#### Pension Amend Scheme Data

Scheme Name | A Full Pension Amendment | Pension Scheme Tax Reference | 12345678RA
Your own File Ref. | 02 - |  |

New Scheme Name

B Full Pension Amendment

Cessation Date of Scheme Administrator

04/11/

Cessation Scheme Administrator Individual / Organisation Name

Ms Alicia Margaret Yousseff

Cessation Scheme Administrator Address

Lincoln Views,
Anton Place,
Smallville Cambridge
CB1 1WW
United Kingdom

Cessation Scheme Administrator ID

A1111170

Cessation Scheme Administrator Declaration for No False statements

Yes

Other Records - Contract-out Reference

E1234567

Other Records - Relief at Source Reference

-

Other Records - VAT Reference

123456789

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