your pension’s an important financial asset it only takes five minutes to fill the form which could yield a lifetime of benefits In order for us to deliver a robust report regarding the merits of transferring your existing pension benefits to New Zealand, it is essential that we obtain accurate information. Please complete the following as comprehensively as you can. If you omit any sections our advice will be based only on the information provided. The scope of our advice is limited to the review of your existing pension(s). It is not intended to provide you with a comprehensive financial planning review. PART 1: About You Title: First Name: Email: Middle names: Last Name: Phone: Date of birth (dd/mm/yyyy): Mobile: Address: Country of Residence: New ZealandAustraliaBelgiumCanadaCyprusFranceHong KongIrelandJapanNetherlandsNew ZealandSingaporeSpainUnited Arab EmiratesUnited KingdomUnited StatesOther Date arrived in New Zealand (dd/mm/yyyy): * Note please enter the first day of the month when only the month is known IRD Number: National Insurance Number: What are you future plans in terms of living in the UK: –None–I plan to return to the UK to liveI do not intend to return to the UK to live Date left the UK (dd/mm/yyyy): * Note please enter the first day of the month when only the month is known Check if you have registered with the HMRC as a non-resident through form P85: Previous UK Address: Marital Status: –None–SingleMarriedDivorcedCivil union/Co-habitationWidow/er Partners date of birth: State of health: –None–ExcellentGoodAveragePoorVery poor Please note that we require the addresses of your UK pension provider as many providers have multiple addresses and different policy numbers are linked to different addresses (this has occurred as mergers between UK pension providers have seen them retain operations all throughout the UK.) PART 2: Existing Pension Arrangements SCHEME 1: Scheme – Provider: Policy or Reference No: Current value GBP (if known): Details of any benefits taken: UK Scheme Address: SCHEME 2: Scheme – Provider: Policy or Reference No: Current value GBP (if known): Details of any benefits taken: UK Scheme Address: SCHEME 3: Scheme – Provider: Policy or Reference No: Current value GBP (if known): Details of any benefits taken: UK Scheme Address: SCHEME 4: Scheme – Provider: Policy or Reference No: Current value GBP (if known): Details of any benefits taken: UK Scheme Address: PART 3 – Data Protection By submitting this document you consent to us or any company associated with us, processing, both manually and by electronic means, your personal data for the purposes of providing advice, administration and management. “Processing” includes obtaining, recording, carrying out operations, or holding information or data, transferring it to other companies associated with us, product providers, any statutory, governmental or regulatory body for legitimate purposes including, where relevant, to solicitors and debt collection agencies. If at any time you wish us or any company associated with us to cease processing your personal data or sensitive personal data, or contacting you, please contact The Data Protection Officer at email@example.com. You may be assured that we and any company associated with us will treat all personal data and sensitive personal data as confidential and will not process it other than for a legitimate purpose. PART 4 – Client Declaration for your free QROPS assessment Please read this section carefully before pressing the submit button below. I confirm that the information I have provided is, to the best of my knowledge correct. I have provided this information understanding that it is used to form the basis of any advice and recommendations made to me and that I am not under any obligation to take up any recommendation made. I further declare that if I do not want to disclose certain personal/financial information I am aware that this may prevent an Adviser from being able to identify areas where it might have been appropriate to make recommendations, or could have an effect on the recommendations that have been made. NB: Please understand that we reserve the right to decline to give advice if full information is not provided.