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Qualifying Recognised Overseas Pension schemes Member information for pension scheme administrators

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Qualifying Recognised Overseas Pension Schemes –
Member information for pension scheme administrators
APSS263 Page 1 HMRC 01/17
About this form
Use this form to give your scheme administrator the information they need to transfer sums or assets held within a registered
pension scheme to a Qualifying Recognised Overseas Pension Scheme (QROPS). You must provide this information to your
scheme administrator within 60 days of your transfer request. The scheme administrator will need this information before
proceeding with your transfer request and HM Revenue & Customs may ask to see this.
Tax charges
There are circumstances in which you may have to pay UK tax on this transfer or later payment out of the overseas scheme
even if you are not resident in the UK. Please note if you don’t provide this information to your pension scheme administrator
within 60 days of your transfer request, your transfer will be subject to the overseas transfer charge. You can find more
information about transferring to an overseas pension scheme on gov.uk at
www.gov.uk/government/collections/overseas-pension-schemes
About you
1
Your full name
Title
Last name
First name(s)
2
National Insurance number
If you have contacted Jobcentre Plus and are not
entitled to a National Insurance number, please state
the reasons and give any HMRC reference number that
you have received
3
Your date of birth DD MM YYYY
4
Your principal residential address
This must not be c/o the scheme manager and must
not be a PO Box number unless this is necessary due to
the country of residence
Country
5
If the address given in the previous question is not in
the UK, please give your last principal address in
the UK
Postcode
Country
6
If your principal residential address is outside the UK,
please give the date you left the UK DD MM YYYY
If you don’t have a previous UK address, please tick
this box
7
Your contact phone number
dd mmm yyyy
Page 2
About the QROPS receiving the transfer
8
HMRC reference number
This is the QROPS reference number, allocated to the
scheme by HMRC, when the notification that it met
the requirements to be a recognised overseas pension
scheme was acknowledged
QROPS
9
Name of QROPS
10
Address of QROPS
Country
11
Country in which QROPS is established and regulated
12
Is the QROPS receiving the transfer an occupational
pension scheme?
No
If No, please go to question 13
Yes
If Yes, please go to question 15
13
Is the QROPS receiving the transfer an overseas public
service scheme?
The QROPS you are transferring to will know if they
fall within the definition of an overseas public service
scheme, as per the definition at regulation 3(1B)
SI2006/206
No
If No, please go to question 14
Yes
If Yes, please go to question 15
14
Is the QROPS receiving the transfer an international
organisation?
The QROPS you are transferring to will know if they fall
within the definition of an international organisation,
as per the definition at regulation 2(5) SI2006/206
No
If No, please go to question 21
Yes
If Yes, please go to question 15
Your employment details
15
Name of your employer
16
Your job title
17
Address of your employer
Postcode
Country
18
Date your employment began DD MM YYYY
19
Do you know your payroll tax reference number?
No
If No, please go to question 21
Yes
If Yes, please go to question 20
20
Payroll tax reference number
dd mmm yyyy
Acknowledgement
21
Have you been told that you can access some or all of
the value of this transfer, either directly or indirectly
before you reach the age of 55?
No
Yes
22
I am aware that:
In some circumstances a transfer of funds might
not be a recognised transfer and may be treated
as an unauthorised payment giving rise to a
liability to pay tax in the UK
In some circumstances a future payment made
or treated as made by a QROPS may be treated
as an unauthorised payment giving rise to a
liability to pay tax in the UK
I understand that in some circumstances a
transfer of funds might give rise to a liability to
pay tax in the UK
I undertake to pay tax to HMRC and provide
information relating to taxable transfers
To the best of my knowledge and belief the
information given in this form is correct and complete.
Signature
Date DD MM YYYY
Page 3
dd mmm yyyy
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Completed 14 August 2019

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