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@sipp Form - Financial Advisors

Application For

This application is for you to become a member of the @sipp SIPP scheme.

You should read the Key Features document, Rules of the scheme, Terms and Conditions, Fee Schedule and Permitted Investments Schedule prior to completing this application.

We also strongly recommend that you seek financial advice in relation to the content of this application. If you are in any doubt about any of the questions in this application please seek advice from your financial adviser.

@sipp cannot proceed with your application or act on your investment instructions until we receive this form fully completed and signed

Where you wish to receive immediate benefits please also complete a Benefit Payment form. Where you are transferring benefits in payment and wish to continue receiving payment please also complete an Alteration to Income Form.

Part A: Personal Information

Your Name

Sex

Date Of Birth

National Insurance Number

Expected Retirement Age

Nationality

Residential Address

I Have lived at this address for 3 years or more

Previous Address (If any within the last 3 years)

Contact Telephone Number

Email Address

Marital Status

Spouse's / Civil Partner's Name

Date of Birth

National Insurance No.

Have you made a decision to opt out or not join your employer's pension scheme in favour of establishing this SIPP?

Please indicate, which of the following is most applicable by ticking one box only.

Trading As

Occupation

Employers Name

Employer Contact Number

Employers Address

Please specify from the following

Other - Please give us more details

Have you registered for protection against the Lifetime Allowance?

Please indicate which protection applies:

Protection Certificate

How will you fund your SIPP product

Full name of transferring provider

Address of transferring provider

Name of Contact

Telephone number of contact

PSTR Number

Transferring Scheme Policy Number

Approximate fund value to be paid to @sipp

Does this represent the full value of the transferring plan?

a) Is this transfer subject to any existing or proposed trustee in bankruptcy order, or earmarking or pension sharing orders, or other receiving orders?

Please provide further details

b) Is this transfer part of a block transfer?

c) Is this transfer from an occupational pension scheme, or from an individual contract, with guaranteed benefits?

I declare:

d) For the purposes of enabling you to access your pension savings?

e) Is this transfer an in specie transfer?

Assets To Be Transferred

* A Property Questionnaire and a current valuation is required for each property to be transferred.

Please provide an up to date list of holdings from the current administrator. Where @sipp cannot accept any of the assets they would need to be sold before transfer could proceed.

Any cash fund transferred will be deposited in the member’s SIPP bank account until instructions are received by @sipp to invest in other asset classes or deposit accounts

Assets to be transferred

Transferring Pension Scheme

Are the funds being transferred

Crystallised

Uncrystallised

Transfer Details (2)

Transfer Details (3)

Transfer Details (4)

Are you subject to the money purchase annual allowance rules?

Will you be making

Single - Net Amount (of Basic Rate)

Regular - Net Amount (of Basic Rate)

Standing Order frequency for regular contributions

For regular contributions we will provide our bank details and reference once this SIPP has been set up.

Start date for regular contributions

Name of person completing the Employer Contribution form

Email address of person completing the Employer Contribution form

Single Gross Employer Amount

Regular Gross Employer Amount

Standing Order frequency for regular contributions

Start date for regular contributions

Do you give authority for @sipp to correspond directly with your Employer?

Employer Declaration

• We confirm our intentions that payments, other than those that are indicated as single contributions, shall continue to be made on the basis indicated above until further notice. If there are any amendments to payments we agree to inform @sipp before the payment date upon which the change will take place

• Where we have a direct payment arrangement to pay pension contributions either on our own account or where deducted from the employee’s pay, we acknowledge that the due date for contributions is the 19th of the month following that due date. We acknowledge that should @sipp receive a contribution after the due date (19th), a report may be issued to the Pensions Regulator

• We understand and agree that we will report all employer contributions in accordance with regulatory requirements

• We declare that the Applicant is employed by us and we have seen and understood their Application in respect of contributions to be made by deduction from pay.

Please provide details of your proposed SIPP investments.

A Permitted Investments list is available at www.atsipp.co.uk

Please provide details of proposed investment(s)

Please enclose the relevant investment application forms and completed Property Questionnaire, as applicable. Our Property Questionnaire can be found here

Have you completed your investment application already? If so, please attach it below.

Beneficiary Details

Percentages must add up to 100%, if split between multiple beneficiaries

Backup Beneficiary Details

Percentages must add up to 100%, if split between multiple beneficiaries

Adviser's Name

FCA Number

Company Name

Address

Telephone Number

Email

Do you authorise your financial adviser to give investment decisions on your behalf?

Is your Financial Adviser to be paid a fee from your designated bank account?

For Transfers In

Initial Fee Amount

Initial Fee % of Initial Investment

Ongoing Fee Amount

Ongoing Fee % of Fund at Anniversary Date

Pay Arrangement

Where an annual fee is being paid, it will continue to be paid at review date.

Ongoing fees will be paid on the 10th of the month. Please allow three days for the payment to reach your account.

I can confirm that the fee is to be paid from funds in my designated SIPP bank account and that I ensure that cleared funds are available to pay the fee when due for payment. I understand that @sipp may make an additional administration charge if it has to refer to me for instructions on how to obtain funds to meet the payment of fees.

For Contributions

Initial Fee Amount

Initial Fee % of Initial Investment

Ongoing Fee Amount

Ongoing Fee % of Fund at Anniversary Date

Pay Arrangement

Where an annual fee is being paid, it will continue to be paid at review date.

Ongoing fees will be paid on the 10th of the month. Please allow three days for the payment to reach your account.

Please note if you are paying a percentage of initial investment to your Financial Adviser this will be calculated on gross contribution amounts, where applicable.

Part G: Applicant's Declaration

General

I acknowledge and accept and agree to be bound by the applicable Terms & Conditions, Fee Schedule and Permitted Investments Schedule applying to the @sipp SIPP product I have chosen.
I agree to be bound by the trust deed and rules of the scheme which may be amended from time to time.
To the best of my knowledge and belief, the particulars given on the application form are correct and complete.
I wish to nominate the named person(s)in Part E “Expression of Wish – Disposal of Death Benefits” to be considered to receive any benefit payment payable under the scheme on my death. I accept that this Expression of Wish is not a binding contract but allows @sipp to consider to whom the death benefits should be paid.
I hereby consent to @sipp obtaining relevant details from the administrator/trustees or insurance company or other registered pension scheme provider, arrangement or contract of which I am or have been a member and authorise the giving of any such details to @sipp.
I understand that any transfer(s) made into my scheme may only be applied to provide benefits at the time I take retirement benefits or on my death.
I will not require, nor attempt to require, the withdrawal of funds held to provide benefits for me under the scheme, or the income on those funds, other than in accordance with the rules of the Scheme.
If appropriate @sipp has my authority to check with HM Revenue & Customs the detail of any certificate which I supply which enhances my lifetime allowance or lump sum entitlement.
I acknowledge and accept the terms of this Agreement and I understand that the services provided under it do not extend to financial advice under the terms of the Financial Services and Markets Act 2000.

Contributions Declaration

I declare I am under the age of 75
I declare that the total contributions to any registered pension schemes in respect of which I am entitled to relief under section 188 of the Finance Act 2004 will not exceed the higher of:
- The basic amount, or
- My UK relevant earnings within the meaning of section 189 of the Finance Act 2004 in any tax year.
I declare, where my total gross contributions exceed the Annual Allowance in the current tax year, that I have sufficient unused annual allowances to carry forward from the three previous tax years
I declare that:
- in relation to
  - the particulars specified in Part A are to the best of my knowledge and belief, correct and complete; and
  - the second bulleted contributions declaration above is to the best of my knowledge and belief, correct
- no later than either the date which is 30 days after the occurrence of the event or 5th April in the tax year of assessment, I will give notice to you if an event occurs, as a result of which I am no longer entitled to tax relief for contributions pursuant to section 188 of the Finance Act 2004.
I undertake to inform the Scheme Administrator in writing (within 30 days) if:
- I cease to be a UK resident
- There is any change in my name or permanent residential status or employment status
- I contribute on aggregate more than 100% of my earnings to this and any other pension scheme in any tax year
- I cease to have UK relevant earnings
- I intend making contributions that are not to benefit from tax relief, for example ‘excess’ contributions.
I understand that by signing this application form I am declaring that I am aware of my annual allowance (including any carry forward) and request that @sipp reclaims tax on my contributions unless I instruct otherwise.
The information on this application is used in dealings with HM Revenue & Customs for tax relief purposes. It is a serious offence to make false statements with penalties being severe. False statements could lead to prosecution.

If you have applied for protection against the lifetime allowance, making a contribution could invalidate this protection

Transfer Declaration

1. Request to Transfer

• I authorise, instruct and apply to the current provider to transfer sums and assets from the plan(s) as listed in this application directly to @sipp and to provide any instructions and/or discharge required by any relevant third party to do so.

• I authorise @sipp, the current provider, any contributing employer and any financial adviser named in this application to obtain from each other, and release to each other any information that may be required to enable the transfer of sums and assets to @sipp.

• Until this application is accepted and complete, @sipp’s responsibility is limited to the return of the total payment(s) to the current provider(s).

• Where the payment is made to @sipp as instructed, this means that I shall no longer be entitled to receive pension benefits from the whole of the plan(s) listed in this application where the whole of the plan(s) is transferring, or that part of the plan(s) represented by payment if only part of the plan(s) is transferring.

• I have read any information provided or made available to me by the current provider in connection with this transfer.

• I accept responsibility in respect of any claims, losses, expenses, additional tax charges or any penalties that @sipp and the current provider may incur as a result of any incorrect, untrue, or misleading information in this application or given by me, or on my behalf, or of any failure on my part to comply with any aspect of this application.

2. Transfer into the Scheme

I request that @sipp accepts the transfer of the funds from the current provider detailed listed in this application.

I hereby request that @sipp apply such transfer payment so to not constitute a separate arrangement for the purposes of Part 4 of the Finance Act 2004, where possible, unless I and @sipp expressly agree otherwise.

3. Cancellation Rights

• I acknowledge under current rules I have the right to cancel my transfer within 30 calendar days of @sipp accepting my transfer request.

• I acknowledge that on receipt of the transfer of funds @sipp will invest these according to my instructions.

• I acknowledge and accept I might not get back the amount originally invested, if I exercise my right to cancel the transfer.

• I acknowledge and accept the amount I will receive will be the realisation value of the investment less any applicable charges.

Data Protection

The information you provide to @sipp on this application form and during the course of your @sipp membership will be held by @sipp as data controllers in accordance with all relevant data protection legislation and our Privacy Information Notice, a copy of which can be obtained from our website.

I confirm that:
- I have read and understood @sipp’s Privacy Information Notice.
- I consent to @sipp (and any data processor or other data controllers they may use) processing data relating to me as set out in the Privacy Information Notice. I also consent to such data being transferred to third parties in connection with the administration and operation of the SIPP as set out in the Privacy Information Notice.
- Where I provide @sipp with information about another person, that they have appointed me to act for them, that they consent to the processing of their personal information and I have informed them of @sipp’s contact details and the purposes for which their personal information will be processed and the disclosures that may be made (both of which are set out in the Privacy Information Notice).
Cancellation Rights
- I acknowledge under current rules I have the right to cancel my SIPP application within 30 days of receiving my SIPP cancellation notice
- I acknowledge that on receipt of any funds @sipp will invest these and pay any adviser charges to my financial adviser according to my instructions
- I acknowledge and accept that I might not get back the amount originally invested, if I exercise my right to cancel my SIPP application
- I acknowledge and accept that once the SIPP is established the SIPP set up fee is due and will not be refunded, and that @sipp will not reclaim any fees already paid to your financial adviser
- I acknowledge and accept that the amount I will receive will be the realisation value of the investment(s) less any applicable charges
Financial Adviser Fees
- I authorise and instruct @sipp to pay to my Financial Adviser the initial and/or regular fee(s) specified in Part F of this application
- I understand that any adviser charge will be paid from funds held in my designated bank account
- I confirm that any adviser charges are genuinely commercial arrangements between myself and my adviser and only relates to pension advice and services provided
- I understand that I can cancel or vary my instructions to pay fees by giving @sipp 14 days notice in writing. However, I agree that any fees due but not paid, prior to the date of receipt of the notice of cancellation or variation will be paid by the @sipp.
Throughout this application, references to "@sipp"/"we"/"us"/"our" refer to @sipp Limited in their capacity as scheme administrator and operator of the @sipp SIPP scheme.

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Timestamp

Audit

September 20, 2023 12:04 pm GMT

@sipp Form - Financial Advisors Uploaded by @sipp form - enquiries@atsipp.co.uk IP 81.104.157.112

November 2, 2023 9:14 am GMT