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Ulster Bank Pension Scheme (ROI)

Death Benefit

Nomination of a Dependant for Pension Benefits Form

1. Member’s details

Name (in full)

Date of birth

PPSEmployee reference

numbernumber

2. Your information

Under the Rules of the Scheme, if you die, a pension may be payable to your spouse or a dependant. If you are married (and normally resident with your spouse) at the time of your death, your spouse will automatically receive a pension. You do not need to complete this form if this situation currently applies to you. If you are not married then this pension may be payable to a partner providing you have been living together for at least six months and your partner is financially dependant or interdependent on you. A financial dependant is a person who relies on your financial support to maintain their standard of living.

The information you provide in this form will be retained by Group Pension Services on behalf of the Trustee and used for the purpose of administering pension benefits. It may be shared with third parties that administer pension benefits on behalf of the Trustee. By completing this form, you are providing your consent to your information being used in this manner.

3. Nominated Partner/ Dependant details

In the event of my death, I wish any discretion under the Scheme Rules to be exercised so that the Trustee will apply any pension arising under the Scheme to or for the benefit of the persondetailed below. I understand that this request is not binding on the Trustee.

Please refer to the notes on entitlement overleaf when completing the section below.

Name (in full)

Home address line 1

Home address line 2

Home address line 3

Home address line 4 OR

overseas country

Postcode

Relationship

4. Confirmation

I understand that the payment of this pension is at the discretion of the Trustee. The Trustee will need to ensure that the conditions described above are met at the time of death before any payments can be made. I agree to keep the Trustee informed in the event of any changes in my personal circumstances.

I confirm that the above person is either financially dependent upon me, or we are financially interdependent (for example the person relies on me for a second income to maintain a standard of living).

Member’s signature

Date

Please return this form to:

Group Pension Services, Group Human Resources, The Royal Bank of Scotland Group, PO Box 1390, Croydon, CR9 5WP

(For internal mail only add Depot Code 190)

Notes

Entitlement

Entitlement shown here applies to members who joined the Scheme after 1st December 1999.

(i) Widow/er’s

On your death your Widow/er will be entitled to receive a pension. The pension will be payable until your Widow/er’s or Civil Partner’s death.

(ii) If you are separated from your spouse

If you are separated from your Widow/er you may request that the Trustee pay the pension which would have otherwise have been payable to your Widow/er, to one or more persons who were at your date of death, wholly or partly dependant upon you for maintenance or support. Payments are made at the Trustee’s discretion. The pension will be payable until the person’s death.

(iii) If you do not leave a Widow/er

If you leave no Widow/er then the Trustee of the Scheme has the discretion to pay the pension which would otherwise have been payable to your Widow/er to one or more persons who were at your date of death, wholly or partly dependant upon you for maintenance or support. The pension will be payable until the person’s death.

(iv) Nomination

If you have no Widow/er or are separated from your spouse then it is important that you complete a form nominating persons who you wish to receive any benefit on your death. Where you are separated from your spouse, if no nomination is made then the payment will be made to your Widow/er.

(v) Children’s Pensions

A pension will also be payable to your Children so long as they are either:

• under the age of 18 years; or

• under the age of 23 years whilst receiving full-time education.

A maximum of three Children’s pensions will be paid. Pensions will be doubled if your

Children become orphaned.

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