1. Name, address, date of birth, date of death (if applicable) and national insurance number of the specified individual. | 1. Name and tax reference number of each relevant pension scheme under which an arrangement is held, in respect of which there has been a change in the value of the individual’s rights during a pension input period ending in a relevant tax year. | 1. Name and tax reference number of each pension scheme under which an arrangement is held, in respect of which a benefit crystallisation event occurred within a relevant tax year. | 1. Name and tax reference number of each pension scheme from which an unauthorised member payment was made in a relevant tax year. |
2. Whether a third party is providing specified information on behalf of a specified individual and, if so—
(a) the name, address, date of birth and national insurance number (if any) of the third party; and
(b) whether the third party is named under
(i) a lasting, continuing or enduring power of attorney, or
(ii) a deputyship or controllership order, in relation to the specified individual.
| 2. Amount of any liability to the annual allowance charge for that tax year, arising otherwise than by the operation of a relevant rectification provision or regulation 14 of the 2023 Regulations (local government new schemes: final salary uplifts ignored in calculating pension input amount). | 2. Amount of any liability to the lifetime allowance charge for that tax year, arising otherwise than by the operation of a relevant rectification provision. | 2. Amount of any liability to the unauthorised payments charge or surcharge for that tax year, arising otherwise than by the operation of a relevant rectification provision. |
3. Whether an assessable representative is providing specified information on behalf of a specified individual who is a deceased member and, if so, the name, address, date of birth and national insurance number (if any) of the representative. | 3. Amount paid of the liability to the charge specified in item 2, and whether it was paid by the individual, or by the scheme administrator on behalf of the individual. | 3. Amount paid of the liability to the charge specified in item 2, and whether it was paid by the individual, or by the scheme administrator on behalf of the individual. | 3. Amount paid of the liability to the charges specified in item 2. |
4.
(a) Declaration that the specified information is provided by, or in respect of, a specified individual;
(b) declaration as to the accuracy of the specified information; and
(c) declaration that the specified individual, or other person who is providing the information, understands the consequences of providing false information.
| 4. Amount of any liability to the annual allowance charge for that tax year, arising as a result of the operation of a relevant rectification provision or regulation 14 of the 2023 Regulations. | 4. Amount of any liability to the lifetime allowance charge for that tax year, arising as a result of the operation of a relevant rectification provision. | 4. Amount of the unauthorised member payment in relation to which the liability to the charge specified in item 2 arose. |
| 5. Details of—
(a) any scheme pays notice() given to a scheme administrator, or
(b) request made to a scheme administrator to pay an amount(), relating to liability to a charge specified in item 2 or 4.
| 5. Whether the individual or the scheme administrator will be paying the liability to the charge specified in item 4. | 5. Amount of any liability to the unauthorised payments charge or the unauthorised payments surcharge, as the case may be, for that tax year, arising as a result of the operation of a relevant rectification provision. |
| | 6. Where a different scheme administrator to that specified in item 1 will be paying the liability to the charge specified in item 4, the name and pension scheme tax reference of that scheme. | 6. Amount of the unauthorised member payment in relation to which the liability to the charge specified in item 5 arose. |
| | 7. Date of any benefit crystallisation event
(a) occurring on or after 1 April 2015, and
(b) in respect of which an amount subject to the lifetime allowance charge may have changed as a result of the operation of a relevant rectification provision.
| 7. In cases where an individual has repaid a lump sum in excess of the permitted maximum() (“the excess lump sum”) to a scheme administrator:
(a) amount of the excess lump sum repaid; and
(b) the date on which the excess lump sum was repaid.
|
| | 8. Whether, at the time of the benefit crystallisation event the individual held lifetime allowance protection or lifetime allowance enhancement factors (), and, if either is held, the type of protection and any associated reference number. | |