Member details

Name*		SIPP Type	Dentons SIPP (single portfolio) Dentons SIPP (full)
Member Date of Birth*		Sex*	Male Female
Dependant Date of Birth		Retirement Age*	55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 0 35 36 37 38 39 40
Investment Commencement Date*		Protection Level*	No Protection Fixed Protection 2012 Fixed Protection 2014 Fixed Protection 2016 Individual Protection 2014 Individual Protection 2016 Enhanced Protection Primary Protection
		Individual Protection Amount (£)

*denotes a mandatory/required field

Payments

Transfers

Amount (£)

Contributions

Gross Amount* (£)	Source	Frequency	Level/Escalating	Escalation Rate (% pa)
	Member Employer	Single Monthly Annual	Level Escalating
	Member Employer	Single Monthly Annual	Level Escalating
	Member Employer	Single Monthly Annual	Level Escalating

*includes basic tax relief of 20% for member contributions

Fees

VAT Rate (%)

Establishment Cost excl VAT (£)		Annual Charges excl VAT (£)
Transfer In Fee excl VAT (£)		Rate of Increase	NAE RPI

*Please apply a fee of £50 per transfer

Estimated Fee on Proposed Initial Investment excl VAT (£)

*Please see charges sheet

Independent Financial Adviser (IFA)

IFA Fees Payable?	No Yes
Initial Fee Basis	% Of Initial Payments Fixed Amount	Annual Fee Basis	% Of Fund Fixed Amount
Initial Fee/%		Annual Fee/%
VAT Payable on Fees?	No Yes

Investment Management

*Please vary the Share of Plan % as appropriate

Fund	% Of Fund Fixed Amount Management Fee % pa

Risk Level Select... Low Risk Medium Low Risk Medium Risk Medium High Risk High Risk Select... Low Risk Medium Low Risk Medium Risk Medium High Risk High Risk Select... Low Risk Medium Low Risk Medium Risk Medium High Risk High Risk Select... Low Risk Medium Low Risk Medium Risk Medium High Risk High Risk Select... Low Risk Medium Low Risk Medium Risk Medium High Risk High Risk

VAT Payable on Fees?	No Yes