Letter of Permission

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

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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 Name Last Name

Date of Birth *

dd/mm/yyyy

Phone Number *

Country Code Area Code Phone Number

Email Address *

example@example.com

National Insurance number

Current Address *

Street Address
Street Address Line 2
City/Town	Provincial location
Postal Code	Country

Last Known Address to Pension Provider

Street Address
Street Address Line 2
City/Town	County
Postal Code	Country

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