HSC Cancellation of Partner Nomination/Death Benefit Form

Please read these notes before completing the form for cancelling an existing nomination, then keep them in a safe place.

You may use this form only if you have membership on or after 1 April 2008.
You may choose to cancel an existing partner nomination or death benefit nomination by completing this form.
If you wish to amend an existing nomination you must submit a new application using form PN1 for a partner nomination or form DG3 for a death benefit nomination.
Submitting this form will result in the appropriate nominations being revoked completely. This means that any benefits payable upon your death will be paid in accordance with the Scheme rules, rather than to named individual(s) or a body.
When you have completed your form please return it to the address at the top of the page.

Section 1 - Personal Details

Name(Required)

Prefix First Last

Address(Required)

Address Line 1 Address Line 2 City Post Code Country

National Insurance Number(Required)

Date of Birth(Required)

Contact Number(Required)

Email Address(Required)

Part B - Cancellation Details

You may cancel your existing partner nomination by indicating below. If you wish to amend an existing nomination you should make a new nomination.

I wish to cancel my:(Required)

Partner Nomination

Death Benefit Nomination