ADVISER CHARGES FORM
Document Info
Notes
Form
55443
Job ID
057619
Version
Size
A4
Pages
4
Colour
Black
Version
JUN 16
Advise
page n
they in
Operator Info
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cm
25/2/16
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KP
11.03.16
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cm
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KP
31.05.16
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KP
01.06.16
22/3/16
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FOR INDIVIDUAL FINANCIAL ADVICE FOR MEMBER OF
GROUP PERSONAL PENSION
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10
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A. YOUR DETAILS
Name
New Brand –
National Insurance (see note 1) Footer/
Policy number
If Spec ch
Scheme name
NOTES
(1) Your National Insurance
Number can be found on
a payslip or P60, or on a
tax return.
(2) “Months” and “years” refer
to the number of monthly or
annual instalments, rather
than a fixed time period. For
a charge to be paid monthly
over 5 years enter 60 into
months box, or for a charge
to be paid yearly over 5
years enter 5 into years box.
(3) Consumer Price Index (CPI);
Retail Price Index (RPI);
Average Weekly Earnings
Index (AWEI). Charges will
automatically increase on
the anniversary
of the scheme start date.
Scheme number
COMPARE
B. ADVISER CHARGES
Remove bad line break
Select the method(s) by which we should pay your Financial Adviser by ticking the options you want to use
and inserting the additional information required.
Quote
Remo
Please note you must inform Scottish Widows should you want to change your financial adviser. We will stop
the adviser charge payments to the adviser. The new adviser will be paid once we receive a new Adviser
Charges Form detailing the new adviser charges.
Telephone nu
Folio/page n
REGULAR CONTRIBUTIONS ADVISER CHARGES
Initial
Fixed amount(s)
Select:
One off or
Spread
If spread, specify below
the number of months
or years.
Ongoing
Tables/boxes/charts/graph
% contribution
% funds
%
%
(enter percentage of fund
to be paid)
For how many
contributions received?
For how many months
or years?
Specify the number
of contributions or
enter ‘ALL’ for every
contribution received i.e.
for the term of the plan.
Graphs/ch
£
(enter percentage of
contribution to be paid)
contributions
Fixed amount
months
OR
years
(see note 2)
Specify the number of
month or years. Enter
‘ALL’ for every month/
year i.e. for the term of
the plan.
M
(enter amount to be paid)
Check FSA replaced w
For how many months or
years?
months
OR
OPERATOR CHECKED Initia
years
Date
(see note 2)
Specify the number of
month or years. Enter
‘ALL’ for every month/
year i.e. for the term of
the plan.
Page 1 of 4
REGULAR CONTRIBUTIONS ADVISER CHARGES (CONTINUED)
Initial
Fixed amount(s)
Ongoing
% contribution
% funds
Fixed amount
Charges can be increased
annually by selecting one
of the rates below. Any
increase is optional.
£
(enter the monthly/yearly
amount, not the total
amount)
Automatically increase
annually at the rate of:
To be paid each month/
year for
CPI
RPI
AWEI
months
(up to a maximum of 60)
OR
%
(specify a rate)
years
(up to a maximum of 5)
(see note 3)
(see note 2)
SINGLE CONTRIBUTIONS ADVISER CHARGES
Initial charges
Fixed amount
£
(enter amount to be paid)
Ongoing
% contribution
% funds
%
(enter percentage of
contribution to be paid)
%
Fixed amount
£
(enter percentage of fund
to be paid)
For how many months or
years?
(enter amount to be paid)
For how many months or
years?
months
months
OR
years
(see note 2)
OR
(see note 2)
Specify the number of
month or years. Enter
‘ALL’ for every month/
year i.e. for the term of
the plan.
years
Specify the number of
month or years. Enter
‘ALL’ for every month/
year i.e. for the term of
the plan.
Charges can be increased
annually by selecting one
of the rates below. Any
increase is optional.
Automatically increase
annually at the rate of:
CPI
RPI
AWEI
%
(specify a rate)
(see note 3)
Page 2 of 4
TRANSFER VALUE ADVISER CHARGES
Initial charges
Fixed amount(s)
Ongoing
% contribution
£
% funds
%
(enter amount to be paid) (enter percentage of
contribution to be paid)
%
Fixed amount
£
(enter percentage of fund
to be paid)
For how many months or
years?
(enter amount to be paid)
For how many months or
years?
months
months
OR
years
(see note 2)
OR
(see note 2)
Specify the number of
month or years. Enter ‘ALL’
for every month/year i.e.
for the term of the plan.
years
Specify the number of
month or years. Enter
‘ALL’ for every month/
year i.e. for the term of
the plan.
Charges can be increased
annually by selecting one
of the rates below. Any
increase is optional.
Automatically increase
annually at the rate of:
CPI
RPI
AWEI
%
(specify a rate)
(see note 3)
ALL CONTRIBUTION TYPES ADVISER CHARGES (I.E. REGULARS, SINGLES AND TRANSFER VALUES AND
FORMER PROTECTED RIGHTS)
% funds
%
(enter percentage of fund to be paid)
For how many months or years?
months
OR
years
(see note 2)
Specify the number of month or years. Enter ‘ALL’ for every month/year i.e. for the term of the plan.
AD-HOC ADVISER CHARGES (I.E. ONE OFF PAYMENT)
£
(enter amount to be paid)
(Specify if it is to be paid from regular, single or transfer contributions)
Regular
Single
Transfer
Page 3 of 4
IMPORTANT INFORMATION FOR WITH PROFIT INVESTORS
If your plan invests in our Unitised With Profits (UWP) fund, we may apply market value reductions to the value of
any UWP units dis-invested to meet the cost of an adviser charge. Market value reductions aim to maintain a fair
level of payout to everyone investing in the UWP fund. For example we may use market value reductions after a
period of falling stockmarkets - please see our With Profits Guide for more information on market value reductions.
The Guide can be accessed at http://reference.scottishwidows.co.uk/docs/44423.pdf, or alternatively you can ask us
for a copy.
For ongoing adviser charges, the amount of each and any reduction will depend on the market value reductions,
if any, applying at the dates of dis-investment.
For initial charges, you can ask us if any market value reductions are currently applying before you submit your
completed Adviser Charges Form.
C. DECLARATION BY ADVISER
I confirm that I have discussed the adviser charges detailed on this form with the member.
Signed
Print name
Date (DD MM YYYY)
Company Name
Scottish Widows
Agency number
D. DECLARATION BY MEMBER
I confirm that the charge(s) detailed above relate wholly to services provided in respect of the above plan by my
financial adviser named above. I understand that these services are optional and not a condition of joining the
scheme. I also understand that if these services stop I can instruct Scottish Widows to stop the charge(s).
I have discussed the charges with my adviser and confirm that I understand the impact on my plan.
I agree to Scottish Widows deducting the charge(s) detailed above from my plan.
Signed
Print name
Date (DD MM YYYY)
Scottish Widows Limited. Registered in England and Wales No. 3196171. Registered office in the United Kingdom at 25 Gresham Street, London EC2V 7HN.
Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services Register number 181655.
53374 06/16
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