HSC (ERRBO) – Application for Agreement Form

To be completed by the member in all cases

Complete this section using the details we provided in the quotation. Please consider the options carefully. Once the application has been accepted we cannot allow you to reduce the ERRBO.

You should keep a copy of your ERRBO contract as in the event of you moving jobs, you will need to submit a copy to payroll at https://payrollquery.hscni.net/ so that they can continue to make deductions from your new posts salary. A copy will be emailed to you upon submission of this form.

Please note that you will need to login/register with payroll before you submit forms via their ticket system.

Name(Required)

Prefix First Last

Address(Required)

Address Line 1 Address Line 2 City Post Code Country

National Insurance Number(Required)

Staff Number(s)(Required)

If you have more than one staff number, just add another line using the (+) function.

Date of Birth(Required)

Email Address(Required)

Your normal pension date (same as your State Pension Date)(Required)

Buy out to purchase in whole years: (1,2 or 3)(Required)

A part year maybe applicable in certain cases

Years

Days

Additional Percentage Contribution Rate(Required)

ERRBO Agreement Start Date(Required)

HSC (ERRBO) – Application for Agreement Form

To be completed by the member in all cases

Also in this Section

Also in this Section