SCHEDULE 4

INFORMATION RELATING TO BENEFICIARIES

1. Name.

2. Postal address.

3. PPS number.

4. Date of birth.

5. Country of Residence and ordinary residence at date of death.

6. Country of domicile at date of death.

7. Relationship of each beneficiary to the deceased person.

8. Value of any benefit transferring to each beneficiary.

9. Group threshold amount relevant for any benefit transferring.

10. Value of prior aggregable benefits received by each beneficiary within each group threshold under Schedule 2 of the Act of 2003 since 5 December 1991.

11. Aggregated value of benefits received by each beneficiary where that value exceeds ?12,000.