Group Self Invested Personal Pension

Group Self Invested Personal Pension 01/08

GSIP36 0515

Who this form is for

When we refer to ‘Standard Life’ we mean ‘Standard Life Assurance Limited’.

You should use this form if you are making regular payments and you wish to invest all or part of each payment in assets that aren’t Standard Life Investment Policy (SLIP) funds. We’ll pay all of the regular payment into the SIPP bank account before investing it (except for any part of the payment that you wish to invest in the SLIP funds).

Filling in this form

A copy of the standard terms and conditions of the Plan and the completed application form will be sent to you on request.

If you are receiving advice from a financial adviser you should remember that the financial adviser is acting on your behalf not only by giving you advice, but also regarding the completion of this form.

Please use BLOCK CAPITALS to fill in this form. Do not use correction fluid if you make a mistake. If you need to correct a mistake, please initial any changes you make.

Important

Please ensure you read the booklet ‘How regular investments under a GSIPP work’ (NEP13). For further details of charges, please see ‘Charges Sheet’ (GSIP20).

Part 1 – Your personal details

National Insurance Number Date of birth (DDMMYYYY) Title (Mr/Mrs/Miss/Ms/ Other eg Dr/Rev) Surname First name(s) in full Plan Number

(if known) Plan Number (if known)

Group Self Invested

Personal Pension

(GSIPP) Instructions

IMPORTANT

Please refer to ‘Information about tax relief, limits and your pension’ (GEN658) for information about your annual allowance.

Part 2 – What self investment assets do you wish to purchase from the SIPP bank

account in respect of your regular payments?

Important

Please refer to the booklet ‘Client investment options and fund management charges guide’ (SLSIP5a) for information on the investments available to you.

Please note that the citicode(s)/fund code(s) and the FULL fund name(s) must be included in order for us to process your application. If we do not have this information we may have to return your application.

Part 2a − SIPPZone mutual funds

For income funds do you wish the income to be paid into the SIPP Bank Account?

Yes No

citicode SIPPZone mutual fund (fund names) Monthly Amount to

be invested £ £ £ £ £ £ £ £ £ Sub Total A £ A European Union directive requires fund managers to produce a Key Investor Information Document (KIID) for most funds. This document sets out key information about the fund including the objectives and risks of the fund, what it invests in and its charges.

Group Self Invested Personal Pension 03/08

Part 2b – Mutual funds from Fidelity FundsNetwork

For income funds do you wish the income to be paid into the SIPP Bank Account? Yes No

Mutual funds from Fidelity FundsNetwork (fund names) Monthly Amount

to be invested £ £ £ £ £ £ £ £ £ Sub Total B £

The sum of Sub Totals A, B and C must not be greater than the regular payment going into the SIPP bank account, less the amounts needed to pay any charges, commission or fees.

Important

Please note that the FULL fund name(s) must be included in order for us to process your application. If we do not have this information we may have to return your application.

Your Financial Adviser must obtain an application form from the other provider for Standard Life to sign.

There may be a requirement to check acceptability of assets before investment can be made.

The sum of Sub Totals A, B and C must not be greater than the regular payment going into the SIPP bank account, less the amounts needed to pay any charges, commission or fees.

Part 2c − Other Investments

(provider, fund name and type of shares) Monthly amount to be invested

Part 3 − Execution Only Stockbroker

1. Do you wish to appoint the specially arranged Execution Only

Stockbroker available through Standard Life? Yes No

If yes, please go to question 2. If no, please go to Part 4.

2. The Stockbroker’s normal procedure is to provide you with the facility to deal and to receive correspondence. They will also provide your financial adviser with copy correspondence and the ability to view account details. Do you want this?

Yes No

If no, please provide details of how you wish your account to be managed: (ie if you or your financial adviser want to use Internet Sharedealing or you wish your financial adviser to manage your account.)

E-mail address

@

An Execution Only Stockbroker carries out trades on your, or if you prefer, your adviser’s instructions. Please refer to our ‘Execution Only Stockbroker’ leaflet for more information. Please provide the relevant e-mail address.

Part 4 − Authorising your adviser to give investment instructions on your behalf

I authorise Standard Life to provide information to, and accept instructions from the adviser intimated in page 5 to buy or sell investments under my plan. This authorisation will apply until Standard Life receives a written instruction from me changing or withdrawing my authorisation.

Signature Date

Group Self Invested Personal Pension 05/08

Part 5 − Adviser fee

If you are not paying your financial adviser a fee, please go to Part 7.

You can only pay an adviser fee if the group scheme was established before 31 December 2012 and is not a Qualifying Workplace Pension arrangement and payment of such a fee is covered in an agreement made between your employer and the adviser before that date.

You can only complete this Part if you will have enough money available to pay your adviser a fee out of your Plan.

1. Please state the fees you authorise us to deduct from your plan, as payment to your adviser for their advice.

One-off fee £

_.

_.

2. If you have chosen to pay a ‘Regular fee’, how frequently do you want the fee to be paid?

Monthly Quarterly Yearly Other

If other please specify:

3. If you have chosen to pay a ‘Regular fee’, how long do you want to pay this fee for?

For the lifetime of the plan Other (please specify term)

Years Months

4. If you have chosen to pay a ‘Regular fee’ when would you like the first payment collected?

Date

(DD/MM/YYYY)

We’ll pay the adviser’s fees by cancelling units in your SLIP funds and by taking money from the SIPP bank account in proportion to the value of your investment in SLIP funds and other assets.

Part 6 − Adviser Charging

You can only pay an adviser an adviser charge if the group scheme was established post 31 December 2012 and was not established on a commission or fee paying basis.

You can only complete this Part if you will have enough money available to pay your adviser for their advice.

Ad-hoc Payment

We’ll pay the adviser charge by cancelling units in your SLIP funds and by taking money from the SIPP bank account in proportion to the value of your investment in SLIP Funds and other assets.

Part 7 − Declaration

I understand that I can access the Key Investor Information Documents (KIIDs) for my chosen funds (where available) from the standardlife.co.uk website or by calling Standard Life.

I have read and understood the booklet ‘How regular investments under a GSIPP work’ (NEP13).

Planholder’s Signature Date

(DD/MM/YYYY)

Note:

All Regular fees are paid in arrears.

Financial adviser details – to be completed by the scheme adviser

Basis of Sale _{Whole of Market Other}

If other please specify: Was advice

given? Advice No advice (eg, Execution-only)

Status of Client

(eg execution-only)

FCA or Authorisation number

The ‘Contact name’ we require is the name of the Registered Individual who advised you on the Self Invested Personal Pension. If your financial adviser is going to use the execution-only stockbroker facility, we will need their email address.

Note:

Adviser charging isn’t available for schemes set up prior to 31 December 2012.

Please complete if the group scheme was established prior to 31 December 2012 and is not a Qualifying Workplace Scheme.

Commission basis

If you gave a personal recommendation, was this in line with an

agreement you made with the employer before 31 December 2012? Yes No

Type of commission

.

Fund Based Commission (FBC)

_.

Level

_.