* Required Field

Section 1 - Applicant

(for 3rd party payments, this is to be the name of the person who you are arranging the pension up for)

Title * Select Mr Master Mrs Miss Dr Prof. Baroness Lord Viscount Dame Ms Lady Last name*

First name Middle name(s)

DOB * NI Number Marital status Select Single Married Divorced Cohabiating Civil partnership

Section 2 - Address and Contact

Applicants home address Post code

Day time telephone * Mobile Email *

Section 3 - Employment

Employment status Select Employed Self-employed Unemployed Retired Housewife Househusband If employed, occupation

Employer address   Employer postcode

Section 4 - When do you plan to retire?

Retirement age * Select 55 56 57 58 59 60 61 62 63 64 65

Section 5a - Pension contributions

Employee

Net Contribution lump sum (£) Net Contribution regular (£)

Regular contribution indexed each year? select N/A Yes No If Yes, by how much? Select 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% 13% 14% 15%

Employer

Gross Contribution lump sum (£) Gross Contribution regular (£)

Regular contribution indexed each year select N/A Yes No If Yes, by how much? Select 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% 13% 14% 15%

3rd Party Payment

Relationship to Applicant Select Mother Father Legal Guardian Other

Contribution lump sum (£) Contribution regular (£)

Require the regular contribution indexed each year select N/A Yes No If Yes, by how much? Select 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% 13% 14% 15%

Section 5b - Transferring your existing pensions

Transfer existing pensions? Select N/A Yes No

If yes, select provider 1 Select Aegon Scottish Equitable Alico (formerly AIG) Allied Dunbar Aviva (formerly Norwich Union) AXA Sun Life CIS Eagle Star Edinburgh Equitable Life Friends Provident Legal & General NPI Phoenix Prudential Royal London Scottish Amicable Scottish Equitable Scottish Life Scottish Widows Skandia Standard Life Sun Life of Canada Windsor Life Winterthur Life If 'Other' please state

Transfer amount (£)

If yes, select provider 2 Select Aegon Scottish Equitable Alico (formerly AIG) Allied Dunbar Aviva (formerly Norwich Union) AXA Sun Life CIS Eagle Star Edinburgh Equitable Life Friends Provident Legal & General NPI Phoenix Prudential Royal London Scottish Amicable Scottish Equitable Scottish Life Scottish Widows Skandia Standard Life Sun Life of Canada Windsor Life Winterthur Life If 'Other' please state

Transfer amount (£)

If yes, select provider 3 Select Aegon Scottish Equitable Alico (formerly AIG) Allied Dunbar Aviva (formerly Norwich Union) AXA Sun Life CIS Eagle Star Edinburgh Equitable Life Friends Provident Legal & General NPI Phoenix Prudential Royal London Scottish Amicable Scottish Equitable Scottish Life Scottish Widows Skandia Standard Life Sun Life of Canada Windsor Life Winterthur Life If 'Other' please state

Transfer amount (£)

Section 6 - Fund Choice

If you would like to pick your own mix of funds then complete section 6a or if you prefer to pick a Managed Fund, then go to 6b

Section 6a - Self Select

Fund Choice and Performance

Please select the funds you wish to invest in and the proportion to be invested in each

Fund 1 % ...... Fund 2 %

Fund 3 % ...... Fund 4 %

Fund 5 % ...... Fund 6 %

Fund 7 % ...... Fund 8 %

Fund 9 % ...... Fund 10 %

Please ensure that the allocation adds up to 100%

Section 6b - Select a Managed Fund

Choose from the default Managed funds.

Select 80/20 Managed (lowest risk) 70/30 Managed (low risk) 60/40 Managed (low to medium risk) 50/50 Managed (medium risk) Global (medium to high risk) % ....... .....

...........

I have read the Terms and Conditions *

Send your application