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Before returning this form to us, please check:
You’ve included the required certied copies of documents.
You’ve completed all of section 5 and read the risk warnings.
You’ve signed and dated the Declaration above.
You’ve reviewed your retirement options and you’re happy with this
decision.
6 Declaration
!
We can’t process
your instruction
until you’ve
met these
requirements
About me Partial
lump sum
Bank details About
the risks
Declaration
Required
documents
In this declaration ‘I’ means the individual
detailed in section 1 and ‘you’ means Scottish
Equitable plc as Scheme Administrator of the
Aegon Self Invested Personal Pension Scheme.
6.1 I request that you pay the funds from
the wrapper(s) to me as small pots
lump sum(s). I declare that the following
conditions for payment of the small pots
lump sum(s) are met:
a I’ve not previously received more
than two such payments in respect of
arrangements under non-occupational
pension schemes;
b where I’ve not previously received a
small pots lump sum from such an
arrangement, I’ve not listed more than
three wrappers and at the time of
payment the fund value under each of
the wrappers isn’t more than £10,000;
c where I’ve previously received one
small pots lump sum from such an
arrangement, I’ve not listed more
than two wrappers and at the time of
payment the fund value under each of
the wrappers isn’t more than £10,000;
d where I’ve previously received two
small pots lump sum from such an
arrangement, I’ve listed only one
wrapper and at the time of payment
the fund value under the wrapper isn’t
more than £10,000;
e at the time of the payment, I’ll have
reached the normal minimum pension
age, currently 55 (or my protected
pension age, if I have one) or I meet
the ill-health condition; and
f the payment will extinguish my
entitlement to benefits under
the wrapper(s).
6.2 I acknowledge that a small pots lump
sum(s) payment can’t be made to me
from the wrapper(s) if I’ve previously
received three small pots lump sums from
arrangements under non-occupational
pension schemes.
6.3 I acknowledge that a small pots lump
sum payment(s) can’t be made from
a wrapper to me if the value of that
wrapper is greater than £10,000 at the
time of payment. If any wrapper listed in
2.2 is greater than £10,000 at the time of
payment then no small pots lump sum
payment can be made from that wrapper.
6.4 I acknowledge that you’ll rely on this
declaration, and confirm that if a small
pots lump sum payment made to me in
connection with this request results in you
becoming liable for a scheme sanction
charge and penalties and/or interest to
HMRC, that I’ll be responsible for, and be
liable to pay to you a sum equal to the
amount of that Scheme sanction charge,
any penalties and interest charged by the
HMRC and any interest charged by you.
6.5 I agree that any sum due may be
deducted from any arrangements for
or in respect of me under the Scheme.
6.6 I confirm that I’ve reviewed my retirement
options and read the appropriate risk
warnings related to my answers in section
5 and still want to go ahead and take the
option of a small pots lump sum.
You (the investor) should sign and date this
form by typing your full name in the signature
box below and typing the date in the date
box. Your typed name in the signature box will
be your signature. When you sign the form, by
typing your name in this box, you are making
the declarations and confirming that you wish
to proceed with the instructions in this form.
Date (dd/mm/yyyy)
Investor signature - type name here
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