*SFSSP0100F*
SMALL PENSION FUND
LUMP SUM PAYMENT REQUEST
for use with the Old Mutual Wealth Personal Pension
or Buyout Bond (BB6)
Form purpose
If the value of your pension fund is small it may be possible to receive it as a cash lump sum.
This form can be used to request the payment of your pension fund as a lump sum. Please refer to Important Information below for more details.
Important notes for completion
• Please use BLOCK CAPITALS only and blue or black ink.
• Please ensure all applicable sections of the form are completed, as missing information will result in a delay in processing or the return of this form.
• This form must be signed and sent to the following address:
Old Mutual Wealth, Old Mutual House, Portland Terrace, Southampton SO14 7AY
Important Information
• To take benefits under the small pension fund lump sum rules, you must have reached age 60.
• The lump sum must not exceed £10,000. Its payment extinguishes all entitlement to benefits under the arrangement.
• You must not have received more than two payments of this type previously.
• The lump sum, except for 25% of any uncrystallised funds, is liable for income tax, which we will deduct and pay to HM Revenue & Customs
(HMRC). Depending on your income from other sources 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. You should discuss the impact of this payment with your financial adviser
or local tax office.
• The lump sum payment will be the value of your pension arrangement on the working day following receipt of this form.
• Prior to making payment, where the policy is made up of multiple arrangements, we may merge arrangements to ensure payment can be made in
accordance with the small pension fund lump sum legislation.
• If a BB6 policy holds an element of protected tax-free lump sum cash, we will be unable to proceed with your request.
It may be necessary in some cases for us to split your pension arrangements in order to meet the necessary criteria to allow us to make a small
pension fund lump sum payment. If you have Enhanced Protection or Fixed Protection 2012 or 2014, the creation of a new arrangement could
jeopardise these protections. Please consult your financial adviser if any of these forms of protection apply to you.
1 PLAN HOLDER DETAILS
Title (3)
Mr
Mrs
Miss
Other
Surname
Full forename(s)
Address
Postcode
Date of birth
(dd/mm/yyyy)
National insurance
number
Pension plan number
Evidence of age – please provide one of the following (or a copy certified by a professional person):
• your photocard driving licence
• your passport
(Your driving licence or passport must be valid and must not have expired.)
• your birth certificate
(If your name is currently different from your birth certificate, we will require evidence of the change of name – for example your marriage certificate or a change of
name deed.)
• a Confirmation of Verification of Identity (CoVI) from your financial adviser.
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2 BANK/BUILDING SOCIETY
Please confirm bank/building society details (payment will be made via BACS)
Name of account
holder
Bank/building society
name
Branch address of bank/
building society
(This must be a UK bank/
building society account.)
Postcode
Account number
Sort code
–
–
Building society
roll number
(If applicable.)
NOTE: B
efore we can make payment, we need to see proof of the bank account ownership. The proof can be a voided cheque
or a copy of your bank account statement (certified as a true copy by your financial adviser). If you have online bank account statements, a
printed copy certified by your adviser will suffice.
3 DECLARATION
• I confirm that I wish to take a lump sum payment from this pension policy.
• I confirm that the information supplied by me is true to the best of my knowledge. I understand that any false statement may result in HMRC taking
legal action against me.
• I declare that the lump sum payment will extinguish the entitlement to benefits under the pension arrangement, and that no more than two payments
of this type from any registered pension scheme have previously been received by me.
• I declare that payment by Old Mutual Wealth Life Assurance Limited of the lump sum under the pension arrangement shall constitute a full
discharge from all liabilities and claims arising.
• I understand that the lump sum payment cannot exceed £10,000 for each arrangement.
• I understand that Old Mutual Wealth Life Assurance Limited will deduct income tax from the lump sum under PAYE procedures except for 25% of
uncrystallised money.
• I understand that I am obliged to contact HMRC to claim a repayment of income tax for which I was not liable or to account for any further income
tax that may be due.
Applicant’s signature
Date
(dd/mm/yyyy)
www.oldmutualwealth.co.uk
Calls may be monitored and recorded for training purposes and to avoid misunderstandings.
Old Mutual Wealth Life Assurance Limited is registered in England & Wales under number 1363932. Registered Office at Old Mutual House,
Portland Terrace, Southampton SO14 7EJ, United Kingdom. Authorised by the Prudential Regulation Authority and regulated by the Financial
Conduct Authority and the Prudential Regulation Authority. Financial Services register number 110462. VAT number 386 1301 59.
PDF8284/214-1349/November 2014
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