a certified copy of your HM Revenue & Customs (HMRC) certificate of protection. If your protection is online only, and you don’t have a certificate, please provide us with both your Protection reference and Pension Scheme Administrator (PSA) reference numbers, which you can check online with HMRC.

Section 7B – Lifetime AllowanceComplete this section to tell us whether you have previously taken benefits from any UK registered pension scheme(s). Select all of the options that apply to you. Please ignore any State Pension you are receiving.

Option A – Select this option if you have never taken tax-free cash and/or income from any UK registered pension scheme.

Option B – Select this option if you have only taken tax-free cash and/ or income from your Collective Retirement Account(s).

Option C – Select this option if you have taken tax-free cash and/or income from a pension scheme, on or after 6 April 2006. The provider(s) who paid your benefits will be able to tell you how much Lifetime Allowance you have used. The percentage figure needs to be the total percentage of the Standard Lifetime Allowance you have used with all your pension providers.

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www.oldmutualwealth.co.ukPlease 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.

PDF12331/220-0581/April 2020

GUIDANCE NOTES (continued)

If you have also taken tax-free cash and/or income before 6 April 2006 you will also need to complete Option D.

Option D – Select this option if you have taken tax-free cash and/or income from a pension scheme and the first payment was before 6 April 2006.

• If you are in capped drawdown, enter the maximum gross annual income limit.

• If you entered flexible drawdown before 6 April 2015, enter the maximum gross annual income limit immediately before the plan was converted to flexible drawdown.

• If you are in flexi-access drawdown and you did not enter flexible drawdown before 6 April 2015, enter the maximum gross annual income limit immediately before the plan was converted to flexi-access drawdown.

• If you are being paid a scheme pension or a lifetime annuity from a pension scheme, enter the gross annual amount you receive.

Section 7C – Benefits in excess of lifetime allowanceHMRC rules allow you to build up a total pension fund, in all registered pension schemes, to a level known as the ‘standard lifetime allowance’. The standard lifetime allowance is set at £1,073,100 from 6 April 2020, but you may have (or be entitled to have) a lifetime allowance that is higher. Your financial adviser will be able to tell you if this affects you.

If you choose to take the excess funds above the Lifetime Allowance as a cash lump sum, a charge of 55% will be deducted before the balance is paid to you.

If you choose to take the excess funds as income, the charge will be 25% and the income will be subject to income tax. The charge will be deducted by Old Mutual Wealth and paid to HMRC. For example, if your account is valued at £500,000 and you use all of it to provide benefits and your available Lifetime Allowance is £400,000, the excess would be £100,000.

Please indicate whether you require any excess to be paid as a cash lump sum, income or a combination of both. Please note that it is not possible to take a lump sum in respect of funds which are already crystallised.