Age Discrimination Remedy Claim Form (NIFRS) (NFPS/Modified Members Only)

Personal Details:

Name(Required)

Prefix First Last

National Insurance Number(Required)

Payroll/Service Number(Required)

Date of Birth(Required)

Email Address(Required)

Contact Number(Required)

Address(Required)

Address Line 1 Address Line 2 City Post Code Country

Age Discrimination Remedy Choice Decision:

Having reviewed the information provided in the Remediable Service Statement, I can confirm that my decision is:

(Please choose one of the options below and then complete the declaration)

Choose one option from the below list:(Required)

A – Option one – Maximum lump sum. I elect for option one; to have legacy scheme (Modified NFPS 2007) benefits paid in respect of membership within the remedy period (1st April 2015 to 31st March 2022).

B – Option two – Maximum lump sum. I elect for option two; to have reformed scheme (CARE 2015) benefits paid in respect of membership within the remedy period.

Age Discrimination Remedy Claim Form (NIFRS) (NFPS/Modified Members Only)

Personal Details:

Age Discrimination Remedy Choice Decision:

Declaration:

Also in this Section

Also in this Section