Pension Potential Annuity Application Form

Personal Information
Enter your date of birth in DD/MM/YYYY format
We recommend using your home email address as it's less likely to change
Re-enter your email address to confirm it's correct
Pension Information
Enter the total value of all your pension savings in pounds

Protecting your details

Pension Potential is committed to protecting and respecting your privacy, and we'll only use your personal information to provide the services you request from us. To find out how we use and store your details when providing services to you, please read our privacy notice . Opens in a new tab

I agree that you can use my personal information, including health and lifestyle details (and those of my spouse/partner, if I choose to include them) to provide quotes and illustrations for my retirement income and to send these to me.

Consent Agreement

Submit Form

Submit the form to get your annuity quote. Button is enabled when you agree to the terms.