Fillable Printable Pension Credit Benefits Claim Form
Fillable Printable Pension Credit Benefits Claim Form
Pension Credit Benefits Claim Form
1
Title (e.g. Mr, Mrs, Miss, Dr)
Surname
Former surname (If applicable)
Other names
National Insurance number
Date of birth (enclose your birth certicate with this form)
NHS Pensions is a service provided by the NHS Business Services Authority
Pension Credit Benets Claim Form - (AW8PC)
Address
Contact telephone number
Email address
/ /
Post code
AW8PC (V3) 05/2012
Before completing this form please read the Retirement Booklet and the guidance notes at
the back of this form
Part 1 - Scheme Reference Number
Please enter your NHS Pension Scheme reference number
SD
/
Part 2 - About Yourself
Please write in CAPITAL LETTERS using BLACK INK
Part 3 - Type of Pension and Retirement Lump Sum
3.1 Why are you claiming your Pension Credit benets? Please tick the box(es) which applies to you.
1995 Section 2008 Section
Reached normal pension age
Early payment of Pension Credit benet.
Your benets will be
actuarially reduced to take account of this*
Early payment of Pension Credit benet on Ill-health grounds
Commuted early payment of Pension Credit benet based on
Ill-health grounds (attach form AW341)
*Please conrm when early payment of Pension Credit benet should begin
/ /
1995 Section (please complete Part 3.3) 2008 Section (Please complete Part 3.4)
3.2 Which Section of the NHS Pension Scheme are you claiming your benets from?
2
3.3 1995 Section
Do you want an additional lump sum
by giving up part of your pension? Yes
please continue below
No go to
Part
4
If YES do you want the maximum
additional lump sum permitted? Yes go to
Part
4 No please continue below
Please specify the additional amount required not more than the maximum amount permitted
Additional lump sum £ (whole pounds only)
(This is in addition to your normal lump sum entitlement)
3.4 2008 Section
Do you wish to give up part of your
pension to receive a lump sum? Yes
please continue below
No go to
Part
4
If YES do you want the maximum
lump sum permitted? Yes go to
Part
4 No please continue below
Please specify the additional amount required not more than the maximum amount permitted
Amount of lump sum £ (whole pounds only)
Part 4 - HM Revenue and Customs (HMRC) Information
To comply with HMRC legislation please answer the following questions. It is important that you complete
these questions fully and correctly and supply any information asked for. Failure to do so will delay the
payment of pension and lump sum and may cause all your benets to have the Lifetime Allowance Charge
(LTAC) applied to them.
4.1 Have you any pension arrangements, this includes money purchase AVC’s, that are separate from
your main NHS pension benets, either in payment or not?
Yes please continue
No go to question 4.6
4.2 Will your annual pension from all your pension arrangements, including the NHS Scheme, be more
than £50,000 per year?
Yes please continue
Don't know please continue
No go to question 4.6
4.3 Excluding your main NHS pension benets were any of your separate pension benets in payment
on or after 6 April 2006?
Yes please continue
No go to question 4.4
(i) Please give us the total combined percentage of LTA (to 2 decimal places i.e.43.21%) used by all your
separate pension benets in payment on or after 6 April 2006.
.
%
3
(ii) Date of rst Benet Crystallisation (The date accrued benets are put into payment from another
pension provider after 5 April 2006)
4.4 Excluding your main NHS pension benets were any of your separate pension benets in payment
before 6 April 2006?
Yes please continue
No go to question 4.5
(i) Gross annual rate (before deduction of income tax) of pension(s) in payment, from your separate
pension arrangements (not your main NHS pension) at the earlier of either today’s date or a date
at 4.3(ii).
4.5 If you are unable to provide us with answers to questions 4.3 and 4.4 we will only be able to process
your application if we treat your NHS Pension Scheme benets as entirely in excess of the LTA. This
will mean the Scheme paying 55% of your lump sum and 25% of your pension directly to HMRC,
unless you instruct NHS Pensions to defer payment of your benets until you have gathered the
necessary information.
If you would like us to do this, please tick this box.
Alternatively please wait until you know what percentage of the LTA has been used before returning
this form. You may need to contact the Scheme Administrator of your other pension arrangements for
this.
4.6. Do you have any valid certicate of protection (e.g. the Enhanced, Primary or Fixed Protection
certicate) from HMRC? If so, you must provide the certicate(s) to your Pensions Ofcer, who will
send a copy to NHS Pensions, or your benets may be delayed.
Yes please give details below
Certicate number
No
/ /
£
.
Data Protection Act 1998: Fair Processing Notice
The NHS Business Services Authority - Pensions Division will only use the information that you have provided on this
form for as long as is required by law. Your details will then be removed from our les. We will not transfer your Per-
sonal Data outside the European Economic Area or disclose it to any third party other than for the purposes of detect-
ing and preventing fraud and errors or as required by law. We may contact you to discuss your application by any of
the methods you have entered on this form.
4
Bank/Building Society account details:
Name(s) of account holder (either applicant's own account
or a joint account with someone else)
Branch sort code
Account number to be credited
and/or Building Society Roll No.
Type of account
Current account - enter 0 Deposit account - enter 1
If your bank is outside the UK, please indicate which country your pension will be paid to:
You will need to complete the mandate for the payment to be made to an overseas bank and attach it to this
form (see guidance notes).
Full name and address of your bank or building
society in the UK, Channel Isles, Isle of Man or Irish
Republic only
Part 5 - Payment details
Post code
- -
Title (e.g. Mr, Mrs, Miss, Dr)
Surname
Former surname (If applicable)
Other names
National Insurance number
Date of birth
Address
Contact telephone number
Email address
/ /
Post code
About yourself. Please write in CAPITAL LETTERS using BLACK INK
Other pensions: Name Reference Number
If you have any other pensions
paid by Paymaster please give
details, including Paymaster reference
number of any other pension
5
Part 6 - Declaration
Please sign and date this in the presence of a witness. The notes below explain who can witness.
I DECLARE that:
• I have read the Retirement Booklet for members of the NHS Pension Scheme and the application
guidance notes attached to this form.
• The information I have given is correct and complete to the best of my knowledge and belief. If I become
aware of any change in the information given on the form, or any further new information relevant to the
form, after I have sent it I hereby agree to notify NHS Pensions of those changes and any further or new
information at the earliest possible opportunity.
• I will notify NHS Pensions if I recycle my NHS Pension Commencement Lump Sum
• I understand that I will have to repay any overpayment of pension if necessary.
• If I have Enhanced, Primary or Fixed protection certicate from HMRC I have enclosed a copy of the
certicate.
• If I have Fixed Protection I declare I have checked for Benet Accrual (Note 2 on the Certicate for Fixed
Protection refers) and have not had Benet Accrual up to and including the date of my retirement.
• I am entitled to and apply for my Pension Credit benets from the NHS Pension Scheme.
Applicant's usual signature
Date
/ /
Please ask your witness to sign and complete the section below.
Witness: The spouse or civil partner of an applicant may not witness.
Persons who may witness -
A person registered in the U.K. as a parliamentary elector may witness in any part of the world.
Outside of the United Kingdom, the Declaration may also be witnessed by one of the following persons.
They should state their qualication in the witness space below:
A listed or retired ofcer of Her Majesty's armed forces.
A permanent or retired civil servant of any country in the British Commonwealth or in the Irish Republic.
A member of Her Majesty's diplomatic service.
An authorised bank ofcial.
A physician or surgeon registered in the territory where the Declaration is made.
A minister of religion.
A master of a merchant ship who is a British subject.
A Commonwealth or Irish Republic university graduate.
A magistrate.
A barrister, solicitor or advocate authorised to practise in the territory where the Declaration is made.
A Notary Public or other person competent by the law of the territory where the Declaration is
made to administer oaths.
In the Channel Isles: A Channel Isle elector.
In the Isle of Man: An Isle of Man elector.
I CERTIFY that the above Declaration was signed IN MY PRESENCE by the applicant, whom I
believe to be the person named.
If you are registered in the United Kingdom as a parliamentary elector, please tick this box:
If you are witnessing outside the United Kingdom
and you are not a U.K. parliamentary elector, please
write your qualication, from the list above, in this box.
/ /
Witness Signature
Please print your full name
Date
Address
Post code
6
General
Before you complete the claim form you may need to read or download further information from the website
at: www.nhsbsa.nhs.uk/pensions.
Please complete and return the Census form which you should have received or downloaded with this form.
If you do not have a Census form you can download one from the website at: www.nhsbsa.nhs.uk/pensions.
Please return this form and the Census form together with the certicates required to NHS Pensions,
Hesketh House, 200-220 Broadway, Fleetwood, Lancashire FY7 8LG.
Part 1 Scheme reference number
Please enter your Scheme reference number. It is an 8 digit number where the rst 2 digits correspond to
your year of birth eg if you were born in 1950, 50/123456. If you do not know your reference number leave
this blank.
Part 2 About yourself
Please enter details about yourself including your contact telephone number and email address, if you have
one. You must enclose your original birth certicate or an original certied copy of it. If you do not have an
original birth certicate you may send your original passport. All documents will be returned to you promptly.
Part 3 Type of Pension and Retirement Lump Sum
3.1
In this part of the form we ask you to indicate the reason you are claiming your Pension Credit benets and
the Section of the Scheme you are claiming them from by ticking the appropriate box(s). If you are unsure
which section of the Scheme you are claiming your benets from please refer to previous correspondance
from us about your Pension Credit.
Reached normal pension age. You can claim this if you have reached the normal pension age of 60 for a
Pension Credit in the 1995 Section or 65 for a Pension Credit in the 2008 Section.
Early payment of Pension Credit benet. If you wish to claim your Pension Credit before you reach
the normal pension age your benets will be reduced to take account of this. If you have not previously
received an estimate of your benets you can see how much they will be reduced by in the table in the
'Early retirement' section of the Scheme Guide available on the website at: www.nhsbsa.nhs.uk/pensions.
You will need to supply the date from which you would like your Pension Credit benets to be paid. The
‘date’ can be the later of your minimum pension age, the date you rst made your enquiry about receiving
these benets or the date you sign this claim form. You must insert a date or your application form will be
returned.
Early payment of Pension Credit benet on Ill-health grounds. You can claim this if you have been
notied that your ill-health retirement application form AW240PC has been accepted.
Commuted early payment of Pension Credit benet on Ill-health grounds. Your Pension Credit
retirement benets can be paid as a one off lump sum if you are terminally ill. Remember to attach a form
AW341, which you can get from the Member Forms section of the website at: www.nhsbsa.nhs.uk/pensions
Pension Credit Claim Form (AW8PC)
- Guidance Notes for Applicants
AW8PC Guidance Notes (V3) 05/2012
7
3.2
Tick the appropriate box to indicate which Section of the Scheme you are claiming Pension Credit benets
from and follow the instruction to complete the relevant remaining questions in this part.
3.3 1995 Section
If your pension sharing order came into effect before the retirement of your former spouse or civil partner
you will receive a lump sum and you have the option to increase your lump sum by converting some of your
pension. The maximum additional lump sum allowed under HM Revenue and Customs rules is 33/14 times
your annual pension (before conversion to additional lump sum). You can claim any amount of additional
lump sum up to a total of this maximum. Pension is converted to lump sum at the rate of £12 additional
lump sum for every £1 of pension given up. You can nd a calculator tool to help you model the amount of
additional lump sum you can claim on the website at: www.nhsbsa.nhs.uk/pensions.
If you are eligible for a lump sum you must indicate whether or not you want an additional lump sum by
ticking the appropriate box. If you want an additional lump sum select either the maximum lump sum
permitted or enter an additional lump sum amount in whole £s and in multiples of £12, which together with
your standard lump sum is not greater than the permitted maximum lump sum.
If your pension sharing order came into effect after the retirement of your former spouse or civil partner you
will not receive a lump sum and should leave this part blank.
3.4 2008 Section
There is no basic lump sum entitlement but if your pension sharing order came into effect before the
retirement of your former spouse or civil partner you do have the option of receiving a retirement lump sum
by giving up a part of your pension. The maximum lump sum allowed under HM Revenue and Customs
rules is 33/14 times your annual pension. You have to give up some of your pension to get a retirement
lump sum. You will receive £12 of retirement lump sum for every £1 of pension you give up.
If you are eligible for a lump sum you must indicate whether or not you want a lump sum by ticking the
appropriate box. If you want a lump sum then select either:
• the maximum lump sum permitted; or
• enter a lump sum in whole £s in multiples of £12, which is not greater than the permitted maximum lump
sum.
If your pension sharing order came into effect after the retirement of your former spouse or civil partner you
will not receive a lump sum and should leave this part blank.
Part 4 HM Revenue and Customs (HMRC) Information
To comply with HMRC legislation it is important that you complete these questions correctly. Failure to do so
may delay the payment of your pension and lump sum.
4.1
You must answer this question. If you do not have any other pension arrangements outside the NHS
Pension Scheme, tick ‘No’ and go straight to question 4.6. ‘Any other pension arrangement’ does not
include any State pension benets you are being paid or any pensions that you are being paid as a survivor
or dependant.
4.2
If you have answered ’Yes’ to question 4.1 you must also complete this question by ticking the appropriate
box. If you answer ‘Yes’ or ‘Don’t know’, you need to read or download the ‘Limits on tax-free pension
benets factsheet’ from the website at www.nhsbsa.nhs.uk/pensions before completing the next question. If
you tick ‘No’ go straight to question 4.6.
8
4.3
If you answer ‘Yes’ please complete both questions 4.3(i) and 4.3(ii). If you do not know the percentage
of the Lifetime Allowance (LTA) used, or the date your benets crystallised, your other pension provider(s)
will be able to conrm these details for you. The date of the Benet Crystallisation Event (BCE) cannot be
before 6 April 2006. This date is important as it could affect the calculation of the LTA you have used. If you
answer ‘No’ please continue to question 4.4.
4.4
If you answer ‘Yes’, because please complete question 4.4(i) conrming the total annual pension in payment
at the earlier of either the date of the rst BCE (see 4.3(i)), or the date you are completing this form. If you
answer ‘No’ please go to question 4.5.
4.5
Please tick this box if you cannot provide the percentage gure and BCE date, or the amount of pension
in payment for a pension that started before 6 April 2006 and you wish your benets to be paid before you
can conrm this information. Your application will be processed by treating your NHS Scheme benets as
entirely in excess of the standard LTA and applying the LTA Charge of 55% to your lump sum and 25% of
the capital value of your pension (this is the pension payable multiplied by 20). When the details are known
please let this ofce know in writing and the charges will be checked and amended as appropriate. Any over
deducted charges will be returned. Please continue to question 4.6.
4.6
If you answer ‘Yes’ you must enclose a copy of your certicate with this application form and conrm the
certicate reference number in the box provided. If you have more than one certicate then please add the
reference number(s) to the form and enclose a copy of each protection certicate.
Part 5 – Payment details
Please enter the details of Bank or Building Society where you would like your benets to be paid. Your
benets will only be paid into a bank or building society account, as this is the safest method of payment.
Complete this section fully to ensure Xanity Paymaster can arrange payment of your benets.
If your bank account is outside the UK, payments can be made direct, providing it is one of the countries
listed in the ‘Retirement Booklet’ and it is capable of receiving secure electronic payments of funds. You will
need to complete the mandate for the payment to be made to an overseas bank and attached it to this claim
form. This is available from the website at: www.nhsbsa.nhs.uk/pensions.
Part 6 Declaration
You must read the declaration before you sign and date the application form in front of a witness and ask
them to certify this by completing their details and also signing the form.
You must read the Retirement Booklet and any associated factsheets if you are unclear on any of the points
in this section.
Information on the recycling of Pension Commencement Lump Sum is available in the 'Limits on tax-free
pension' factsheet available from the website at: www.nhsbsa.nhs.uk/pensions.
