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<div id="" data-propsId="a9264e5d229e4c87941e2b63fc442462" class="react-component" data-name="Form"><div id="react_0HNOF5JKRG49G"><div><section class="module form theme-warm-grey module--product module-noCurveTop module-noCurveBottom module-curve-before-concave      "><div class="wrapper"><div class="container form__container"><form data-validateall="true" autoComplete="off" action="/life/api/form/submit/Annuities" method="post"><div></div><div><fieldset><div class="xx"><div class="xx__left"><div class="legend-wrapper"><legend>Your personal details</legend><h2 class="editable">Your personal details</h2></div></div><div class="xx__right"><div class="editablediv form__header">Please fill in all parts of the form marked with a *</div><div class="form-field form-field--text form-field--valid" for="Title"><label class="form-field__label" for="Title" data-label="Your title"><span class="labelText">Your title</span><span class="fieldErrors" for="Title"></span></label><div class="form-field__field"><input class="lg" placeholder="Please enter your title" data-validate="true" type="text" id="Title" name="Title"/></div></div><div class="form-field form-field--text form-field--valid" for="Your name"><label class="form-field__label" for="Your name" data-label="Your first name"><span class="labelText">Your first name <em title="Required">*</em></span><span class="fieldErrors" for="Your name"></span></label><div class="form-field__field"><input data-required="true" class="lg" placeholder="Please enter your first name" data-validate="true" type="text" id="Your name" required="" name="Your name"/></div></div><div class="form-field form-field--text form-field--valid" for="Surname"><label class="form-field__label" for="Surname" data-label="Your surname"><span class="labelText">Your surname <em title="Required">*</em></span><span class="fieldErrors" for="Surname"></span></label><div class="form-field__field"><input data-required="true" class="lg" placeholder="Please enter your surname" data-validate="true" type="text" id="Surname" required="" name="Surname"/></div></div><div class="form-field form-field--text form-field--valid" for="Email address"><label class="form-field__label" for="Email address" data-label="Your email"><span class="labelText">Your email</span><span class="fieldErrors" for="Email address"></span></label><div class="form-field__field"><input class="lg" placeholder="Your email address" data-validate="true" type="text" id="Email address" name="Email address"/></div></div><div class="form-field form-field--text form-field--valid" for="Your number"><label class="form-field__label" for="Your number" data-label="Your number"><span class="labelText">Your number</span><span class="fieldErrors" for="Your number"></span></label><div class="form-field__field"><input class="lg" placeholder="Your telephone number" data-validate="true" type="text" id="Your number" name="Your number"/></div></div><div class="form-field form-field--checkbox form-field--valid" for="email consent"><label class="form-field__label" for="email consent" data-label="Please tick this box if you’d like to receive emails from us in the future about our pension and retirement products and services"><span class="labelText">Please tick this box if you’d like to receive emails from us in the future about our pension and retirement products and services</span><span class="fieldErrors" for="email consent"></span></label><div class="form-field__field"><ul><li><input type="checkbox" id="email consentYes I want to receive emails0" name="email consent" value="Yes I want to receive emails"/><label for="email consentYes I want to receive emails0"><span><span class="icon icon--tick"><svg fetchPriority="auto" loading="lazy" decoding="async" focusable="false" width="16" height="16" viewBox="0 0 16 16"><path d="M4.8,15.5c-0.4,0-0.8-0.2-1.1-0.4L0.6,12C0,11.4,0,10.4,0.6,9.8s1.5-0.6,2.1,0l1.9,1.9l8.5-10.4 c0.5-0.6,1.5-0.7,2.1-0.2c0.6,0.5,0.7,1.5,0.2,2.1L5.9,15C5.6,15.3,5.3,15.5,4.8,15.5C4.8,15.5,4.8,15.5,4.8,15.5z"></path></svg></span></span>Yes I want to receive emails</label></li></ul></div></div><div class="form-field form-field--checkbox form-field--valid" for="get in touch"><label class="form-field__label" for="get in touch" data-label="How would you like us to get in touch?"><span class="labelText">How would you like us to get in touch?</span><span class="fieldErrors" for="get in touch"></span></label><div class="form-field__field"><ul><li><input type="checkbox" id="get in touchEmail0" name="get in touch" value="Email"/><label for="get in touchEmail0"><span><span class="icon icon--tick"><svg fetchPriority="auto" loading="lazy" decoding="async" focusable="false" width="16" height="16" viewBox="0 0 16 16"><path d="M4.8,15.5c-0.4,0-0.8-0.2-1.1-0.4L0.6,12C0,11.4,0,10.4,0.6,9.8s1.5-0.6,2.1,0l1.9,1.9l8.5-10.4 c0.5-0.6,1.5-0.7,2.1-0.2c0.6,0.5,0.7,1.5,0.2,2.1L5.9,15C5.6,15.3,5.3,15.5,4.8,15.5C4.8,15.5,4.8,15.5,4.8,15.5z"></path></svg></span></span>Email</label></li><li><input type="checkbox" id="get in touch Telephone1" name="get in touch" value=" Telephone"/><label for="get in touch Telephone1"><span><span class="icon icon--tick"><svg fetchPriority="auto" loading="lazy" decoding="async" focusable="false" width="16" height="16" viewBox="0 0 16 16"><path d="M4.8,15.5c-0.4,0-0.8-0.2-1.1-0.4L0.6,12C0,11.4,0,10.4,0.6,9.8s1.5-0.6,2.1,0l1.9,1.9l8.5-10.4 c0.5-0.6,1.5-0.7,2.1-0.2c0.6,0.5,0.7,1.5,0.2,2.1L5.9,15C5.6,15.3,5.3,15.5,4.8,15.5C4.8,15.5,4.8,15.5,4.8,15.5z"></path></svg></span></span> Telephone</label></li></ul></div></div><div class="form-field form-field--select form-field--valid" for="best time to call"><label class="form-field__label" for="best time to call" data-label="Select day and time"><span class="labelText">Select day and time</span><span class="fieldErrors" for="best time to call"></span></label><div class="form-field__field"><div><select id="best time to call"><option value="Monday 8.30am to 1pm">Monday 8.30am to 1pm</option><option value=" Monday 1pm to 6pm"> Monday 1pm to 6pm</option><option value=" Tuesday 8.30am to 1pm"> Tuesday 8.30am to 1pm</option><option value=" Tuesday 1pm to 6pm"> Tuesday 1pm to 6pm</option><option value=" Wednesday 8.30am to 1pm"> Wednesday 8.30am to 1pm</option><option value=" Wednesday 1pm to 6pm"> Wednesday 1pm to 6pm</option><option value=" Thursday 1pm to 6pm"> Thursday 1pm to 6pm</option><option value=" Friday 8.30am to 1pm"> Friday 8.30am to 1pm</option><option value=" Friday 1pm - 6pm"> Friday 1pm - 6pm</option></select></div></div></div></div></div></fieldset><fieldset><div class="xx"><div class="xx__left"><div class="legend-wrapper"><legend>Your pensions</legend><h2 class="editable">Your pensions</h2></div></div><div class="xx__right"><div class="editablediv form__header">If you&#39;re not sure about some of the details, just move onto the next question</div><div class="form-field form-field--checkbox form-field--valid" for="what-type-of-pension"><label class="form-field__label" for="what-type-of-pension" data-label="What type of pension do you have? (Tick all that apply)"><span class="labelText">What type of pension do you have? (Tick all that apply)</span><span class="fieldErrors" for="what-type-of-pension"></span></label><div class="form-field__field"><ul><li><input type="checkbox" id="what-type-of-pensionPersonal pension0" name="what-type-of-pension" value="Personal pension"/><label for="what-type-of-pensionPersonal pension0"><span><span class="icon icon--tick"><svg fetchPriority="auto" loading="lazy" decoding="async" focusable="false" width="16" height="16" viewBox="0 0 16 16"><path d="M4.8,15.5c-0.4,0-0.8-0.2-1.1-0.4L0.6,12C0,11.4,0,10.4,0.6,9.8s1.5-0.6,2.1,0l1.9,1.9l8.5-10.4 c0.5-0.6,1.5-0.7,2.1-0.2c0.6,0.5,0.7,1.5,0.2,2.1L5.9,15C5.6,15.3,5.3,15.5,4.8,15.5C4.8,15.5,4.8,15.5,4.8,15.5z"></path></svg></span></span>Personal pension</label></li><li><input type="checkbox" id="what-type-of-pension Final salary1" name="what-type-of-pension" value=" Final salary"/><label for="what-type-of-pension Final salary1"><span><span class="icon icon--tick"><svg fetchPriority="auto" loading="lazy" decoding="async" focusable="false" width="16" height="16" viewBox="0 0 16 16"><path d="M4.8,15.5c-0.4,0-0.8-0.2-1.1-0.4L0.6,12C0,11.4,0,10.4,0.6,9.8s1.5-0.6,2.1,0l1.9,1.9l8.5-10.4 c0.5-0.6,1.5-0.7,2.1-0.2c0.6,0.5,0.7,1.5,0.2,2.1L5.9,15C5.6,15.3,5.3,15.5,4.8,15.5C4.8,15.5,4.8,15.5,4.8,15.5z"></path></svg></span></span> Final salary</label></li></ul></div></div><div class="form-field form-field--text form-field--valid" for="what is the value of all your pension pots"><label class="form-field__label" for="what is the value of all your pension pots" data-label="What is the value of all your pension pots?"><span class="labelText">What is the value of all your pension pots?</span><span class="fieldErrors" for="what is the value of all your pension pots"></span></label><div class="form-field__field"><input class="lg" placeholder="e.g. £150,000" data-validate="true" type="text" id="what is the value of all your pension pots" name="what is the value of all your pension pots"/></div></div><div class="form-field form-field--select form-field--valid" for="do you have an ongoing pension review service available"><label class="form-field__label" for="do you have an ongoing pension review service available" data-label="Do you have ongoing pension review service available?"><span class="labelText">Do you have ongoing pension review service available?</span><span class="fieldErrors" for="do you have an ongoing pension review service available"></span></label><div class="form-field__field"><div><select id="do you have an ongoing pension review service available"><option value="Yes">Yes</option><option value=" No"> No</option><option value=" Not sure"> Not sure</option></select></div></div></div><div class="form-field form-field--select form-field--valid" for="Will your pension have any charges applied if you transfer it"><label class="form-field__label" for="Will your pension have any charges applied if you transfer it" data-label="Will your pension have any charges applied if you transfer it?"><span class="labelText">Will your pension have any charges applied if you transfer it?</span><span class="fieldErrors" for="Will your pension have any charges applied if you transfer it"></span></label><div class="form-field__field"><div><select id="Will your pension have any charges applied if you transfer it"><option value="Yes">Yes</option><option value=" No"> No</option><option value=" Not sure"> Not sure</option></select></div></div></div><div class="form-field form-field--text form-field--valid" for="Is there a specific question you&#x27;d like us to answer?"><label class="form-field__label" for="Is there a specific question you&#x27;d like us to answer?" data-label="Is there a specific question you&amp;#39;d like us to answer?"><span class="labelText">Is there a specific question you&#39;d like us to answer?</span><span class="fieldErrors" for="Is there a specific question you&#x27;d like us to answer?"></span></label><div class="form-field__field"><input class="lg" placeholder="" data-validate="true" type="text" id="Is there a specific question you&#x27;d like us to answer?" name="Is there a specific question you&#x27;d like us to answer?"/></div></div></div></div></fieldset><fieldset><div class="xx"><div class="xx__left"><div class="legend-wrapper"><legend>Your pension contributions</legend><h2 class="editable">Your pension contributions</h2></div></div><div class="xx__right"><div class="editablediv form__header">Tell us how much you are paying into your pension</div><div class="form-field form-field--text form-field--valid" for="Gross salary per year"><label class="form-field__label" for="Gross salary per year" data-label="What is your gross salary per year?"><span class="labelText">What is your gross salary per year?</span><span class="fieldErrors" for="Gross salary per year"></span></label><div class="form-field__field"><input class="lg" placeholder="£" data-validate="true" type="text" id="Gross salary per year" name="Gross salary per year"/><span class="form-field__infoicon "><svg fetchPriority="auto" loading="lazy" decoding="async" focusable="false" width="29" height="29" viewBox="0 0 29 29" class="icon icon--infoTooltop">
      <g id='tt-bg' style="stroke:none;">
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        <path id='tt-i' d="m 14.744,10.01 c -0.858,0 -1.584,-0.704 -1.584,-1.584 0,-0.88 0.77,-1.584 1.628,-1.584 0.858,0 1.584,0.704 1.584,1.584 0,0.88 -0.77,1.584 -1.628,1.584 z m -2.42,11.11 v -1.98 h 1.474 v -5.632 h -1.474 v -2.024 h 3.872 v 7.656 h 1.43 v 1.98 z" />
      </g></svg></span></div><div class="editablediv form-field__info "><div>Your gross salary is your salary before and tax or other deductions</div></div></div><div class="form-field form-field--select form-field--valid" for="pension charges"><label class="form-field__label" for="pension charges" data-label="How often are you paying in your pension?"><span class="labelText">How often are you paying in your pension?</span><span class="fieldErrors" for="pension charges"></span></label><div class="form-field__field"><div><select id="pension charges"><option value="Weekly">Weekly</option><option value=" Monthly"> Monthly</option><option value=" Yearly"> Yearly</option></select></div></div></div><div class="form-field form-field--text form-field--valid" for="How much are you paying?"><label class="form-field__label" for="How much are you paying?" data-label="How much are you paying?"><span class="labelText">How much are you paying?</span><span class="fieldErrors" for="How much are you paying?"></span></label><div class="form-field__field"><input class="lg" placeholder="Please enter a value (£) or percentage (%)" data-validate="true" type="text" id="How much are you paying?" name="How much are you paying?"/></div></div><div class="form-field form-field--radio form-field--valid" for="percent or value"><label class="form-field__label" for="percent or value" data-label="Is the amount above a value (&amp;#163;) or percentage (%)?"><span class="labelText">Is the amount above a value (&#163;) or percentage (%)?</span><span class="fieldErrors" for="percent or value"></span></label><div class="form-field__field"><ul><li><input type="radio" id="percent or value£0" name="percent or value" value="£"/><label for="percent or value£0"><span></span>£</label></li><li><input type="radio" id="percent or value %1" name="percent or value" value=" %"/><label for="percent or value %1"><span></span> %</label></li></ul></div></div><div class="form-field form-field--text form-field--valid" for="How much is your employer paying"><label class="form-field__label" for="How much is your employer paying" data-label="How much is your employer contributing?"><span class="labelText">How much is your employer contributing?</span><span class="fieldErrors" for="How much is your employer paying"></span></label><div class="form-field__field"><input class="lg" placeholder="Please enter a percentage (%) or value (£)" data-validate="true" type="text" id="How much is your employer paying" name="How much is your employer paying"/></div></div><div class="form-field form-field--radio form-field--valid" for="Employer percent or value"><label class="form-field__label" for="Employer percent or value" data-label="Is the amount above a percentage (%) or value (&amp;#163;)?"><span class="labelText">Is the amount above a percentage (%) or value (&#163;)?</span><span class="fieldErrors" for="Employer percent or value"></span></label><div class="form-field__field"><ul><li><input type="radio" id="Employer percent or value%0" name="Employer percent or value" value="%"/><label for="Employer percent or value%0"><span></span>%</label></li><li><input type="radio" id="Employer percent or value £1" name="Employer percent or value" value=" £"/><label for="Employer percent or value £1"><span></span> £</label></li></ul></div></div></div></div></fieldset><div class="form-field form-field--button"><button class="cta cta--sm cta--primary cta--no-icon" name="submit">Submit</button></div></div></form></div></div></section></div></div></div>
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