for customers application form - aegon uk · pdf filework phone number mobile phone number ......

About this form You should complete this form if you want to apply for a Flexible Pension Plan.

Whenever you see this icon *, we’re asking you to send us additional material with this form.

Words in bold are defined terms that we explain in Part B of this form.

This form is split into two parts:Part A – contains the application and the charge deduction instruction. You must complete this part and sign and date the declaration and consent in section 10.

Part B – contains notes and definitions to help you complete this form. You should read this section before you sign the declaration and consent in section 10.

Check any details that are already filled in If any details are already completed (based on what you’ve told a financial adviser), you should check these before you sign the declaration and consent in section 10. If you find any details that are incorrect or incomplete, you should change them, initial the changes and let the financial adviser know.

This application is for a contract with usThis application will form the basis of a contract of insurance with Aegon (a brand name of Scottish Equitable plc). When you answer a question, you must give all relevant information. This means that you must completely and accurately disclose all of the facts when answering each question.

The tax information given in this form is based on our understanding of current taxation law and HM Revenue & Customs (HMRC) practice, which may change.

The value of any tax relief depends on your individual circumstances.

Illustration number

You must insert the illustration number. If you don’t, we can’t progress this application.

Please read these notes before filling in this application form

Application form(with adviser charges option)

For customers Flexible Pension Plan

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National Insurance number

You’ll find your National Insurance (NI) number on your payslip and/or on a tax code notice.

1.2 Will you be a relevant UK individual in the tax year that you or your employer will pay the first contribution?

Yes No – don’t complete this form, speak to a financial adviser.

1.3 Give details about your employment status

I’m not in employment.

I’m self-employed.

I’m employed – give the full name and address of your employer.

Employer’s name

Address

Postcode

1.1 Your personal detailsIf you’re filling this form in on someone else’s behalf, fill in all the details as if you were that person.

Title

Mr/Mrs/Miss/Ms/Other – please specify

Full forename(s)

Surname

Date of birth (dd/mm/yyyy)

Gender: Male Female

Permanent home address

Postcode

Home phone number

Work phone number

Mobile phone number

Email address

We might use your email address and phone numbers to get in touch with you about your application and policy. If you don’t want us to send you information about our products, tick the appropriate box in section 10.

Please complete this form in BLOCK CAPITALS and ballpoint pen.

Part A – Application form

1. Personal details

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2.3 How often will the regular contributions shown above be paid?

Monthly Yearly

2.4 Give the date you want regular contributions to start (dd/mm/yyyy). This must be between the 1st and 28th of the month.

2.5 Atwhatagedoyouwanttotakebenefits?

2.6 If you want regular contributions to your plan to increase automatically each year, indicate below by how much they’ll increase.

At a fixed rate of % a year (maximum 15%)

or

At a rate in line with Average Weekly Earnings (with a minimum of 5% and a maximum of 15% a year)

You’ll be eligible for tax relief on any personal contributions up to the greater of 100% of your relevant UK earnings and the basic amount each year (this limit applies across all registered pension arrangements that you make contributions to in any year).

Where your employer makes contributions and/or deducts your contributions from your pay, they must send us a completed Record of payments due form. You’ll find a copy of this in your quotation pack. *

2.1 How much will you be contributing to your plan?£ gross regular contributions

£ gross single contribution

2.2 How much will your employer be contributing to your plan?

£ gross regular contributions

£ gross single contribution

2. Contributions

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3. Investment choice

How would you like your contributions to be invested?Make sure you enter the exact fund name(s) and percentage split in the table below. You can find this by going to aegon.co.uk/fullfundrange and selecting ‘other fund ranges’. You can find more investment information in the ‘Investment choice’ notes in Part B.

Regular contributions Single contributions

Fund name(s) % Fund name(s) %

Total 100% Total 100%

Please tell us if the money purchase annual allowance applies to you. You may have this if, for example you’ve received any uncrystallised funds pension lump sum payment or taken income from a flexi-access drawdown arrangement. For more information please see the definitions section.

If this applies to you, your provider or scheme administrator will have given you a statement confirming that you have flexibly accessed your benefits and you can give us a copy of that statement. If you’re not sure please contact your pension provider or scheme administrator.

If you don’t tell us, this could result in a fine by HMRC. You can find more information about this at www.gov.uk/tax-on-your-private-pension/overview

Does the money purchase annual allowance apply to you?

No

Yes – what’s the date of the relevant event?

Date (dd/mm/yyyy)

Please enclose a copy of the statement with this form *.

4. Money purchase annual allowance

http://aegon.co.uk/fullfundrange

http://www.gov.uk/tax-on-your-private-pension/overview

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6.3 Let us know what industry you work in and your occupation.

Industry

Occupation

6.1 Do you want to apply for waiver of contribution on:

all regular contributions?

all single contributions?

6.2 Do the regular and single contributions that you’ve detailed in section 2 add up to over £3,600 (gross)?

Yes – you must complete a separate medical questionnaire in addition to this form. Go straight to section 7.

No – answer the questions below. We’ll use your answers to assess whether we can offer you waiver of contribution benefit.

6. Waiver of contribution

You only need to fill in this section if you’re applying for waiver of contribution.Before you fill in this section, make sure you read over the waiver of contribution notes in Part B and 8. ‘Access to medical reports – your rights’.

Who would you like to receive any death benefits? I would like the scheme administrator to pay any lump sum death benefits to the beneficiaries named,

and in the proportions set out below.

I note that the scheme administrator has absolute discretion about which of the beneficiaries named below (if any) it chooses. This nomination is only an expression of my wishes and isn’t binding on the scheme administrator.

I note that I can change my nomination by filling in a new form. The scheme administrator will then look at the last-dated form received before my death.

In the table below, enter the full name of each beneficiary, their relationship to you and the percentage of any lump sum benefit that you’d like the scheme administrator to pay them. If you’d like to nominate more than four people, give the details on a separate sheet and sign and date that sheet and attach it to this form. *

Full name of beneficiary Relationship to you(for example son, friend)

Percentage ofbenefits (%)

5. Death benefits

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6.7 Give the name and address of your current doctor.

Name

Practice name

Address

Postcode

6.8 How long have you been registered with your current doctor?

One year or more – specify how many years.

Under one year – give the name and address of your previous doctor.

Name

Practice name

Address

Postcode

6.4 Do you currently have any illness or condition for which you need to take drugs, or receive medical treatment or advice, or have investigations periodically, or are awaiting medical, surgical, x-ray or any other investigation?

No

Yes – give details.

6.5 During the last five years, have you suffered any illness or injury that has stopped you from working for two weeks or more, or that meant you needed a hospital or specialist investigation?

No


6.6 Do you take part in any sport or pastime generally considered to be dangerous (for example private aviation, mountaineering, motor sports or diving activities)?

No


6. Waiver of contribution – continued

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7. Charge deduction instruction

7.1 Initial adviser charge

7.1.1 Regular contributionsEnter the amount or percentage to be deducted. Tick one option only.

Amount £ a month/year as selected below

This charge will be deducted proportionately across your plan.

Percentage % of each regular contribution

This charge will be deducted from each regular contribution.

Enter frequency of the charge. Tick one option only.

Monthly in instalments (maximum of 60)

Yearly in instalments (maximum of 5)

If you’ve selected the percentage option above, the frequency and number of instalments must be based on your regular contribution frequency.

7.1.2 Single contributionEnter the amount or percentage to be deducted. Tick one option only.

Amount £

This charge will be deducted proportionately across your plan.

Percentage %

of the single contribution entered in section 2.1 and/or 2.2

This charge will be deducted from the single contribution.

This instruction must be completed when you’ve agreed to pay adviser charges to a financial adviser and is your instruction to Aegon to facilitate the payment of these charges from your pension plan and pass them on to a financial adviser.

If you want to add, or to instruct Aegon to take further adviser charges, you need to complete a new charge deduction instruction.

You have the right to cancel this charge deduction instruction at any time.

You can find more information on adviser charges in our Adviser/consultancy charges terms and conditions which you received with your illustration.

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8. Access to medical reports – your rights

8.1 We may need to get medical reports before providing you with the proposed level of cover. Before we can ask any doctor that you’ve consulted to fill in a report, we need your permission under the Access to Medical Reports Act 1988 (or the Access to Personal Files and Medical Reports (Northern Ireland) Order 1991).

Your rights under the legislation are as follows:a You don’t need to give your permission,

but if you don’t, we may not be able to provide the proposed level of cover. This doesn’t prevent you from applying personally to other companies for insurance.

b You can ask to see the report before the doctor returns it to us. If this is the case, we’ll tell the doctor to keep the report

for 21 days so that you can arrange to see it. If you haven’t made arrangements to see the report within this time, your doctor will send the report to us.

c If you choose not to see the report at this stage, you may ask the doctor for a copy within six months of it being sent to us. We can send a copy of the report to your doctor if you ask to see it at a later date.

d If you think that any part of the report isn’t correct or is misleading, you may ask the doctor to amend it. If your doctor refuses to make the amendments, you may ask them to attach a statement outlining your views, which will then accompany the report.

e Your doctor can withhold access to the report if they feel that it would cause physical or mental harm to you or others.

7.2 Ongoing adviser charge If you are making more than one type of

payment on multiple forms, make sure that the ongoing adviser charge details are the same on all forms.

7.2.1 Charge start dateThe ongoing adviser charge due date is based on the frequency selected and the day and month of the plan start date. Only complete this section 7.2.1 if you want to start the ongoing adviser charge in the future. Otherwise, we’ll deduct the charges on the next charge due date. You can find more information and examples of how this works in Part B – Application form notes.

Enter start date if charge is to be deducted in the future.Month (mm) Year (yyyy)

7.2.2 Charge to be deductedEnter the amount or percentage to be deducted. Tick one option only.

Amount £ each year

If the amount is to escalate each year, show percentage below.

% each year on the anniversary of your plan start date

Percentage % of your plan each year

7.2.3 Enter frequency of the charge. Tick one box only.

Monthly

Quarterly

Yearly

7. Charge deduction instruction – continued

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8. Access to medical reports – your rights – continued

8.2 The medical report your doctor fills in asks about the following:a Your current health: • Any care, medication or treatment

you’re currently receiving. • The results of referrals or tests you’re

waiting for.

b Any time off work in the last three years.

c Your past health: • Details of any relevant illness, trauma,

or referrals for specialist advice or treatment, hospital admissions, consultations with your doctor or any other medical adviser, therapist or counsellor. In particular whether you have a history of:– malignancy (cancer), cardiovascular

(heart) disease, diabetes, and degenerative (gradually worsening) diseases

– musculoskeletal disease or injury, for example arthritis, rheumatism, back problems or any other disorder of the joints or muscles

– anxiety, depression, neurosis (such as phobias, obsessions and so on), psychosis (a mental disorder where you lose contact with reality), stress or fatigue

– suicidal thoughts or attempts at suicide, or

– conditions related to drug or alcohol misuse or smoking or chewing tobacco

• Details of any biopsies, blood tests, electrocardiograms (heart tests), height, weight if measured in the last two years, urinalyses (tests on urine), x-rays or other investigations.

• Any blood pressure readings in the last three years.

d Any history of disease among your parents or brothers or sisters that you’ve told your doctor about.

8.3 We’ve asked your doctor not to reveal information about:a negative tests for HIV, hepatitis B or C

b any sexually transmitted diseases unless there could be long-term effects on your health

c predictive genetic test results unless there’s a favourable test result which shows that you haven’t inherited a condition your family suffers from

8.4 The information you and your doctor provide about your health may result in us:a providing cover for you at normal rates

b imposing special rates for the level of cover being underwritten

c imposing special terms, for example exclusions, to the level of cover being underwritten

d refusing to provide the level of cover being underwritten

e using the information to assess a claim

8.5 Contact us If you’ve any questions about your rights

under the Act or questions relating to the process of getting, assessing or storing medical information, write to:Chief Medical OfficerAegonEdinburgh ParkEdinburghEH12 9SE

8.6 Do you want to see the report before the doctor sends it to us?

Yes – I do want to see the medical report before it’s sent to you.

No – I don’t want to see the medical report before it’s sent to you.

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amended to include any special terms and conditions you believe reasonably apply (based on the information and documentation that has been given in relation to my application). Any special terms and conditions will be in your current style or, where you don’t have a current style, in the format you think best reflects them.

10.3 I agree to be bound by the documents and rules of the Scheme.

10.4 I confirm that if I’ve not received face-to-face advice from a financial adviser in connection with this application, I’ve received and had the opportunity to read the Flexible Pension Plan key features document and policy conditions that are relevant to this application.

In the declaration ‘I’ means the individual detailed in section 1 and ‘you’ means Scottish Equitable plc as Scheme Administrator of the Scottish Equitable Self-administered Personal Pension Scheme.

Applicant declaration10.1 I apply to you to become a member of the

Scottish Equitable Self-administered Personal Pension Scheme (the Scheme).

10.2 I apply to you for an Aegon Flexible Pension Plan and, if I’ve completed the waiver of contribution section, for an Aegon plan to provide waiver of contribution cover.

I want you to issue me with a plan or plans that sets out your standard conditions

10. Declaration and consent

9. How we use your information

Aegon uses your information to administer your policy, process claims, carry out any underwriting and deal with complaints.

We need your consent to process your sensitive information, including medical details required to set up and administer your policy. We might share this information with other parties for underwriting, reinsurance, medical assessment and claims purposes. We might use an automatic decision-taking system during the underwriting process.

We won’t disclose your information to a third party unless: • it’s part of our administration process;

• it’s a legal requirement;

• it’s necessary to prevent and detect fraud; or

• you’ve authorised this disclosure, for example to your financial adviser.

As part of the administration process, we might use third parties who are based outside of the European Economic Area (EEA), for example the USA. If we do, we’ll make sure appropriate controls are in place so we protect your information.

We might use UK and European credit reference agency (CRA) and fraud prevention agency (FPA) records about you to prevent crime, fraud and money laundering. We might also use CRA records about you and those financially linked to you to verify your identity if you, or someone financially linked with you, applies for services. If you give false or inaccurate information and we identify fraud, we’ll pass details to the FPA to prevent fraud and money laundering.

We might share your information with other members of the Aegon UK Group (which means Aegon UK and its subsidiary companies) and would like to keep you informed about our products and services that might interest you. We won’t pass your information to other companies outside the Aegon UK Group for marketing purposes.

You can find more on how we use and protect your personal information, and how information held by the FPA might be used, in the Protecting your personal information leaflet. Please ask if you’d like a copy, or you can find one at aegon.co.uk/usefulforms

http://aegon.co.uk/usefulforms

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10.9 I agree to the scheme administrator or its representative obtaining from me (or any other person or body to whom an authorised payment can be made under the Scheme) any evidence and information that it may need in order to make payments.

10.10 I note that if there’s any failure to provide information that the scheme administrator needs to administer my benefits accurately, the scheme administrator has the right to make further administration charges.

10.11 I declare that the total contributions in a tax year, to any and all registered pension schemes to which I’m entitled to tax relief under section 188 of the Finance Act 2004, won’t be more than £3,600 or my relevant UK earnings in that tax year, whichever is higher.

10.12 I declare that the information I‘ve given in relation to clause 10.11 above is, to the best of my knowledge, correct and complete.

10.13 I declare that, to the best of my knowledge, the details I’ve given in the ‘Personal details’ section of this application form and the information given elsewhere in this application form, whether in handwriting or not, are correct and complete.

10.14 I undertake to inform the scheme administrator if an event occurs that means that I’m no longer entitled to tax relief on my contributions under Section 188 of the Finance Act 2004. I’ll inform the scheme administrator about this by 5 April in the tax year in which the event occurs or 30 days after the event occurs, whichever is later.

10.15 I agree that this application, along with any answer or statement that I make to you (or a medical officer acting on your behalf) now or in the future, will form the basis of contracts between you and me consisting in arrangements under the Scheme.

10.16 I agree that you or your representatives may approach the scheme administrator or the provider of any other registered pension scheme that I’m contributing to or have contributed to in the past, to get any information you feel is necessary to administer my arrangements under the Scheme.

10.5 I agree that I’ll pay the contributions specified in the arrangements or, with my knowledge, someone else will pay them on my behalf. I confirm that if I’m employed:a my employer will pay the amount of

employer contributions set out in this application

b if my contributions are to be taken straight from my salary and paid to you, I authorise my employer to do this

c if my contributions are to be taken straight from my salary on a weekly basis, I authorise my employer to pay these contributions to you on my behalf on a monthly basis

10.6 I agree as follows:a Any contributions to the plan will be

applied to investment funds, according to my instructions to you (which include any instructions set out in the ‘Investment choice’ section of this application).

b I’m aware that you have an investment fund allocation procedure and that this procedure may change from time to time.

c That procedure will be part of the plan I’m applying for.

d Whenever a contribution is given to you to apply under the plan, and you don’t have clear and complete instructions from me about which investment fund(s) the contribution is to be applied to, then you’ll apply the contribution to the investment fund(s) chosen in accordance with your investment fund allocation procedure.

10.7 I declare that no contribution that I make to the plan, whether set out in the ‘Contributions’ section or in the future, will be paid in whole or in part from any tax-free cash that I’ve previously received from any approved or registered pension scheme.

10.8 I’ll inform the scheme administrator immediately whenever my status (as set out in the ‘Personal details’ section) changes.

10. Declaration and consent – continued

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10.23 Consent to adviser charges I authorise you to deduct the adviser charge(s) agreed with my financial adviser as set out in section 7 and facilitate the onward payment of the amount deducted to my financial adviser. I acknowledge that in performing this role you’ll be acting as agent for my financial adviser for the sole purpose of transferring the amount equal to the adviser charge that has to be deducted and paid to my financial adviser.

I confirm that I’ve received a copy of the Adviser/consultancy charges terms and conditions.

I confirm that I’ve received an illustration showing the impact of the charges.

10.24 Consent to access to medical reports I confirm the following:

a I agree to you obtaining medical information from any doctor whom I’ve consulted about my physical or mental health in order to assess my proposal. You may obtain relevant information from other insurers about previous or current applications for life, critical illness, sickness, disability, accident or private medical insurance that I’ve applied for. I authorise anyone you ask for such information to provide it when you’ve given them a copy of this consent. This consent allows you to obtain medical reports to support any claim made on the plan within six months of the start of the plan or after my death.

b I consent to you making known, in my best interests, to my doctor (whose name and address I’ve given in this form), any medical information that comes up in an independent medical examination or test that may be relevant to my care, about which they may not be aware.

10.17 I agree that deliberate or careless failure to answer any questions correctly and completely, to the best of my knowledge and belief, may result in the benefits not being payable.

10.18 I agree that this declaration applies for each and every contract or arrangement that I’ve applied for.

10.19 Where I’m applying for waiver of contribution benefit, I confirm that I’ll tell you as soon as possible about any change in my health or about any other material fact between the date I sign this application and the date when any waiver of contribution benefit comes into force. A ‘material fact’ is information that might influence how you deal with this application.

10.20 I confirm that I’ve not withheld any relevant information you’ve asked for, whether of a medical nature or otherwise, in a belief that any doctor or medical adviser would give you the information on my behalf.

10.21 Actively at work If I’m applying for cover for waiver of

contribution cover, I confirm that I’m actively at work and physically and mentally capable of performing my usual occupation on the date of signing this application.

10.22 Consent to processing your information Unless I’ve ticked the appropriate box below

to object, by signing this form I’m consenting to receive marketing messages from the Aegon UK group of companies by post.

I don’t want you to contact me by post with marketing communications

I would like you to send me marketing communications in the following ways (please tick the relevant boxes):

email SMS phone

I consent to you processing and using my information as explained in section 9.

I consent to you using this information to process any claim made on this plan.


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Important informationWe’ll issue a plan or plans in the applicant’s name. The plan or plans will be for the benefits provided under the Scheme.

On request, we’ll supply an example of the standard policy conditions and a copy of the completed application form.

Scottish Equitable plc, the provider and scheme administrator of the Scheme, agrees to administer the Scheme in accordance with the rules and arrangements of the Scheme.

c I’ll inform you immediately of any changes that occur before the plan starts. I note that if I fail to do so, this may result in the contract being declared void, and that you may not pay out any of the proceeds as a result.

d I agree that if you need to accept my application on terms which mean that you’ll not pay benefits in certain circumstances, these terms and circumstances may be revealed to my financial adviser in the normal course of business. Any exclusions could refer to personal information, for example a medical condition, which the financial adviser may not otherwise be aware of.

e This information can also be used to maintain management information for business analysis.

I confirm I’ve sent confidential medical information separately to the Chief Medical Officer (you should read Part B – Application form notes).

I‘ve read the declaration, important notes and information relating to my rights under the Access to Medical Reports Act.

If I don’t agree to any of the statements in the ‘Consent to access to medical reports’ part of section 8, I’ll delete the paragraph clearly.

The information in this application is needed for income tax purposes and may be inspected by UK tax authorities. If I give false information, the tax authorities may prosecute me, which could lead to severe penalties.

Date (dd/mm/yyyy)

Signature of applicant

7� 7


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5 For confidentiality, or if you would prefer not to answer any or all of the medical questions in the presence of a financial adviser, you have the right to send your answers in a sealed envelope direct to the Chief Medical Officer, at the address at the end of section 8.5. You should tick the box in the declaration at the end of section 10 if you’ve done this. Alternatively, you can attach the envelope securely to this application form.

6 If you’re applying for insurance with other companies at the same time, by signing the declaration and consent you’re consenting to copies of medical reports being sent to other companies at their request. However, if another company approaches us to provide copies of highly sensitive information, including HIV or genetic test results, we’ll ask for your specific permission before giving it.

7 If you’re applying for waiver of contribution, once we’ve assessed your application, we’ll write to you again to tell you about the terms on which we can offer you protection.

8 If you’d like a copy of our confidentiality policy, you should let us know and we’ll send it to you.

1 The questions we ask in this application form cover the facts that we consider could affect how we assess your application.

2 You don’t need to make any personal assessment about the relevance or otherwise of any information. If you don’t disclose all relevant facts, the protection that the plan provides could be lost or cancelled and your claim rejected.

3 You must not, in any circumstances, assume that we’ll write to your doctor for medical information. You must not partially disclose information when answering any question and assume that we’ll write to your doctor. You’re personally responsible for fully and completely disclosing all the facts required when answering the questions in this application form.

4 If you’re in any doubt about the information we need, you should disclose full details. You must tell us about any changes in health and/or circumstances during the period between when you fill in this application and when the plan starts.

This section is to be completed by the financial adviser.

Did you give this applicant advice when choosing to set up this plan?

Yes No

Financial adviser case number

Money laundering Politically exposed persons We’re required by the Money Laundering

Regulation 2007 (‘the Regulations’) to carry

out enhanced customer due diligence for customers who are ‘politically exposed persons’ (as defined in the Regulations) in order to establish the source of wealth and the source of funds that are being used to pay the contribution.

If you’re aware that any person you’re required to submit a confirmation of verification of identity certificate for is a ‘politically exposed person’, you should contact us and we’ll confirm what additional information we need from you.

11. For financial adviser use only

Please read this section before you fill in the application or sign the declaration.

Part B – Application form notes

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should have received a copy of this with this application form but you can get a further copy on request by phoning our Customer Services Helpdesk on 03456 10 00 10 or download a copy from our website at aegon.co.uk/usefulformsDeath benefitsIt’s important that you consider completing this section as it may affect who’ll receive any lump sum death benefits when you die.

If you want to change your nomination at any time in the future, you can get a new form by phoning our customer services helpdesk on 03456 10 00 10, or download a copy from our website at aegon.co.uk/usefulformsThe scheme administrator can only take into account death benefit nomination forms received before you die. If you complete a death benefit nomination form but die before the scheme administrator receives it, it can’t be taken into account.

Waiver of contributionIf you’re applying for waiver of contribution, there may be underwriting requirements.

Waiver of contribution is insurance cover to help with paying contributions to your Flexible Pension Plan if you become seriously ill or disabled, and are unable to work for more than six months. You must be over the age of 18 to take out waiver of contribution and it will stop when you reach age 60, even if your retirement date is over age 60.

We’ll set up your waiver of contribution as a separate plan.

We’ll take the cost of this plan from the contributions detailed in the ‘Contributions’ section. You should note that your contributions, as set out in the ‘Contributions’ section, will be made and applied whether or not you receive any benefits from waiver of contribution cover.

Ongoing adviser charge start dateThe ongoing adviser charge due date is based on the frequency selected and the day and month of the plan start date, see example 1.

Notes on sections in the application formPersonal detailsTo apply for a Flexible Pension Plan, you must be a relevant UK individual and at least 18 and under 75.

If you’re 75 or over, you should talk to a financial adviser about alternative plans.

Although we don’t need to see identity documents to set up your pension plan, we’ll have to see these documents before we pay any benefits.

ContributionsEach tax year, you can only receive tax relief on personal contributions to a registered pension scheme up to the higher of the basic amount or your relevant UK earnings. This limit applies to all contributions made by yourself, or someone else other than your employer, to all registered pension schemes that you have. We only accept personal contributions that receive tax relief. To find out how much the basic amount is, see the ‘Definitions’ section.

You should enter the contributions that you or your employer will make to this plan. We’ll collect all personal contributions (including those made by someone else other than your employer on your behalf) net of basic rate tax – so tax relief will be added to your contribution when it’s paid into your plan.

Currently you can choose to take benefits between 55 and 75.

We’ll fix the start date for your plan or plans. We normally do this based on when we receive your completed application and when your first payment is due, whether that’s by Direct Debit or another method.

If your application shows that a payment is due before the start date, then we need to agree that this payment can go into the plan or plans.

Investment choiceWe’ll invest your contributions according to your choice.But if you don’t make a clear and complete investment choice, we’ll invest the contributions using our own Investment fund allocation procedure for this contract. You

Part B – Application form notes – continued



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If the payment is based on a percentage. Where the payment frequency is: • monthly, the payment is calculated by

multiplying the fund value by the ongoing adviser charge % divided by 12;

• quarterly, the payment is calculated by multiplying the fund value by the ongoing adviser charge % divided by 4; and

• yearly, the payment is calculated by multiplying the fund value multiplied by the ongoing adviser charge %.

DefinitionsBasic amount means the amount you can receive tax relief on in any tax year to all registered pension schemes, without having relevant UK earnings of more than the basic amount. The basic amount for the current tax year is £3,600. This figure may change in future years.

Flexi-access drawdown is a drawdown arrangement which lets you take as much or as little income (which may be subject to tax) from the arrangement as you wish.

Money purchase annual allowance. Where this applies to you the amount that can be paid by or for you into money purchase arrangements (like this one) without a tax charge arising may be restricted to the money purchase annual allowance, which from 6 April 2017 is £4,000. The restriction applies if you had a flexible drawdown plan at any time before 6 April 2015. It also applies if you take (or have already taken) certain types of pension benefit, including an uncrystallised funds pension lump sum or income from a flexi-access drawdown plan.

Special rules apply in the year that the money purchase annual allowance provisions first apply to you. Please speak to a financial adviser for more information.

Registered pension scheme is a pension scheme that’s registered with HMRC under Chapter 2 Part 4 of the Finance Act 2004.

If the plan start day is the 29th, 30th or 31st we’ll use the 28th. If you want to set a future date, see example 2.

For an explanation on how the charge is calculated, see example 3.

Example 1 Where the plan start date is also the payment due date.

Plan start date 01/01/2015.

Where the payment frequency is: • monthly, the payment date is the 1st of each

month;• quarterly, the payment date is 1st January,

1st April, 1st July and 1st October each year; and

• yearly, the payment date is 1st January each year.

Example 2 Where plan start date and payment due date are different.

Plan start date is 01/01/15 and the start date of the ongoing adviser charge in the charge deduction instruction is 05/2015.Where the payment frequency is: • monthly, the payment date is 1st of each

month with the first payment on 1st May 2015;

• quarterly, the payment date is 1st January, 1st April, 1st July and 1st October each year with the first payment on 1st July 2015; and

• yearly, the first payment date is 1st January each year with the first payment on 1st January 2016.

Example 3 How payment is calculated.

If the payment is based on a monetary amount.Where the payment frequency is: • monthly, the payment is calculated by

dividing the yearly ongoing adviser charge amount by 12;

• quarterly, the payment is calculated by dividing the yearly ongoing adviser charge amount by 4; and

• yearly, the payment is the yearly ongoing adviser charge amount


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Relevant UK individual means an individual who, in a tax year: • has relevant UK earnings that they pay

income tax on for that year;• is resident in the UK at some time in that

year;• was resident in the UK at some time during

the five tax years immediately before that year and when they became a member of the pension scheme; or

• has general earnings from being employed by the Crown overseas that are subject to UK tax, or is the spouse or civil partner of someone who has these (as explained in section 28 of the Income Tax (Earnings and Pensions) Act 2003).

Uncrystallised funds pension lump sum is a lump sum paid to you from a money purchase arrangement on or after 6 April 2015 which meets certain conditions. Your pension provider or scheme administrator will have made you aware of any payment to you that’s an uncrystallised funds pension lump sum.

Relevant UK earnings are defined in Section 189 of the Finance Act 2004 and mean:• income from employment;• income from carrying on or exercising a

trade, profession or vocation (whether individually or as a partner acting personally in a partnership); and

• income to which section 529 of the Income and Corporation Taxes Act 1988 (patent income of an individual in respect of inventions) applies.

Income tax isn’t charged on relevant UK earnings if, according to arrangements under section 788 of the Income and Corporation Taxes Act 1988 (double taxation agreements), they aren’t taxable in the UK.


Instruction to your bank or building society to pay by Direct Debit

Please fill in the whole form using a ballpoint pen and send it to: Aegon, Edinburgh Park, Edinburgh EH12 9SE

Name(s) of account holder(s)

Bank or building society account number

Bank or building society sort code

– –

Name of bank or building society

To the manager

Address

Postcode

FOR SCOTTISH EQUITABLE PLC OFFICIAL USE ONLY This is not part of the instruction to your bank or building society.Plan/Scheme number

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

Service user number

8 0 8 4 6 6

9 9 0 0 3 3

Reference

/

Instruction to your bank or building society Please pay Scottish Equitable plc Direct Debits from the account detailed in this instruction subject to the safeguards assured by the Direct Debit Guarantee. I acknowledge that this instruction may remain with Scottish Equitable plc and, if so, details will be passed electronically to my bank/building society.

Signature(s)

Date (dd/mm/yyyy)

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This guarantee should be detached and retained by the payer.

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, Scottish Equitable plc will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Scottish Equitable plc to collect a payment, confirmation 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 Scottish Equitable plc 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 Scottish Equitable plc asks you to.

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

Aegon is a brand name of Scottish Equitable plc. Scottish Equitable plc, registered office: Edinburgh Park, Edinburgh EH12 9SE. Registered in Scotland (No. 144517). Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services Register number 165548. An Aegon company. www.aegon.co.uk © 2017 Aegon UK plcRET00269868 04/17

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