Pension Annuity Deferral Declaration - Aviva

Pension Annuity
Deferral Declaration
Defined Contribution Scheme/Executive Pension Policy Name
Individual Name
Pension Board No
Retirement Date
Members of Defined Contribution occupational pension schemes and Executive pension policies who wish to
avail of this option should clearly understand that, while they may possibly benefit from investment gains by
deferring the purchase of the annuity up to and including the two year period, there is also the risk that they
may suffer further investment loss if they postpone the decision to purchase the annuity to a later date.
Prior to availing of this deferral, the individual should consider taking appropriate independent professional
advice.
In advance of the Tax Free Lump Sum, the individual must choose what annuity they wish to fund for:
Annuity offered by Aviva
Open Market Annuity
Joint
Single
Guaranteed
No
Yes 5 years 10 years
Escalating
No
Yes 3% per annum 5% per annum
These options can be altered at any time during the deferral period.
During deferral, unless otherwise requested, the policy will continue to be invested in the fund(s) it is currently invested in
at the time of this decision. The following product charges will continue to apply to the policy; fund management charge,
policy fee and pension board fee.
I confirm that I have requested the Trustee(s) of the above referenced Defined Contribution Occupational Pension
Scheme/Executive Pension Policy to defer the purchase of an annuity on my behalf until a time between this date up to,
and including, 31 December 2010.
I am aware that the Trustee(s) have no duty to me concerning the amount of money available to me at the time of
annuity purchase as a result of me availing of this option. I understand that the amount of pension I will receive when I
choose to ask the Trustee(s) to purchase my annuity is dependant on, amongst other things, the following factors:
1. The amount of money available to me at the time of annuity purchase
2. The cost of an annuity at that time

I am aware that the above factors may be less favourable to me when purchasing an annuity at a later date, on or
before 31 December 2010. Therefore, the future pension I will receive may be less than the pension I could purchase
today.
The Trustee(s) agree that should I request them in writing to purchase an annuity at any time within the deferred
period they shall do so on the date set out in my request.
Signed - Individual
Signed - Trustee(s)
Date
Date
Aviva Life & Pensions Ireland Limited. A private company limited by shares. Registered in Ireland No. 252737
Registered Office One Park Place, Hatch Street, Dublin 2.
Member of the Irish Insurance Federation. Aviva Life & Pensions Ireland Limited is regulated by the Central Bank of Ireland.
Life & Pensions One Park Place, Hatch Street, Dublin 2. Phone (01) 898 7000 Fax (01) 898 7329
www.aviva.ie
Telephone calls may be recorded for quality assurance purposes.
22.39.02.13