HSC Pension Scheme Forms

Entitlement to HSC pension benefits often requires supporting documentation such as birth, marriage and death certificates and other legal documents. Any original certificates received will be returned by standard post unless accompanied by alternative return prepaid postage. Please note HSC Pension Service will accept copies.

The HSC Pension Scheme forms are broken down into the main pension event categories. Each category is then divided into either member or employer specific forms.

You can use the links below to access the scheme forms you will need to complete when members Join, Leave or Retire from the Scheme.

Forms are also available in respect of Ill Health Retirement, Permanent Injury Benefit, Additional Pension Purchase and Internal Disputes Resolution.

 

• Allocation of Pension Forms

  Allocation of Pension Medical Report Form (To be completed by the member, and their GP)

  Allocation of Pension Form & Guidance

   

• Annual Allowance Forms

  SPE2 – Scheme Pays Election 2017/18 onwards

  SPE2 – Scheme Pays Election up to 2016/17

• Bereavement Forms

  AW9 – Child Allowance Application Form

  AW10 – Application for Lump Sum on Death and Widow(er)’s/Partner’s Pension – Death in Service

  AW10A – Application For Lump Sum On Death ONLY

  AW11 – Application For Widow(er)’s Partners Pension

  AW135 – Notification of Salary Related Survivor’s Pension

   

   

   

   

• Declaration of Entitlement

  DECLARATION OF ENTITLEMENT

• Dental Practitioner Forms

  SS14 – Dentists

• Employer Forms

  EAAF – Employing Authority Authorisation Form (For employers to confirm they are paying the capitalised costs for agreed VER (Interests of efficiency of the service)

  Protection of Pay Forms for Employers

  ProPay2 – For Employers

  PP2 – Protection of Pay Guidance for Employers

  Request for a Chargeable Estimate of Benefits
  Please see our Schedule of Charges

  IP2016 – Individual Protection Valuation Request

  RPA1 – Employer Request for Early Retirement Estimate

• GP Practice Forms

  J2 – Scheme Joining Form – GP Practices/OOH Providers/Direction Employers

  Online J2 Form

  T55A – Termination Of Scheme Membership Notice

  GP1 Incorporating GP55a 2023 – 2024

  Guide for Completion of GP1 Incorporating GP55a

  Direct Debit Mandate

  Request for Estimate of Pension Benefits (EST1)

  Authorised Signature

• Ill Health Application Forms

  AW240B – Consideration of Entitlement to Tier 2 Benefits – Application within 3 years of Tier 1 Award

  AW240 – Application for Consideration for Ill Health Retirement for Recent Leavers and Deferred Scheme Members

  AW34A – Commute Serious Ill Health Retirement Benefits

  AW33 – Application for Consideration for Ill Health Retirement for Active Members

  Allocation of Pension Medical Report Form (To be completed by the member, and their GP)

• Internal Disputes Forms

  DRP1 – Internal Disputes Resolution – Stage 1

  DRP2 – Internal Disputes Resolution – Stage 2

   

  You can find guidance on the completion of and Internal Dispute Resolution Form here.

• Joiner Forms

  The employer is responsible for making you a member of the Scheme automatically.  You may wish to refer to the Becoming a New Member section for more information.

  New Joiner Questionnaire

  Re-Joiner Form
  Please see our Re-Joiner Guidance Notes for guidance on completion of this form.

  Five Year Re-Joiner Questionnaire

  SD77 – New Joiner Form for Directional Bodies

  Scheme Joining Form – To be completed by GP Practice, Out of Hours and Direction Employers (J2 Form)

  Auto-Enrolment Eligibility Questionnarire

• Leaving the Scheme Forms

  SD502 – Application to Leave the Scheme Form
  Please see our Guidance section for help completing this form.

  REF1 – Application for Refund of Benefits

  T55A – Termination of Scheme Membership Notice

   

• Letter of Authority

  Letter of Authority (LOA)

• Mental Health Officer (MHO) and Special Class Forms

  Mental Health Officer (MHO) and Special Class (SC) status are only relevant to eligible 1995 Section members. Although not relevant to the 2015 Scheme, it may still need to be recorded to establish possible early retirement criteria for those members who hold preserved rights in the 1995 Section. Employers will need to continue to accurately record either status in these circumstances. The same processes and forms used for protected 1995 members will continue to apply.

  Mental Health Officer (MHO) status

  If your membership record does not already show MHO status and you believe it should apply then please complete the MHO Application Form.

  Retention of Mental Health Officer (MHO) Application

  Special Class status

  There are no forms relevant to the member in this section as entitlement to Special Class status is automatically applied to eligible members.

• Nomination Forms

  There are a number of forms provided for you to nominate someone to receive a survivor pension / life assurance Lump sum or cancel a previous nomination in the event of your death.

  DG3 – Death Grant Nomination Form

  PN1 – Partner Nomination Form

  Cancellation of Partner Nomination/Death Grant

• Pension Estimate Forms

  Estimate Request Form (ESTREQ) Online Form

  Estimate Request Form – Printable Format

  Estimate Form for GP Practice Staff, Federation & Directional Body Staff

  Please send completed forms to aw6.est.ppt@hscni.net or post to:

  Payroll Pension Team
  HSC Pension Service
  Waterside House
  75 Duke Street
  Derry
  BT47 6FP

  Request for a Chargeable Estimate of Benefits
  Please see our Schedule of Charges

  IP2016 – Individual Protection Valuation Request

  RPA1 – Employer Request for Early Retirement Estimate

• Pension on Divorce Forms

  Member Forms

  A series of application forms and guidance notes for members to apply for a Cash Equivalent Transfer Value (CETV) specifically for divorce or dissolution of a civil partnership.

  PD1 – Pensions on Divorce or Dissolution of Civil Partnership Application

  PD2 – Pay details request form

  The Schedule of Charges for CETVs can be found here.

  Employer Forms

  There are no relevant forms for the employer to complete in this section, although the PD2 is a form that the member is instructed to print off and pass to the relevant employer for completion where a CETV is required.

  More information can be found on Pensions on Divorce here.

• Practitioners Forms

  SS14 form for Principle and Salaried GPs

  SS14 Form for Locums

  55B Form for Practitioners – End of Year Returns

  Correspondence Details

• Protection/Voluntary Protection of Pay Forms

  These forms are provided to protect pay when a member either suffers a reduction in pay through no fault of their own or where a voluntary step down arrangement takes place.

  ProPay1 – For Members

  ProPay2 – For Employers

   

  PP1 – Protection of Pay Guidance for Members

  PP2 – Protection of Pay Guidance for Employers

• Public Service Pension History Form

  Public Service Pension History Form

• Purchasing Additional Pension and ERRBO Forms

  Members can increase their pension benefits by paying additional contributions. Please refer to the Increasing your Benefits Section for more information.

  Early Retirement Reduction Buy Out (ERRBO)

  ERRBO – Expression Of Interest

  ERRBO -Application Form

  Preliminary Application for Purchase of Additional Pension

  AP1 – Additional Pension Benefit Form Final Salary

  AP1 – 2015 CARE Form

  Election To Purchase Additional Pension Online Form

  Election to Purchase Additional Pension

  AP2 – Additional Pension Benefit Form Final Salary

  AP2 – 2015 CARE Form

• Retirement Forms

  AW6 – Pension Application Form

  Online AW6 Form

  AW6P – Pension Application for Preserved Members

   

  Partial Retirement Application Form (to be completed by the member and their manager)

  AW171 – Post Award Revised Details Form

• Transfer Forms

  Transferring In:

  Transfer In Request Form

  Guidance on transferring benefits into the scheme can be found here.

  Transferring Out:

  If you wish to transfer your benefits out of the HSC Pension Scheme, you must contact your new provider and request that they contact us to request a transfer out valuation.

   

  More information on transferring in/out of the scheme can be found in our transfer section of the website.

• Voluntary Exit Scheme (VES) Form

  VES VOLUNTARY EXIT SCHEME PAYBACK LETTER