To the best of my knowledge and belief, having made such reasonable enquiries as are appropriate, the information contained in this form is true and complete.

Signature: ______________

Date: ______________

Name: ______________ Qualification: ______________

Name of Actuary’s Employer/Firm: ______________

Scheme Actuary Certificate No.: ______________

Notes On Completion Of Annual Actuarial Data Return

1. All sections of the form must be competed in full. "None" or "Not Applicable" should be entered where appropriate, but blank spaces or "to be advised" or similar responses may result in the form being rejected as incomplete.

2. A Frozen Scheme is a scheme where there is no further accrual of any long service benefit and the link to final retiring salary has been broken. A current scheme is a scheme that is neither frozen or in wind-up.

3. Exclude members who have attained normal pensionable age.

4. The DC Element of a scheme has the meaning given in the Occupational Pension Schemes (Disclosure of Information) Regulations 2006 to 2012. Broadly, it means contributions or other amounts treated on a defined contribution basis.

5. These are assets which cannot be used to determine if scheme satisfies the funding standard due to restrictions in the Funding Standard Regulations, in particular, due to self-investment/concentration of investment requirements.