SSAS Member Information Form

July 2016

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SSAS Member Information Form

Barnett Waddingham LLP is the UK’s largest independent firm of actuaries, administrators and consultants. We have a team of over 30 SSAS specialists spread over 5 offices: Amersham, Cheltenham, Glasgow, Leeds and Liverpool. We have over 25 years involvement in the self-invested pensions market and manage one of the largest portfolios of SSASs in the UK. We offer a comprehensive range of services to our SSAS clients, providing: • Professional trustee to act with the individual trustees • Management of the day-to-day administration • Dedicated point of contact • Dealing with the set up of retirement and death benefits • Registration of the SSAS with HM Revenue and Customs (HMRC) • On-going monitoring of HMRC regulations

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SSAS Member Information Form

Section 1: Your personal details (please us block capitals) Title (Dr/Mr/Mrs/Miss/Ms/Other) Surname Forename(s) Date of birth Male

Sex

Female

National Insurance number Address same as following member/trustee Permanent address

Postcode Email address It is our usual practice to password protect email attachments containing personal data such as bank account details. If you would like us to use a particular, password please state it here:

Daytime telephone number Mobile telephone number Marital status (Single/Married/Separated/Divorced/Widowed/Civil Partner) Spouse’s/Partner’s name Spouse’s/Partner’s date of birth Do you hold a certificate of protection? (if yes, please enclose a copy)

Yes

No

Note: You will have a certificate of protection if you had pension rights in force as at 5 April 2006 and applied for Enhanced Protection or Primary Protection, or if you obtained Fixed Protection from 6 April 2012 or 6 April 2014.

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SSAS Member Information Form

Section 2: Other benefits Please complete details of your other pension benefits that are not being transferred to the SSAS

Name of Scheme Employer (if applicable) Provider/Insurer Policy number/Reference number Type of arrangement Benefits being taken (if any - Annuity/Income Drawdown/Flexible Drawdown/Scheme Pension)

Section 3: Declaration • I declare that the information provided in this application form, and any other documents completed in connection with this application, are to the best of my knowledge and belief, correct and complete. • I authorise Barnett Waddingham LLP to verify my identity by checking the details I have provided against those held on databases with a credit reference agency (i.e. information from the Electoral Register and fraud prevention agencies). I understand that: • My information may be passed to organisations involved in fraud prevention • If I supply false or inaccurate information and Barnett Waddingham suspect fraud, Barnett Waddingham may record this and share this information with other organisations • We may process any information obtained from you in relation to the provision of services. All copies of information held by Barnett Waddingham shall be retained and processed in accordance with the provisions of the Data Protection Act 1998 and any subsequent applicable legislation. Signed

Print name

Date

Do not forget to enclose the following original documents or certified copies: Current Driving licence (with photo) or Passport

Your marriage certificate

Enhanced Protection/Primary Protection/Fixed Protection Certificate (if applicable) Current utility bill (NOT a mobile phone bill) confirming address dated within the past 3 months or HMRC tax notification or Driving License (no photo) Benefit Crystallisation Event Statement (if you are drawing benefits from any other pension arrangements)

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For further information on our SSAS services please contact: Leeds 0113 394 3700 [email protected] Amersham 01494 788100 [email protected] Cheltenham 01242 538500 [email protected] Liverpool

Glasgow

0151 235 6600 [email protected] Glasgow 0141 243 4400 [email protected]

Barnett Waddingham LLP is the UK’s largest independent firm of actuaries, administrators and consultants with seven offices throughout the UK.

Liverpool

Leeds

Bromsgrove Cheltenham Amersham

We were founded in 1989 and offer a full range of services to trustees, employers, insurance companies and individuals.

London

www.barnett-waddingham.co.uk/ssas July 2016 Barnett Waddingham LLP is a body corporate with members to whom we refer as “partners”. A list of members can be inspected at the registered office. Barnett Waddingham LLP (OC307678), BW SIPP LLP (OC322417), and Barnett Waddingham Actuaries and Consultants Limited (06498431) are registered in England and Wales with their registered office at Cheapside House, 138 Cheapside, London EC2V 6BW. Barnett Waddingham LLP is authorised and regulated by the Financial Conduct Authority and is licensed by the Institute and Faculty of Actuaries for a range of investment business activities. BW SIPP LLP is authorised and regulated by the Financial Conduct Authority. Barnett Waddingham Actuaries and Consultants Limited is licensed by the Institute and Faculty of Actuaries in respect of a range of investment business activities.

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