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Small lump sum claim form. Individual pension plan

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Option A – Individual plan value is not more than £10,000

This option may be available if you are age 55 or over (or earlier if you have a protected retirement age or are in ill health), regardless of the value of your other pension savings or small lump sum

payments under an occupational pension scheme. The current regulations allow up to £10,000**

from each arrangement to be paid as a lump sum and for this to happen under a maximum of three arrangements.

You may need to take advice if you have several low value plans.

**Note – before 27 March 2014 the maximum amount was £2,000 per arrangement.

Option B – Individual plan value is more than £10,000 and up to £30,000

This option may be available if you are age 55 or over (or earlier if you have a protected retirement age or are in ill health), regardless of the value of your other pension savings or small lump sum

payments under an occupational pension scheme. The current regulations allow up to £10,000**

from each arrangement to be paid as a lump sum and for this to happen under a maximum of three arrangements.

If you meet these requirements, Zurich will endorse your plan so that it becomes two or three arrangements.

You may need to take advice if you have several low value plans.

**Note – before 27 March 2014 the maximum amount was £2,000 per arrangement.

You are entitled to free guidance about your retirement options. The Government has set up a free guidance service called ‘Pension Wise’ which offers a free, impartial service to help you understand your choices at retirement. Pension Wise can provide you with guidance by telephone, over the internet, or face to face. You can visit their website www.pensionwise.gov.uk

If the value of your retirement fund is low enough

In certain circumstances HM Revenue & Customs (HMRC) will allow you to take the full plan value as a lump sum called a small lump sum payment. To receive this you must be eligible under HMRC Rules. There are different small lump sum options explained below. You should take advice if you need help or are not sure what to do.

Your guide to small lump sum payments

How is the payment taxed

One quarter of the value of your benefi ts is paid as a tax-free cash sum. The rest of your fund is taxed at basic rate and is paid as a lump sum. As all ‘small lump sum payments’ are treated as income in the tax year in which they are paid, this could impact any tax allowances such as age allowance or any means tested state benefi ts.

Depending on your income from other sources, such as income from employment or your state pension, you may need to pay more tax or you may be able to get a tax refund from HMRC. How much tax you pay will depend on your personal circumstances.

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Claim Form

If you want to take your benefi ts as a small lump sum payment, you’ll need to complete the claim form and return it to us. We are obliged to tell HMRC if we make a small lump sum payment to you.

If you have more than one plan with Zurich, we will need a separate claim form completed for all small lump sum payments being claimed under small lump sum rules.

As the claim value isn’t known until we receive all our requirements, we’ll contact you if your plan value is more than the permitted amount for the option you have chosen, and ask you how you want to proceed.

Advice

We are not able to give any advice about the implications of you taking benefi ts in this way or any impact it may have on tax allowances or other state benefi ts such as Housing Benefi t and Pension Credit. Please contact your adviser if you need any help.

You can get information about Housing Benefi t from your local council offi ce and other state benefi ts from your local Department for Work and Pensions offi ce.

Title

Name

Previous surname

(If applicable) Portfolio/Account number

Address

Postcode Date of birth

We will pay your benefi ts once we’ve received all our requirements. If you want to take your benefi ts

at a later date, please tell us below. Date

Marital status

(for example single, married, separated, divorced) Sex Male Female

National insurance number (from your tax return or payslip)

Contacting you

We may need to contact you to discuss the claim and if you provide your telephone number this will help to avoid any delays.

Daytime telephone number Evening telephone number

If you would like to receive email and text updates on the progress of your claim, please provide an email address or a mobile phone number.

1

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Claim form (continued)

Bank account details

Zurich will send your payment directly into your chosen bank/building society account. Please complete your bank/building society details.

Name of Bank /Building Society

Branch name Sort code

Branch address

Postcode Account number

Building Society roll number

(if applicable)

Account holder name Account type (ie. Sole /Joint / Deposit)

Have you taken advice or guidance on your retirement options?

We recommend you consider taking regulated fi nancial advice or use the guidance available from Pension Wise before making a decision.

Have you used the guidance available from Pension Wise? Yes No Please confi rm if you have received advice from a regulated fi nancial adviser before making this claim:

Have you received advice? Yes No

2

3

Which small lump sum option do you want to use?

Option A – (Individual plan value is not more than £10,000)

This option can only be used three times under current regulations.

Please tick to confi rm you have not taken this type of small lump sum payment more than twice before under any of your individual pension plans (whether with Zurich or other providers)? If you selected option A, please complete section 4.

or

Option B – (Individual plan value is between £10,000 and £30,000)

The current regulations allow up to £10,000** from each arrangement to be paid as a small lump sum and for this to happen under a maximum of three arrangements. If you cannot meet this requirement you will not be able to take a small lump sum under this option.

Have you taken a small lump sum payment previously? Yes No If yes, please give details of amounts and dates.

**Note – before 27 March 2014 the maximum amount of small lump sum payment was £2,000. The notes on pages

2 and 3 give more information to help you decide which option

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4

Declaration

Warning: Zurich must report certain details in this form to HMRC. If any of the details and statements you have made in this form are not true or complete this may lead to additional tax charges or severe penalties being imposed on you by HMRC.

We have enclosed information on the things you should consider before making your claim. If you do not understand the information we’ve provided or would like to ask any questions, then please contact us, use the guidance available from Pension Wise, or speak to a fi nancial adviser before signing and returning this claim form.

I authorise Sterling ISA Managers Limited, trading as Zurich, to pay the plan proceeds as detailed in this claim form and as permitted by the plan terms and conditions and any other supporting documentation. Further, I authorise Sterling ISA Managers Limited, trading as Zurich, to use the information provided on this form for the administration and payment of benefi ts arising from this plan in accordance with the Data Protection Act 1998. Where you are providing information relating to a third party, we assume you have their authority to do this.

I am aware that:

• Zurich recommend I consider taking regulated fi nancial advice or use the guidance available from Pension Wise

• the payment, less my tax-free cash lump sum, is subject to tax as income and consent to the payment via PAYE

• the fi nal value will be calculated on the next valuation date following receipt of this fully completed claim form and any other information required, or a later date you have chosen in section 1. I declare that:

• I am not bankrupt and have not been since starting this plan

• the benefi ts in the plan do not form part of a divorce settlement and I understand I must tell Zurich if that is the case

• the statements and information contained in this form, and the details Zurich holds in respect of me are, to the best of my knowledge and belief, correct and complete.

I authorise Zurich to pay the benefi ts detailed in this form in full and fi nal settlement of my claim and discharge Zurich from any further liability in respect of this plan.

Date

Signature

Checklist

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