Election To Purchase Additional Pension

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Employer(Required)

Please ChooseNIFRSHSC

Section 1 - Personal Details

Name(Required)

Dr.MissMr.Mrs.Ms.Mx.Prof.Rev.They/Them Prefix First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Date of Birth(Required)

National Insurance Number(Required)

Address(Required)

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Work Location

Payroll//Staff/Service Number(Required)

Gender

Male

Female

Other

Current Employer

Section 2 - Choice of Options

I wish to purchase an additional sum of £* per annum(Required)

(up to a maximum of £8,717) Please note that if you have an existing Early Retirement Reduction Buy Out (ERRBO) this may impact on the amount of the maximum additional pension that may be purchased.

I wish to purchase addition pension for (tick one only)(Required)

Personal Benefits Only

Personal Benefits and Dependant Benefits

I wish to pay by (tick one only)(Required)

A one off payment*

Installments from my salary **

If payment is to be made by installments please state number of whole years over which payments are to be made. This can be any period from 1 year up to 20 years and can end no later than the day before your State Pension Age.If paying by installments you can pay a percentage of your pensionable pay, or a fixed monthly sum. Please enter below which of these options you wish to have deducted from your salary. *Please note if the payment is by a one off lump sum then it must be received within one month of you receiving the acceptance letter from BSO NIFRS Pension Team.

I wish to pay my ERRBO in installments:

as a percentage of my pensionable pay

as a fixed monthly sum

I wish to pay the following percentage of my pensionable pay:

Please enter a percentage below.

I wish to pay a fixed sum of £XXX each month:

Please enter a monetary amount below.

I wish to make instalments over x years (as detailed above).

Please enter the number of years you wish to pay your installments over below.

Section 3 - Members with Multiple Contracts of Employment (complete if applicable)

If you are currently working for more than one employer please specify the employment that deductions should be taken from.

Section 4 - Verification

Verification of Date of Birth(Required)

Max. file size: 40 MB.

Please supply us with a copy of your Birth Certificate with this application form so that we can verify your Date of Birth. We will be unable to process any applications until we receive this document.

Section 5 - Declaration

Agree(Required)

To the best of my knowledge the information given in this form is true. I have no reason to believe that my health prevents me from continuing in pensionable employment until the payment period is completed.

Please note: The actuarial factors used to calculate additional pension are based on a normal retirement age which is linked to your State Pension Age, therefore if you take out an additional pension contract and then retire between the minimum retirement age and normal pension age for the scheme your additional pension will be reduced accordingly.

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