West Sussex Pension Fund administered by Hampshire Pension Services

LOCAL GOVERNMENT PENSION SCHEME (LGPS) ADDITIONAL VOLUNTARY CONTRIBUTIONS (AVCs) - STANDARD LIFE

You must ensure that you have read and understand the relevant fund information.

I authorise my employer to make regular monthly deductions from my pay with effect from ______[Next salary payment], in respect of Standard Life AVCs as follows: -

Fund Name Code Contribution1 £ per month or % of pay

Standard Life Managed Fund FA

Standard Life Pension 2 With Profits 2 2006 WN Fund 2

Standard Life Money Market Pension Fund3 GS

Standard Life Deposit and Treasury G4 Pension Fund Pension 2 Fund Investment Strategy – 2OPP Opportunity Pension 2 Fund Investment Strategy – 2BAL Balanced Pension 2 Fund Investment Strategy – 2CAU Cautious Note on Pension 2 Investment Strategy • You are only able to invest in one of the Pension 2 Fund Investment Strategy Funds. • If you wish to invest in a Pension 2 Fund Investment Strategy Funds but do not wish to invest the full 100% of your contribution in that fund, the only other fund available to you is the ‘Standard Life Pension 2 With Profits 2 Fund’ (W8).

Signed:

Date

1 Contributions must not exceed 100% of your pensionable pay after allowing for Income Tax, National Insurance and any other deductions. 2 If your plan started before 10 July 2006 you can invest in the Standard Life Pension 2 With Profits 2 Fund (W8). Otherwise you can invest in the Standard Life Pension 2 With Profits 2 2006 Fund 3 Previously Standard Life Sterling Fund.

Name

National Insurance No.

Date of Birth

Employer

Pay Reference

Please send completed form to: Hampshire Pension Services, The Castle, Winchester, SO23 8UB

West Sussex County Council is the Data Controller for the purposes of the Data Protection Act 1998. This means that the County Council is responsible for making decisions about how your personal data will be processed and how it may be used. The purpose(s) for which your data will be processed is/are to administer the West Sussex Pension Fund, to include information sent to the Actuary and other relevant professionals for Pension Fund Valuation purposes, to enable the carrying out of detailed mortality analysis on members of the Fund, and to assist with predicting future liability of the Fund. Research deriving from such analysis may be used by the Actuary to sell products and services to other customers. In addition, the County Council is under a duty to protect the public funds it administers, and to this end may use your information for the prevention and detection of fraud. It may also share this information with other bodies responsible for auditing or administering public funds for these purposes. For further information see www.westsussex.gov.uk/nfi. The information you provide at any time will be treated confidentially at all times. Security safeguards apply to both manual and computerised held data, and only relevant staff/named disclosures can access your information. If you have any queries, contact the Data Protection Officer tel: 01243 777955.