Annuity Quotation Request Form

Name in Full:
Address:
Postcode:
Telephone number:
E-mail address:

1st Life

Date of Birth:	/ /
Smoker:	Yes No
Do you have any pre-existing medical conditions?	Yes No
If yes, brief details:
Current Occupation:
Previous Occupation:

Partner / Spouse

Please complete this section only if the annuity is to be passed to the survivor on the death of the first life.

Date of Birth:	/ /
Smoker:	Yes No
Do you have any pre-existing medical conditions?	Yes No
If yes, brief details:
Current Occupation:
Previous Occupation:

Pension Fund Value:	£
Percentage to be taken as tax free cash (maximum 25%):
Annuity to be paid:	Monthly Annually In Advance In Arrears
Is a partners/spouse annuity required?	Yes No
If yes, at what level (e.g. 50%):
Is a guaranteed period required*?	Yes No
If yes, for how long?	5 years 10 years
Is Value Protection required**?	Yes No
Are annual increase required:	Yes No
If yes, at what rate?	3% 5% RPI (inflation rate)

* A guarantee means that if you die within a chosen period (5 or 10 years) your estate will receive a sum equivalent to the remaining annuity payments. For example, if you choose a 5 year guarantee and die after 1 year, your estate will receive the remaining 4 years' payments. However, a guaranteed annuity provides a lower annual return than a non-guaranteed annuity.

** Value Protection is where the balance of the annuity fund can be returned to the Estate if death occurs before age 75 less a 35% tax charge (e.g. £100,000 fund, £50,000 income taken, balance less 35% tax charge repaid (£32,500)).