55B Form for Practitioners

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55B Practitioners

Personal Details

Your Name(Required)

Prefix First Last

Date of Birth(Required)

National Insurance Number(Required)

Sex(Required)

Male

Female

Other

Employment:(Required)

Medical Practitioner

Dental Practitioner

Address (if terminating contract)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Remuneration and Contribution Record

Please list your previous employers, the dates you worked and the position you held (Click the plus icon at the end of the row to go back up to 5 years. The 'Year Ended' column should show the value of 31.3.

Remuneration £

Year Ended

Contributions Paid £

Events affecting reckonable service/ contributions including extra contributions for purchase (s)

Refund of Contributions (£)

Please enter a number from 0 to 9999999.99.

Less Income Tax (£)

Please enter a number from 0 to 9999999.99.

Net Refund (£)

Please enter a number from 0 to 9999999.99.

Outstanding Contributions (£)

Please enter a number from 0 to 9999999.99.

Exit Code

Superannuation Dates

Present Service Began

Earlier Commencement Date

Last Day of Contributing Service

Reckonable Service

At last day on previous SD55 or transferred in (in Years and Days):

For the Period Covered by this form (In years and days):

Total (In Years and Days):

Contract for Purchase of Added Years (Old Style) in Years and Days:

Contract for Purchase of Added Years (New Style) in Years and Days:

End Date:

Contract for Purchase of Unreduced Lump Sum Years (Old Style) in Years and Days:

Contract for Purchase of Unreduced Lump Sum Years (New Style) in Years and Days:

End Date

Name

This field is for validation purposes and should be left unchanged.

55B Form for Practitioners

55B Practitioners

Personal Details

Superannuation Dates

Reckonable Service

Also in this Section

Also in this Section