Letter of Authority Client Address: ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ Provider/Scheme Address: Clients previous UK address. ____________________________ _________________________ ____________________________ _________________________ ____________________________ _________________________ ____________________________ _________________________ Dear Sirs, Policy Number/Member Numbers(s): Scheme / Provider Name: I authorise you to provide any office of Teachers’ Wealth with information they request regarding benefits held in the above scheme / policies (and any other policies), which I may have with your company. Furthermore, please issue a cash equivalent transfer value to Teachers’ Wealth for my pension(s) that I hold with you. Yours faithfully Signature______________________________ Date_____/_____/________ Print Name____________________________ Maiden name (as applicable)_____________________________ National Insurance Number : _____________________________ Date of Birth : _____________________________ ________________________________________________________________________________________________________ TEACHERS‘ WEALTH is a trading name of STAR CAPITAL FINANCE, s.r.o. Václavské náměstí 19, 110 00 Prague 1, Czech Republic tel.: +420 234 656 121, fax: +420 234 656 138, info@teacherswealth.com, www.teacherswealth.com Star Capital Finance is regulated by Czech National Bank and member of FEIFA