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The Trinity Mirror Pension Plan Application Form

Please complete this form using CAPITAL LETTERS and return it to the Pensions Office, One Canada Square, Canary Wharf, London, E14 5AP. If we do not receive your application in time to meet this month’s or week’s payroll deadline, your first contribution will be deducted from next month’s or week’s salary. SECTION 1: About you Title (Mr, Mrs, Miss etc): First name(s): Surname: Address: Postcode: Date of birth:

Contact number:

National Insurance number: Employer:

Date of employment:

Office location:

Email address:*

*For alternative contact purposes only – optional. SECTION 2: Your contributions Please note, the minimum contribution you can pay to join the plan is 4% of your pensionable salary*. I wish to pay regular contributions of (please tick one box): 4% of my pensionable salary 5% of my pensionable salary 6% of my pensionable salary 7% of my pensionable salary * Your pensionable salary is your basic salary at the previous 1 July, the date you started employment with the company, or the date you joined the plan if later. It does not include overtime, bonuses, commission, car allowances, benefits in kind, fixed expense payments, housing allowances and other fluctuating earnings. SECTION 3: Your investment choice You should complete this section to tell us how you would like to invest your contributions and the contributions that the company pays on your behalf. You should select EITHER 3A (choosing your own funds) or 3B (lifestyle strategy). If you do not complete this section you will have been deemed by the trustee to have chosen to have your contributions invested in the lifestyle strategy (3B). Please note, you cannot split your contributions between 3A (choosing your own funds) and 3B (lifestyle strategy). PLEASE TURN OVER


3A. Choosing your own funds If you wish to invest in your own choice of funds, please tick the box below then indicate your choice of fund or funds from the list below. I wish to invest in my own choice of funds (tick box) I wish to invest my contributions and the company's contributions in the following funds: Fund name

Percentage (%)

Fidelity BGI Global Equity 50/50 Fund Fidelity Artemis UK Special Situations Fund Fidelity Newton International Growth Fund Fidelity F&C Stewardship Fund Fidelity HSBC Life Amanah Fund Fidelity Index-Linked Bond Pensions Fund Fidelity Cash Pensions Fund Please note that the value of investments may go down as well as up and you may not get back the amount invested. If the fund you choose invests in overseas markets, changes in rates of exchange between currencies may cause the value of your investment to fall. Investments in small and emerging markets can be more volatile and liquidity may be lower than other overseas markets. Due to the greater possibility of default, an investment in corporate bonds is generally less secure than an investment in government bonds. 3B. Lifestyle strategy If you choose the Lifestyle strategy, it will apply to your own contributions, the company’s contributions and any AVCs you make. Unless you specify otherwise, the Lifestyle strategy will be based on the normal retirement age of 65. If you would like to select a different retirement age, please enter your selected retirement age in the box below. The minimum age you can select is currently 50 (but this will increase to 55 on 6 April 2010). Please note, you will need the company’s consent to retire earlier than 65. I would like to invest in the Lifestyle strategy (tick box) My selected retirement age is (enter age) SECTION 4: Your declaration •

I authorise the company to deduct the above contributions from my salary.

I understand that if I have not completed either section 3A or 3B above, the trustee will deem me to have elected that my contributions and company's contributions be invested in accordance with the lifestyle strategy.

I consent to the the company and the trustee (as data controller for the purposes of the Data Protection Act 1998) holding and processing the information contained in this form, some of which may be sensitive personal data, for the purposes of the proper running of the plan. I understand that the trustee and the company will treat all information on this form as confidential and will comply with their obligations under the Data Protection Act 1998. Your signature:

Date:

TO BE COMPLETED BY THE PENSIONS OFFICE Employee's payroll number: Employee's pensionable salary: Medical forms required:

Start date for contributions: Yes/No

Date issued:

Initials:

Payroll and HR notified:

Date:

Initials:

A copy of this form sent to Fidelity:

Date:

Initials:

FIL Limited, established in Bermuda, and its subsidiaries are commonly referred to as Fidelity International. Fidelity, Fidelity International and the Pyramid Logo are trademarks of FIL Limited. Fidelity only gives information about its own products and services and does not provide investment advice based on individual circumstances. If you would like advice, please contact a Financial Adviser. For your protection and to provide additional security, all calls to the Pensions Service Centre are recorded and possibly monitored. Past performance is not a reliable indicator of future results. Issued and approved by FIL Life Insurance Limited (FSA registered number 186526). Authorised and regulated by the Financial Services Authority. Registered in England and Wales No. 3406905. Registered Office at: Oakhill House, 130 Tonbridge Road, Hildenborough, Kent, England TN11 9DZ. July 2008. MDC02419. IMC806/25951.

Sample  

Pension Form to see if this works

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