ADDING OR
AMENDING CONTRIBUTIONS
– to your Personal Pension (PP6)
This application contains technical and legal terms with which you may not be familiar. You should therefore complete
it with the help of your financial adviser.
With this form you can:
– add or amend regular contributions
– make an additional single contribution
into a Personal Pension ‘PP6’.
There is a separate form for making transfers in from other pension arrangements.
NOTE
• Before completing the form, please refer to the flow chart below. It contains information about whether this application will convert your
plan to Adviser Charging
• We try not to use technical jargon but where this is unavoidable we have explained the meanings in a glossary on page 8 .
• 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 financial adviser.
– If you don’t have an adviser and would like to find one in your area, you can find a range of options by visiting
www.oldmutualwealth.co.uk/find-an-adviser.
Is your plan on an Adviser Charging basis?
no
IF YOU ARE NOT SURE
Please speak to your financial adviser or call our Customer Contact
Centre on 0808 171 2600 and we’ll be happy to confirm.
yes
Have you received advice from your financial adviser for this transaction?
no
yes
Your plan WILL NOT CONVERT to Adviser Charging
when you submit this application.
Your plan WILL CONVERT to Adviser Charging
when you submit this application.
•Initial fees:
• This means that only the fees specified in section
H will be paid to your financial adviser from now
on.
– for single contributions or new regular contributions,
will only be paid if selected in section H.
– for increased existing regular contributions, will be
paid on the basis previously selected.
Your plan
WILL REMAIN
on Adviser Charging.
• Once your plan converts to Adviser Charging, this
cannot be reversed.
•Ongoing fees:
– any ongoing fees will continue at the rate previously
requested, unless you inform us otherwise.
You can authorise fees for your financial adviser in section H, if required
1
Please tick/complete this form, as applicable, using BLOCK CAPITALS and blue or black ink, initialling any amendments or corrections
Failure to answer the following question will delay your application
Have you been given advice about this application by your financial adviser?
Yes
No
A YOUR DETAILS
u If you are under 16, or between 16 and 18 and not in employment, this application must be completed by your legal guardian.
P
Your plan number
P
6
–
0
Your full name
Permanent
residential address
(c/o addresses are not
acceptable)
Postcode
u 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.
National Insurance
Number (if 16 or over)
Date of birth
(ddmmyyyy)
Contact details
Tel: Email:
B LEGAL GUARDIAN’S DETAILS (if applicable)
Full name
Permanent
residential address
(c/o addresses are
not acceptable)
Postcode
Date of birth
(ddmmyyyy)
Contact details
Tel:
Email:
C YOUR STATUS
Complete this section, as applicable, with details of your status and your estimated gross UK earnings in the current tax year.
If you have two or more sources of earnings please complete all relevant boxes below and indicate which is your main source of earnings.
Employed
u Your main source of income is paid to you by an employer and is taxed as earned income
Pensioner
u Your main source of income is from a pension and is taxed as pension income
Self-employed
u Your main source of income is from a trade or business operated by you and is taxed accordingly
Child under 16
Caring for one or more children aged under 16
Caring for a person aged 16 or over
In full-time education
Unemployed
Other u please specify below
State your estimated gross UK earnings which will be liable to income tax in the current tax year:
2
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£
D CONTRIBUTIONS
Complete this section with details of the contributions for your pension.
NOTE
• You could suffer a tax liability if contributions are funded from a tax-free cash sum received from a registered pension scheme.
• Contributions may be made by you or your employer alone, or by you and your employer together.
• Old Mutual Wealth will allocate the gross personal contribution and reclaim the basic rate income tax from HM Revenue & Customs.
Minimum contributions:
• Single contributions – for additional single contributions, the minimum is £500 gross.
• New regular contributions – if you are starting regular contributions for the first time, the minimum is £100 gross each month or
£1,000 gross each year.
• Existing regular contributions – if you are increasing existing regular contributions, the minimum additional contribution is £5 gross
each month or £50 gross each year.
Single contribution
Employer’s contribution (gross)
(including any contribution being made by salary sacrifice)
£.
Your employer must complete section J
Your contribution (net)
£.
If being paid by a third party, complete section E
Total
£.
Regular contribution
Employer’s contribution (gross)
(including any contribution being made by salary sacrifice)
£.
Your employer must complete section J
Your contribution (net)
£.
If being paid by a third party, complete section E
Total
£.
Frequency of regular contributions
Monthly
Yearly
The start date for your regular contribution, or for the amended regular contribution, will be the next available first of the month following receipt of the
application.
If you would like a later start date, please state the month and year required here:
0
1
M
M
2
0
Y
Y
u this cannot be back-dated
If you are paying regular contributions for the first time, do you want them to be increased
automatically at each yearly review?
Yes
No
u the increase will normally be the greater of 10% or the rate of inflation.
Please complete the direct debit instruction at the end of this form if you are paying regular contributions for the first
time or if you are changing your bank details for existing regular contributions.
E THIRD PARTY PAYER DETAILS (if applicable)
Complete this section with details of any third party (other than your employer) paying your contributions.
NOTE
• The data may be made available to a third party for the purpose of verifying the identity in accordance with Money Laundering
Regulations.
• 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.
• All third party payments will be allocated net of basic rate tax.
Full name(s) of the third
party
Permanent UK
residential address
Postcode
Date of birth
(ddmmyyyy)
Contact number
u in case of query
Which contribution is being paid by this third party?
Single
Regular
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3
F FUND CHOICE
Please state your fund choice below.
• Amended regular contributions
Now go to section G
If your fund choice for the amended contribution is the same as your current regular contribution fund choice, tick here*
OR
Complete the table below to select different fund(s) for your amended contributions
• Single/New regular contributions
Complete the table below to select fund(s) for your single/regular contributions
NOTE
• 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 financial adviser will be able to help you choose the funds most suitable for you.
• If there is insufficient 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.
Fund manager
Full fund name
Whole %
(minimum 1% in each fund)
Total
100%
G MONEY PURCHASE ANNUAL ALLOWANCE
You do not need to complete this section if you have already provided the information to Old Mutual Wealth.
Have you taken any benefits 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
Yes
contributions that can be paid to money purchase registered pension schemes to £4,000 a year?
If Yes please confirm the date on which the MPAA first applied to you
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No
H PAYMENTS TO YOUR FINANCIAL ADVISER
You do not need to complete this section if: you HAVE NOT been given advice about this application by your financial adviser, and your
plan is NOT on Adviser Charging , and you do not wish to change any adviser fund-based fees or servicing fees previously authorised. Go to section I
Otherwise complete the parts below, if you want to authorise fees for your financial adviser.
u
We do not pay remuneration to financial advisers for plans opened in their own names. Financial advisers should refer to our Terms of Business for further information.
PART 1 Initial fee – single contribution
NOTE
• This is a percentage or a monetary amount which can be selected for each single contribution.
• You can choose a different amount for each single contribution you make.
• We deduct units from your plan to meet the fee, which is in addition to any other adviser fees.
Initial fee required:
OR
£
.
%
Where more than one single contribution is being paid, do you want the same initial fee to apply to each single contribution?
Yes
No
Go to section I
Please state clearly the fee required for each
PART 2 Initial fee – regular contribution
NOTE
• This is a percentage or a monetary amount which is taken from each regular payment.
• We deduct units from your plan to meet the fee, which is in addition to any other adviser fees.
• If you are adding a regular contribution to your plan for the first time, choose one of the options below if you want to authorise an
initial fee for your financial adviser.
• If you are increasing an existing regular payment:
• – the current initial fee can only be decreased or stopped (after which it cannot subsequently be increased or restarted)
• – If you leave this section blank, the existing initial fee will continue.
Choose one of the following types of initial fee, if required:
(A)A percentage from each regular contribution for the term of the plan
It will apply to the entire contribution, not just to any increase
u
.
%
.
%
OR
(B) A percentage from each regular contribution for the first two years from when it starts
u I
t will apply to the entire contribution, not just to any increase
OR
(C)A monetary amount paid from each regular contribution during the first two years from when it starts
£
PART 3 Ongoing fees
NOTE
• These fees apply to the plan as a whole.
• Any existing fund-based fee or servicing fee for your financial adviser will continue as previously authorised, unless you request
a new rate below.
• We deduct units from your plan to meet the fees, which are in addition to any other adviser fees.
Choose one of the following types of ongoing fee, if required:
(A)
Adviser’s fund-based fee u only available if you have not previously selected the adviser’s servicing fee
Fee required
.
%
of the plan value each year
(this annual percentage will be divided and paid at the frequency selected)
Payable for
the term of the plan
OR
year(s)
Frequency (if you are adding a fund-based fee for the first time)
u the frequency cannot be changed for existing fund-based fees
OR
Monthly
Quarterly
Half-yearly
Yearly
(B)
Adviser’s servicing fee u a new servicing fee cannot be added; an existing fee can be reduced or stopped but not increased
Fee required
£
Escalation (if required)
%
the fee will be increased by this percentage each year
u
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5
I YOUR Declaration
NOTE
• Any omission or misstatement of a material fact in this application could affect the payment of benefits under the arrangements
comprising the Personal Pension.
• A material fact is one which is likely to influence 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 significance. • If you become aware of such a fact while we are considering your application, you should notify us immediately. • 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.
1. Declaration
I request that the changes detailed in this application are made to my existing plan.
a)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.
b)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
the higher of the basic amount (£3,600) or my relevant UK earnings for the tax year.
c)I agree to supply information relevant to the Personal Pension as shall be required by Old Mutual Wealth from time to time.
d)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.
e) 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 neither I nor Old Mutual Wealth will suffer a tax liability.
f) I declare that any person paying contributions as a third party has been made aware and accepts that they have no claim to benefits arising from
my membership of this pension scheme.
g) If Portfolio Rebalancing applies to my plan, I understand that:
i) my instructions will automatically be cancelled as a result of this application.
ii) a new set of Portfolio Rebalancing instructions will be required should I wish to reinstate the instructions.
2. Legal guardian declaration
a)I understand the contributions paid to the contract may only be returned to the member in the form of benefits 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 contract 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.
3. Where I have completed section H:
I authorise Old Mutual Wealth to deduct any fee(s) detailed in section H from my plan and pay them to my financial adviser.
(a)
I understand that:
(i) the fee(s) agreed will be met as follows:
• Adviser’s Fund-based Fee – by deduction of units from the investments in my pension
• Adviser’s Servicing Fee – by deduction of units from the investments in my pension
• Initial Fees – by deduction of units after the contribution has been applied to my plan
(ii) the amount of the agreed fee is assumed to include VAT (at the rate prevailing when the fee is due), if applicable.
(b)
I confirm that:
(i) I have completed and agreed this section with my financial adviser
(ii) my financial adviser has explained the effect that selling units from my pension will have on its future value
(iii)any fees agreed under Adviser Charging on this application are solely in relation to advice and/or services I have received or will be
receiving on this plan only, and do not relate to any other advice or services provided.
(c) I understand that:
(i) I can amend the Adviser Servicing Fee or Adviser’s Fund-based Fee by giving at least 10 working days notice before it is deducted
(ii)I cannot cancel a fee once it has been deducted from my plan, instead I would need to contact my financial adviser to discuss whether a refund
is payable in full or in part.
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I YOUR Declaration (continued)
4. Personal Data Statement
I agree that you may keep and use my personal data to process my application and to service my plan.
I understand that you may provide my personal data, by electronic or other means, to:
• other companies within the Old Mutual plc group of companies if you regard this as necessary to service my plan
• my financial adviser including via a secure restricted access internet service
• my employer/trustee/administrators of the scheme (where applicable)
• a third party to verify my identity in line with money laundering or other requirements
• r e-insurers and other third parties who perform tasks for you to help you to service my plan. These third parties may be based in countries outside the
EEA. These countries may not have laws to protect data equivalent to those in the UK. However, you will ensure that any such third parties agree to
treat my data with the same level of protection as if you were dealing with it.
• investigate or prevent fraud.
I understand that to prevent and detect fraud you may:
• share my personal data with other organisations including the police
• c heck and/or file my personal data with fraud prevention agencies and databases and if I give you false or inaccurate information and you suspect
fraud you will record this.
I understand that:
• the Old Mutual plc group of companies may use my data for assessment and statistical analysis purposes and without identifying me make results
available to third parties.
• my personal data may be made available to third parties where required by law, court order or regulation.
• o
n payment of a small fee I am entitled to receive a copy of the personal data that you hold on me and that I have the right to require you to correct
any inaccuracies.
Date
(ddmmyyyy)
Your signature
D
D
M
M
2
0
Y
Y
u if 16 or over
Date
(ddmmyyyy)
Legal guardian’s
signature
D
D
M
M
2
0
Y
Y
M
2
0
Y
Y
u this is required if the applicant is under 18, even if he or she has signed above
Your employer must complete section J below if contributing to your pension
J EMPLOYER’S DECLARATION
u please remember to tell us if any of your details have changed, such as your address
The statements in this form are correct to the best of our knowledge and belief.
Employer’s name
Employer’s registered
address
Postcode
Person dealing with
correspondence
Correspondence
address
(if different from above)
Postcode
Company registration
number
Telephone number
Email address
Date
(ddmmyyyy)
Signed
D
D
M
on behalf of the employer named above
Capacity
u this must be an authorised official
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7
K confirmation of verification of identity – to be completed by your financial adviser
Please complete this section to verify the identity of all relevant parties referred to in this application.
I/We confirm that:
(a)the information in this form was obtained by me/us in relation to the relevant parties
(b)the evidence I/we have obtained to verify the identity of the relevant parties meets the standard of evidence set out within the guidance for the UK
Financial Sector issued by the Joint Money Laundering Steering Group
(c) I have not verified the identity of the following parties because they are exempt from verification under Money Laundering Regulations
(d) The following parties were existing client(s) of mine/ours prior to the introduction of the requirement for identity verification
Signed*
Date
(dd/mm/yyyy)
2 0
Name
Position
Full name of regulated
firm (or sole trader)
FS registered number
* This must be signed by the person who has seen the original documentary evidence, which may include an electronic identity check.
GLOSSARY
Adviser charging
If you have received personal advice from your adviser for a transaction since 1 January 2013,
your plan may have converted to an adviser charging basis. This means that any fees that are
deducted from your plan and paid to your adviser are classed as adviser charges.
Adviser’s fund-based fee
This is an ongoing fee, which is deducted from your plan and paid to your financial adviser. It is
calculated as a percentage of the encashment value of your plan.
Salary sacrifice
If your contributions are paid through salary sacrifice, it means you have given up part of your
paid salary and that amount is paid into your pension.
Send the completed form to:
Old Mutual Wealth
Old Mutual House
Portland Terrace
Southampton
SO14 7AY
Customer Contact Centre
Tel: 0808 171 2600
www.oldmutualwealth.co.uk
Calls may be monitored and recorded for training purposes and to avoid misunderstandings.
Old Mutual Wealth Life Assurance Limited is registered in England & Wales under number 1363932. Registered Office 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 fibre from controlled sources and
virgin fibre sourced from well managed, sustainable forests.
PDF8752/217-0407/July 2017 (Add/Amend PP6)
8
DIRECT DEBIT INSTRUCTION
Complete and return this form if you are paying regular contributions for the first time or
where your bank details are changing for existing regular contributions.
NOTE
• We will collect all regular contributions using one direct debit instruction. If you are an employee and your employer is paying any part
of the contributions, the direct debit must come from your employer’s bank account. Your employer will be responsible for collecting your
personal contributions.
• Direct Debit collections 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.
The instruction below must be signed in accordance with the authorised signature(s) for the bank account.
Instruction to your bank
or building society to pay
by Direct Debit.
Please complete the form and send to:
Service user number
Old Mutual Wealth Life Assurance Limited,
9 9 5 3 0 1
Old Mutual House, Portland Terrace, Southampton SO14 7AY.
Name and full postal address of bank/building society
Reference
To: The Manager
B
bank/building society
Instruction to your bank or building society
Please 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.
Address
Postcode
Signature(s)
Name(s) of account holder(s)
Date
/
/
/
/
Bank/building society account number
Branch sort code
-
-
Banks and building societies may not accept Direct Debit Instructions for some types of account.
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 Old Mutual Wealth Life Assurance Limited will notify you
five 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, 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 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.
• Y
ou 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.
9
www.oldmutualwealth.co.uk
Calls may be monitored and recorded for training purposes and to avoid misunderstandings.
Old Mutual Wealth Life Assurance Limited is registered in England & Wales under number 1363932. Registered Office 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 fibre from controlled sources and
virgin fibre sourced from well managed, sustainable forests.
PDF8752/217-0407/July 2017 (Add/Amend PP6)
www.oldmutualwealth.co.uk
Calls may be monitored and recorded for training purposes and to avoid misunderstandings.
Old Mutual Wealth Life Assurance Limited is registered in England & Wales under number 1363932. Registered Office 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 fibre from controlled sources and
virgin fibre sourced from well managed, sustainable forests.
PDF8752/217-0407/July 2017 (Add/Amend PP6)
10