This form should be completed in block capitals by the ...
|AUCO |
AUC Offshore Retirement Investment Plan - Leavers/Retirement form
This form should be completed in block capitals by the company Human Resources Department in conjunction with the member. When complete [Please fax the form to Fidelity on: +44 1737 837 751.] or [Please email to Fidelity at: dcadministration@]
| |
|Section A – Participant details |
|This section should be completed in block capitals by local company representative. |
| | |
|Full Name: | |
|(As shown on passport. Please do | |
|not use initials or abbreviations.| |
|This MUST include ALL names.) | |
| | | | |
|Title: | |Employee/Payroll | |
|Mr/Ms/Mrs/Miss | |Number: | |
| | | | |
| | |
|Correspondence address: | |
|(please note a ‘care of’ or | |
|employer address is not | |
|acceptable) | |
| |N/A | | |
|Postcode/Zip code: | |Date of leaving/retirement: | |
| | |Delete as applicable | |
| | |DD/MM/YYYY | |
| | | | |
|Date of last contribution: | |Is the member vested: | |
|DD/MM/YYYY | | |Yes No |
| |
|Section B – Leaving employment |
|This section should be completed by the Employer of the member leaving the company. |
| |
|Please mark relevant box: |
| |
|I instruct Fidelity to leave the value of the member’s account invested within the plan. |
|Please sign below |
| |
|I instruct Fidelity to disinvest the value of the member’s account and make payment to [the member’s/my] bank account. |
|Please sign below and complete Sections D. |
| |
| | |
|[Member/Employer/Trustee] signature: | |
| |
|Section C – Retirement |
|This section should be completed if the member is approaching their selected retirement age. |
|Please note that the value of the members account will be paid in full. (Please also complete section D). |
|I confirm that I am retiring and request that Fidelity (on the instruction from the company in Section E below) disinvest my account and pay benefits in full.|
| | | | |
|Signature: | |Date: | |
|To be signed by member | |DD/MM/YYYY | |
| |
|Section D – Member bank account details |
|The Member should complete this section in block capitals. Please note that if the member wishes to retain the value of their account with Fidelity then this |
|section should not be completed. |
|Please note that all funds will be paid in the plan’s currency. |
| | |
|Full name of account holder: | |
|(As shown on passport. Please do not use | |
|initials or abbreviations. This MUST include ALL| |
|names.) | |
| | | | |
|Account holder’s full telephone number | |Account holder’s date of birth | |
|including any dialling codes required | | | |
| | | | |
|Account holder’s full residential address | |Account holder’s email address | |
|Including postcode or zip code. Please note a | | | |
|‘care of’ or employer address is not | | | |
|acceptable. | | | |
| | | | |
|Nationality | |Passport number: | |
| | | | |
|Passport place of issue: | |Passport expiry date | |
| | |
|Bank/ building society name: | |
| | |
| | |
| | |
|Bank/ building society full address: | |
|Including postcode or zip code | |
| | | | |
|Bank account number/Building Society account | |Branch Sort Code/ Routing | |
|number: | |number/Building Society number: | |
| | | | |
| | | | |
| | | |
|Swift number: | |Example of a SWIFT Code: |
|For international transfers to banks outside of| |APNYUS33 XXX |
|the UK a SWIFT code my be provided | | |
| | | | |
|Member signature: | |Date: | |
|I confirm that the above details are correct | |DD/MM/YYYY | |
| | | | |
| | | | |
| |
|Section E – Company/Trustee declaration |
|This section should be completed by company representative. |
| |
|Please mark relevant box: |
| |
|I instruct Fidelity to disinvest the member’s account and to make the payment to the member’s bank account. |
| |
|I confirm that the member has left the plan. I instruct Fidelity to leave the value of the member’s account invested within the plan. |
| | | | |
|Signature: | |Date: | |
|Authorised signatory on behalf | |DD/MM/YYYY | |
|of the company | | | |
| | | | |
|Signature: | |Date: | |
|Authorised signatory on behalf | |DD/MM/YYYY | |
|of the company | | | |
Issued and approved by FIL Pensions Management (FSA registered number 144345). Authorised and regulated by the Financial Services Authority. Registered in England and Wales No.2015142. Registered offices at: Oakhill House, 130 Tonbridge Road, Hildenborough, Kent, England TN11 9DZ. Fidelity, Fidelity Worldwide Investment, the Fidelity Worldwide Investment logo and F symbol are trademarks of FIL Limited. April 2012. CI3231
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