Letter of Permission

Letter of Permission

PERMISSION TO PROVIDE INFORMATION ONLY
AUTHORISED PARTIES

Financial Adviser
Holborn Assets Limited

Kuala Lumpur Address

21-10, Q Sentral
2A Jalan Stesen Sentral 2, KL Sentral,
50470 Kuala Lumpur
Malaysia

International Offices: UAE; South Africa; Malaysia; Hong Kong; Cyprus; Thailand; Kuala Lumpur

----------------------------------------------------------------------

Correspondence Address

Holborn International LOP Administration

Clarendon House, 114-116 George Street,

Edinburgh, EH2 4LH

Contact Information: Tel: 0345 646 0236; Fax: 0131 777 2668;

Email: lop.pensionadmin@holbornassets.com
Name*

First NameLast Name
Date of Birth*
dd/mm/yyyy
Phone Number*

Country CodeArea CodePhone Number
Email Address*
example@example.com
National Insurance number
Current Address*

Street Address

Street Address Line 2

City/TownProvincial location

Postal Code
Last Known Address to Pension Provider

Street Address

Street Address Line 2

City/TownCounty

Postal Code
Plan Scheme Name
Plan scheme Reference
Dear Sirs,

I write with reference to the above in order to ask that you establish authority to request and receive information for the above noted party. I am considering my options with respect to transferring the pension to a Self-Invested Personal Pension (SIPP) and therefore require by return a full benefit and transfer statement, along with any forms and documentary requirements should I wish to transfer my pension held with yourselves to another registered pension provider.

Where I am still an active member of the pension scheme, I request a Transfer Valuation without leaving the scheme in order for me to consider my options before I take any actions. Please provide this by email to lop.pensionadmin@holbornassets.com or fax on +44 (0) 131 777 2668.

If this information can only be sent by post, please send to

Holborn International LOP Administration, Clarendon House, 114-116 George Street, Edinburgh, EH2 4LH.

If, for any reason, your procedures insist that such documents can only be sent directly to me as the member, please remit electronically to my email address above, to prevent issues with the international postal systems.

Yours faithfully,
Members Signature*

Clear
Holborn Assets Ltd is authorised and regulated by the Financial Conduct Authority (Ref : 648817) in the UK, the Financial Services Board (Ref : 44154) in South Africa, the Labuan Financial Services Authority (Ref : BS200756) in Malaysia and the Federal Insurance Authority (Ref:180) in the United Arab Emirates.

Email: lop.pensionadmin@holbornassets.com

Tel: +971 4 457 3800

Fax: +971 4 457 3999

www.holbornassets.com
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