Data Capture
Form
for the SmartSIPP
This form is for your internal use only. Please do
not return it to us.
You will need to:
• complete the online SmartSIPP application
• return the signed application form to us
• send any required enclosures to us, as detailed
on the application form.
Section
Page
1 Adviser section
3
2 Client details
3
3 Client verification
5
4 Transfers
7
5 Contributions
8
6 Investment options
10
7 Taking Benefits
11
8 Post sales illustrations
13
9 Beneficiaries on death
14
Contents
This form is for your internal use only, please do not return to us.
Use this form to gather details from your client in order to create an online
SmartSIPP application.
Note: Not all fields will directly apply to your client, therefore please ensure
you only gather details relevant to their application.
1 Adviser section
Fixed Amount
(Excl.VAT) Percentage (Excl.VAT) Subject to VAT?
and/or of the initial transfer value(s) / single contribution / funding of the plan value each year in arrears of the gross amount of each regular contribution received
Initial/one-off adviser charge Ongoing adviser charge
% £ and/or % £ and/or % £ Yes No Yes No Yes No
Frequency of ongoing payments: Yearly Half Yearly Quarterly
Basis for investment charges? Annual Management Charge (AMC)
(flat rate)
Total Expense Ratio (TER) /
Initial external investment charges
/ Annual external investment charges
(flat rate)
2 Client details
If married or in a registered civil partnership, spouse’s/registered civil partner’s date of birth
Status Single Married
If married, spouse’s sex Male Female
2.1 Personal
Title Mr/Mrs/Miss/Ms/Dr/Other First name
Surname Date of birth Day/Month/Year Middle name(s)
Nationality
Male Female
Sex
Expected retirement age National Insurance number
Registered civil partnership
Investment charges
£ %
% / £
Adviser charges to be paid
by Suffolk Life and/or the
investment platform
Employer’s name
2.3 Client’s status
Tick one box only.
Employed If you have ticked this box, please give your employer’s details below.
1
Receiving a pension chargeable to tax
Self-employed If trading under a different name please write it in the box below.
2 3
Postcode Employer’s address
Postcode
Caring for one or more children under the age of 16 years 5
Caring for a person aged 16 years or over In full time education
6 7
Unemployed
Other If you have ticked this box, please give details below.
8 9
Tax status UK Relevant Non-UK Relevant
2.4 Money Purchase Annual Allowance (MPAA)
Has the client triggered the MPAA inanother registered pension scheme?
If yes, please confirm the date of the trigger event, and the name of the pension scheme where it occured:
Date Name of pension scheme
Yes No
Permanent residential address
Postcode Postcode Email address Telephone numbers Home Work Correspondence address (if different from above)
2.2 Client’s address
Work status
Tax status
3 Client verification
3.1 Identity
Item Place of birth Date of expiry
Current full passport
Ref./Acc. Date of birth
Date of expiry
Issuing authority Residence permit issued to EU
Nationals by the Home Office Current UK/EU photo
driving licence Firearms certificate State pension or benefits book /notification letter HM Revenue & Customs tax notification
Premises entered? Home visit
Ref./Acc.
Local authority rent card or tenancy agreement
Yes No
Item Date of visit
Date of check
Name of issuing authority Electoral roll check
Most recent mortgage statement Current local authority tax bill
Name of lender Date of issue
Name of utility company Bank/building society/credit
union statement or passbook Utility bill (not mobile phone)
Name of issuer
Current UK/EU photo driving licence State pension or benefits book /notification letter
Evidence of address
Evidence of name
Date of expiry3.2 Source of funds
Current occupation Annual income £Source of wealth Income from employment Income from savings/investments Gift
Lottery and other gambling winnings Inheritance
Property sale Divorce settlement
Pension income from registered pension scheme(s) Income from a lifetime annuity
Other; please specify
3.3 Evidence of age
Birth certificate verification
Client place of birth Client name
Date of registration
Entry number Parish (if applicable) and county
Name of registrar/ official witness
Marriage/Registered civil
partnership verification
Full name of client’s spouse/RCP Date of Marriage/registered civil partnership ceremony
Spouse/RCP date of birth
Entry number Parish (if applicable) and county
Name of registrar/ official witness Registration district Registration district
Client’s full name
This section is only required if retirement benefits are to be taken, otherwise please go on to section 4.
3 Client verification (continued)
Cash only Stock (in Specie)
You will need to enclose a portfolio valuation (including SEDOL numbers) with the completed application, alternatively you provide the investment information online.
4 Transfers
Type of scheme to be transferred (e.g. PP, EPP, etc)
Estimated transfer value £
Full transfer Partial transfer
Is the transfer from a defined benefit occupational scheme?
Name of scheme administrator
Scheme administrator address Policy or membership number
Postcode Personal scheme
Occupational scheme
Full name of scheme to be transferred
Scheme administrator telephone number Transfer all assets?
On what basis is the transfer being effected?
Type of arrangement to be transferred.
If yes, you will need to confirm that a suitably authorised financial adviser recommended the transfer of the defined benefits pension scheme.
We will not be able to accept the transfer without advice.
If you did not give this advice, please confirm the authorised firm and individual who did give your client the advice:
Adviser name FCA reference for company (FRN) Firm name
Yes No
None of the scheme has begun paying benefits (uncrystallised) go on to section 5
Some of the scheme has begun paying benefits (partially crystallised)
Which of the following statements will apply at the time of the transfer to your client’s plan?
All of the scheme has begun paying benefits (crystallised) 1
2 3
Where you have selected either 2 or 3 above, for this arrangement is the client: The original member A dependant
5 Contributions
Net single contribution Net monthly contribution
£ £
5.1 Personal contributions
Bank name Account name Account number Address Postcode Sort codeStart date of regular contribution
15
Net annual contribution £
For monthly contributions please also capture the following: Maximum permitted income
Taxable income taken to date in the current reference year Reference date
Capped drawdown Flexi-access drawdown
If your client is staying in capped drawdown, we also require the following information about the transferring scheme:
What type of drawdown is this arrangement in:
Does your client want to switch to flexi-access drawdown upon transfer to Suffolk Life?
Yes No
£ £ £ £
Income payment type: (complete for both flexi-access and capped drawdown):
One off Monthly Quarterly
Half-yearly Yearly
None
Whole of fund (flexi-access drawdown only)
Date of first payment following transfer Month/Year
Were the funds crystallised before 6 April 2006? Yes No Annual/single income required
following transfer £
5.2 Employer contributions
Gross single contribution Gross monthly contribution
£ £ Employer name Registered number Bank name Account name Account number Address Postcode Sort code
Start date of regular contribution
15
Gross annual contribution £ Contact name for employer
5 Contributions (continued)
For monthly contributions please also capture the following:
5.3 Third party contributions
Third party name Is this an individual or a company? Net single contribution Net monthly contribution£ £ Bank name Account name Account number Address Postcode Sort code
Start date of regular contribution
15
Net annual contribution £
6 Investment options
Investment
platform
AscentricClient’s Ascentric account reference number (if applicable) 1 Cofunds 2 FundsNetwork 3 LIFT-Invest 4 Raymond James 5
Seven Investment Management (7IM Platform) 6
Skandia 7
Succession Investment Platform 8 Towergate 9 Transact 10
Execution only
Stockbrokers
Stocktrade Barclays Stockbrokers 1 2Your Cofunds intermediary authorisation code Client’s segment name
Client’s Cofunds customer reference number (if applicable)
FundsNetwork unique adviser number (UAN) (if applicable)
Your LIFT reference number Client’s LIFT reference number (if applicable)
Yes No
Does your client have an existing account with Seven Investment Management
Client’s Succession Investment Platform reference number (if applicable)
Client’s Towergate reference number (if applicable)
Yes No
Does your client wish for you or another third party to trade via this account?
Your email address (if not an existing Stocktrade user)
The following information and communications will be available online via the Stocktrade web portal. Please indicate below if your client also wishes to receive paper copies of any of the following:
Contract notes Statements Corporate action notifications
You Your client
Who should Stocktrade contact with corporate actions? Your Stocktrade user name (if applicable)
Your client’s email address (if your client wishes to trade via this account or have view-only access)
7 Taking benefits
7.1 Benefit requirements
Gross annual income
Preferred date of first payment Month/Year
Frequency of income payments One off Monthly Quarterly Half-yearly Yearly
BACS Faster Payments/CHAPS Does your client require
income from their plan? Yes No
If income is required:
Yes No
If No to the above: £
How is any lump sum(s) to be paid?
Does your client want to take the whole fund (after PCLS) as a single income payment?
Yes No
Will your client be crystallising benefits from another scheme at the same time as this plan?
Partial crystallisation Full crystallisation
How are the benefits going to be taken from your client’s plan?
If partially crystallised, how will you specify the portion of the uncrystallised fund to be crystallised?
Plan value Percentage of plan
By PCLS amount
Percentage of uncrystallised fund to be crystallised %
Value to be crystallised £
Pension commencement lump sum required £
Receipts of transfers, contributions and tax reclaims from contributions are to be transferred to the following investment platform account.
Receipts of transfers, contributions and tax reclaims from contributions are to be transferred to the execution only stockbroker.
All monies received are to remain in the SIPP bank account pending investment instructions. How would you like cash to be handled?
Will the plan invest in assets that are not available via your chosen investment platform or execution only stockbroker?
Yes No
7.3 Lifetime allowance
Benefits taken after 5 April 2006
Where your client has taken retirement benefits, from any scheme, that came into payment after 5 April 2006, you will need to provide the following:
If your client has transferred benefits to a QROPS after 5 April 2006, you will need to provide the following:
Date of benefit crystallisation event Percentage of the lifetime allowance used when taking this benefit
%
%
%
%
Date of transfer Percentage of the lifetime allowance used when taking this transfer
%
%
If your client has not taken any retirement benefits from any registered pension scheme, please go straight to the protection section below.
Benefits taken before 6 April 2006
A Yes - Date of the first benefit crystallisation event after 5 April 2006 No
B
For the following, you need to provide the details: • at the date in A, if completed; or
• at today’s date if B is ticked
Where your client taken benefits before 6 April 2006 (pre A-Day), have they put any other retirement benefits into payment after 5 April 2006?
Total maximum annual drawdown pensions*
Total annual pensions from other pensions and annuities
£ £
Provide the following details for any of these arrangements which have been converted to flexible or flexi-access drawdown:
Date of conversion Income limit at conversion date Date of last income limit review before
conversion
£ £ £
*If any drawdown pensions have been converted to flexible or flexi-access drawdown, please give the amounts at the date of conversion.
Qualifying Registered Overseas Pension Scheme (QROPS)
7.2 Bank account details
Bank name
Account number Roll number
Account name Address
Postcode Sort code
This section is required if your client wishes to receive a lump sum and/or income.
7 Taking benefits (continued)
No protection Fixed protection 2012 Fixed protection 2014 Individual protection
Primary protection (capture the below where applicable)
Enhanced protection Other Date of PCLS Amount of PCLS £ £ £
Protection Protection status:
8 Post Sales Illustrations
The FCA requires projections to accurately reflect the investment potential of the plan. The maximum nominal medium growth rate is 5%.
Please enter the blended medium growth rate based on the asset classes selected when completing the pre-sale illustration.
Alternatively, if you would prefer to use your own medium growth rate, please enter this. The immediate post sale projection will then be made at your chosen rate.
% Underlying mid growth rate for immediate post sale projections
If your client has taken any retirement benefits on or after their 75th birthday, you will need to provide the following:
Date benefits were taken The amount crystallised The PCLS taken
Retirement benefits
after age 75
7 Taking benefits (continued)
Lump sum Income
Combination If you have ticked this box, please also capture: Percentage payable as lump sum
Percentage payable as income
Benefits from
chargeable amount Where the total value of benefits taken exceeds your client’s LTA, the excess amount (the chargeable amount) will be subject to a tax charge. Where the excess is taken as a lump sum the tax charge is 55%. Where it is taken as income, the excess is subject to a 25% tax charge and the income will be taxed at your client’s marginal rate.
How will benefits from any chargeable amount be taken?
% %
9 Beneficiaries on death
9.1 Expression of wishes
Full name
Percentage payable to beneficiary Relationship to client Date of birth Address Postcode % Dependant Nominee Full name
Percentage payable to beneficiary Relationship to client Date of birth Address Postcode % Dependant Nominee Full name
Percentage payable to beneficiary Relationship to client Date of birth Address Postcode % Dependant Nominee Full name
Percentage payable to beneficiary Relationship to client Date of birth Address Postcode % Dependant Nominee
Registered charity name
Address
Postcode
Percentage payable to beneficiary % Registered charity number
Charity
Organisation name Address
Postcode
Percentage payable to beneficiary %
Organisation
Name of trust
Percentage payable to beneficiary Names of trustees Date of trust Address Postcode %
