	INSURANCE AND BENEFITS MANAGEMENT INTERNATIONAL EMPLOYEE BENEFITS
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UK Frozen Pension Transfers

There is absolutely no charge to you for us to do this research. The information is confidential. Should we find money in your pensions, we will recommend the best approach for your investments, at again, no charge to you.

Please give as much information as you can to allow us to thoroughly research your application. When you have completed filling in this form, please print it, and sign the bottom and fax directly to us at (281) 531 - 9445. This service is provided by Kestrel International USA Inc and is not available to residents of the United Kingdom.

First Name
Middle Name
Last Name
(Maiden or married name at time of employment in UK)
E-mail Address
How did you hear about us?


	Please give your complete address in the United States
Address

City
State
Zip


	Please give your last address in the United Kingdom
UK Address

City/Town/Village
Postal Code


	Please provide the following telephone numbers:
Daytime Phone
Home Phone
Work Fax
Home Fax
Best time to contact you

Your date of birth
Did you belong to a UK Occupational Scheme?
	If yes, please provide details below
EMPLOYER'S NAME (1)
Address

City
Postal Code
Country
No of years with employer
What years were you employed
Was the scheme contributory or non contributory
Do you know the value of your pension fund?
If YES, state the valuation and date of valuation)


EMPLOYER'S NAME(2)
Address

City
Postal Code
Country
No of years with employer
What years were you employed
Was the scheme contributory or non contributory
Do you know the value of your pension fund?
If YES, state the valuation and date of valuation)


EMPLOYER'S NAME(3)
Address

City
Postal Code
Country
No of years with employer
What years were you employed
Was the scheme contributory or non contributory
Do you know the value of your pension fund?
If YES, state the valuation and date of valuation)


Did you have a personal pension arrangement or make voluntary contributions (AVC or FSAVC)
Were you contracted out of SERPS
Please state your UK National Insurance Number, if known
Are you interested in applying for your 25% tax free lump sum (if you are 50 years of age or older)


To: Name of Company	(This is to authorise you to provide Kestrel Pensions Administration Ltd. with all information they require in respect of my UK preserved pension benefits. I confirm I am not a UK resident.)
Type your full name
Date

Contacts

Office Address:
1001 S. Dairy Ashford, Suite 175
Houston, Texas 77077

Mailing Address:
P.O. Box 440006
Houston, Texas 77244-0006

Phone:
(00) 1.281.531.5368
1.800.820.4581

Fax:
(00) 1.281.531.9445

Email:
info@kentinternationalgroup.com