Unmarried partner nomination form - Pensions

GUS 4
Public Sector Pensions Authority
Isle of Man Government Unified Scheme 2011
Deferred Benefits Claim Form
Before completing this form please read the Unified Scheme Guide and the guidance notes on Page 6 of
this form.
Part 1 – PSPA or Scheme Reference Number
Please enter your PSPA or scheme reference number
Part 2 – About Yourself
2.1 About yourself. Please write in CAPITAL LETTERS using BLACK INK
Title (e.g. Mr, Mrs, Miss, Dr)
Address
Surname
Former surname (if applicable)
Other names
Postcode
Contact telephone number
National Insurance Number
Email Address
Date of birth (enclose your birth certificate with this form) / /
2.2 Verification of your Identity
Please indicate what you have enclosed:
I enclose a certified true copy of my passport
I enclose a certified true copy of my driving licence
2.3 Verification of your Address
I enclose a current utility bill / bank statement* as proof of my address
*delete as appropriate

2.4 About your status – Please ensure that all documents supplied are the originals or a certified true copy
Single (not previously married)
Married Please give date / /
(enclose your marriage certificate and spouse‟s birth certificate)
Civil Partnership Please give date / /
(enclose your civil partnership registration and civil partners birth certificate)
Widowed/surviving partner Please give date / /
(enclose your spouse‟s or civil partners death certificate)
Divorced or dissolved civil partnership Please give date / /
(enclose your decree absolute or certified civil partnership dissolution order)
2.5 About your spouse/civil partner
Your spouse‟s or civil partner‟s surname
Your spouse‟s or civil partners other names
Your spouse‟s or civil partner‟s date of birth
/ /
Your spouse‟s or civil partner‟s NI No.
2.6 Have you any dependant children? No Yes Please give details below
Surname Forenames Gender (M/F) Date of birth
Continue on a separate sheet if needed
Part 3 Type of Pension and Retirement Lump Sum
3.1 Why are you claiming your deferred benefits? Please tick the box(es) which applies to you.
Retirement based on age*
*For Existing Deferred Members your benefits may be actuarially reduced to take account of this
Early payment of benefits based on ill-health grounds
Commuted early payment of benefits based on ill-health grounds
Date you are claiming your benefits from
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3.2 Benefits - If you need a pension benefits estimate to help you decide how much lump sum you
need, please see Notes Page 6 which will tell you how to request one.
Do you wish to give up part of your pension Yes continue below No go to part 4
to receive a lump sum or if you are an
Existing Deferred Member a higher lump
Sum?
If YES do you want the maximum Yes go to part 4 No continue below
lump sum permitted?
If NO, please specify the amount required not more than the maximum amount permitted
Amount of lump sum £
(whole pounds only)
3.3 Trivial Commutation of Pension
If your pension entitlement is small you may be able to claim your pension on grounds of Triviality.
Do you wish to claim your pension benefits Yes continue below No go to part 4
on the grounds of triviality?
Is your overall pension fund value from all Yes No
your pension‟s schemes, including the
Unified Scheme less than £18,000 (or
overall pension entitlement less than £900 pa)?
Part 4 – Employment Details
What was the name of your last IOM Government Employer?
What date did you leave? / /
What was your job title?
Are you currently working for the Yes No
IOM Government?
If YES, where are you employed?
What date will you be leaving?
We cannot pay your pension without this information
Do you intend to work for the IOM Yes No
Government after you get your pension?
If yes, please provide the name and address of your employer
Name
Address
Postcode 3

Part 5 Payment Details
About yourself. Please write in CAPITAL LETTERS using BLACK INK
Title (e.g. Mr, Mrs, Miss, Dr)
Address
Surname
Former surname (if applicable)
Other names
Postcode
Contact telephone number
National Insurance Number
Email Address
Bank/Building Society account details:
Name(s) of account holder (either applicants own account or a joint account with someone else)
Full name and address of your bank or building Society (IOM, UK, Channel Islands only)
Branch sort code
-- --
Account number to be credited
And/or Building Society Roll No.
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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 Isle of Man Government Unified Scheme 2011 Guide Book and or the Retirement Fact
Sheet 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 the Public Sector Pensions Authority
(PSPA) of those changes and any further or new information at the earliest possible opportunity.
Applicants usual signature
Date
Please ask your witness to sign and complete the section below.
Section 4 – Witness declaration
A witness must be an authorised Bank Official, Public or Civil Servant, Doctor, Justice of the Peace or a
Solicitor. By signing below, the witness confirms they are not a relative or nominee and were present at
the time the applicant signed above.
Title (Mr, Mrs, Miss, Ms, Dr,
other )
Surname
Other names (in full)
Address
Occupation
Witness signature
Date
Return to
Please return your completed PSPA Deferred Benefits Claim Form and enclosures to:
Public Sector Pensions Authority
Goldie House
1 - 4 Goldie Terrace, Upper Church Street
Douglas, ISLE OF MAN
IM1 1EB
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Deferred Benefits Claim Form
Guidance Notes for Applicants
General
Before you complete the claim form you may need to read the scheme member guide or download
further information from the PSPA website at www.pspa.im
Requesting an Estimate
Your annual statement will give you an estimate of the pension and lump sum benefit that is payable to
you at retirement. If you need an up to date estimate, you can request one by emailing
pensions@pspa.im To help us deal with your request, please include your full name, address, date of
birth and scheme reference number (this can be found on your annual statement). Please also include
the date you wish to claim your benefits from.
Part 1 Your PSPA or Scheme Reference Number
Please enter your reference number. It will usually be stated on any correspondence from us. If you
don‟t know it, leave this blank.
Part 2 – About Yourself
2.1 Personal Details
Please enter details about yourself including your contact telephone number and email address, if you
have one. You must enclose your original birth certificate or an original certified copy of it. If you do not
have an original birth certificate you may send your original passport. All documents will be returned to
you promptly. If you prefer, you can call in to our offices in Douglas and we will take a copy of your birth
certificate or passport.
2.2 and 2.3 Verification of Identity and Address
As with any type of financial claim, we need to ensure you are who you say you are and that you live at
the address you have provided. We verify this information by requesting sight of a:
Photographic identity (by way of a original or certified copy of your driving licence or passport)
and
An original utility bill or bank statement
2.4 and 2.5 About Your Adult Dependants
It is important that your tell us your current status and supply details of your spouse or civil partner, if
you have one. This information is used in the event of your death and informs us if there is any
survivor‟s benefits payable if you die before your spouse or civil partner. Having these details will speed
up the payment of any survivor‟s benefits due and will also put less strain on your dependants at that
time. You must enclose original or certified copies of any certificate or documents asked form.
Photocopies are not acceptable. If you have previously nominated a partner by sending us Form GUS 4,
please refer to this here.
2.6 Dependant Children
A child allowance may be payable on your death. The terms „child allowance‟ and „child‟ can cover a
number of other possible dependants as well as your own children – see below for more information.
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An allowance may be paid if the child is dependant on you, both at retirement and on death, and they
are:
‣ Below age 18;
‣ Below age 23 and undergoing full time education or vocational training; or
‣ Aged 23 or over and incapable of earning a living due to permanent mental or physical disability
which he/she is suffering at the time of your death
“Child” can include:
‣ Your natural children
‣ Your step children and children of a civil partnership
‣ Adopted children
‣ Natural grandchild who was financially dependent on you at the date of your death
A full list of the definitions of a Child can be found in the Scheme Rules available on the website at
www.pspa.im
Enter the details of any qualifying children in the boxes.
Part 3 – Type of Pension and Retirement Lump Sum
3.1 In this part of the form we ask you to indicate the type of pension you are claiming.
Retirement based on your age. You can claim this if you are aged 55 or over.
If you are an Existing Deferred Members the early payment of your deferred benefits, before the normal
pension age specified on your Statement of Entitlement, will be reduced to take account of this.
You will need to supply the date from which you would like your retirement benefits to be paid. The
„date‟ can be the later of your minimum pension age, the date you first made your enquiry about
receiving these benefits or the date you sign this claim form. You must insert a date or your application
form will be returned.
Early payment of deferred benefits on Ill-health grounds. You can claim this if you have been
notified that your ill-health retirement application has been accepted.
Commuted early payment of deferred benefits on Ill-health grounds. Your ill-health retirement
benefits can be paid as a one off lump sum if you are terminally ill. You can claim this if you have been
notified that your ill-health retirement application has been accepted.
3.2 In this part of the form we ask you to indicate if you wish to commute or ‘give up’ some
of your pension in exchange for a lump sum.
How this work will depend on what type of deferred member you are.
If you are an Existing Deferred member with the right to an automatic lump sum – see note 3.2a
If you are an Existing Deferred member with no right to an automatic lump sum or a deferred member
from the Unified Scheme – see note 3.2b.
3.2a Deferred Members with a right to an automatic lump sum
Some Existing Deferred Members have a right to an automatic lump sum as well as having the option to
a commute or „give up‟ some of your pension for a higher lump sum. Your Statement of Entitlement will
confirm your right to an automatic lump Sum. You can refer to our Existing Deferred Members Factsheet
on the resources page of our website for more information.
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You are able to give up part of your pension for a higher one-off cash lump sum of up to 30% of the
value of your benefits. For each £1 of pension given up, a lump sum of £18 will be paid.
The maximum lump sum you can take is approximately 5.8 times your pension, before you take a lump
sum.
Claiming a bigger lump sum does not affect the level of survivor benefits payable to a partner or
dependent child.
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 £18, which together with any standard lump sum is not
greater than the permitted maximum lump sum.
3.2b Deferred Members with no automatic lump sum
If you are a deferred member, with no automatic right to a lump sum i.e. an Ex member of a Nuvos,
Premium, NHS 2008 or Unified Scheme you would not have had a automatic lump sum. Instead, you
have the option of receiving a retirement lump sum by giving up a part of your pension.
You are able to give up part of your pension for a higher one-off cash lump sum of up to 30% of the
value of your benefits. For each £1 of pension given up, a lump sum of £18 will be paid.
The maximum lump sum you can take is approximately 5.8 times your pension, before you take a lump
sum.
Claiming a bigger lump sum does not affect the level of survivor benefits payable to a partner or
dependent child.
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 £18, which is not greater than the
permitted maximum lump sum.
3.3 Trivial Pensions
If your expected total pension income from all your pension arrangements, including the Unified Scheme
is small at less than £900 per year or has a value of £18,000 or less, then you may be able to claim them
on grounds of triviality.
This means that instead of paying you a small pension each year, we will exchange the pension for a
one-off trivial cash lump sum.
If you choose to do this, any surviving partner pension will be included in the trivial lump sum. All liability
for a surviving partner pension and any death benefit lump sum will be discharge once the trivial
commutation is paid.
This can only be paid to you if you are under age 75 at the time of payment.
Part 4 – Employment Details
In this part of the form we ask for details of your previous/current IOM Government employer. We also
ask for future employer details if you intend to work (or continue to work) for the IOM Government after
you get your pension in case it is subject to suspension or abatement.
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If you are claiming benefits from the Unified Scheme, you will normally have stopped working for the Isle
of Man Government. However, if you are in employment being in receipt of a deferred pension may
affect your right to future participation of the Unified Scheme.
Part 5 – Payment Details
You must fully complete this section, including entering your personal details again.
Please enter the details of Bank or Building Society where you would like your benefits to be paid. Your
benefits will only be paid into a bank or building society account, as this is the safest method of
payment.
Payments will only be made to IOM, UK or Channel Islands bank accounts that are capable of receiving
secure electronic payments of funds.
Pensions are paid in monthly instalments on the 25th of each month, direct to either your bank or
building society account. It is important to note that for any retirements that fall after the 7th of the
month, the first instalments will not be paid into your back account until the 25th of the following month.
Lump Sums are paid by directly into your bank or building society account. It is important to note that
the PSPA aim to pay out the lump sum on the Friday following your retirement date and within 2 weeks
of your retirement date.
Important Note: We would encourage all members to check with the pension administrators when
your pension and or lump sum will be paid, before making any financial commitments.
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 information in our Scheme Guide and any associated factsheets if you are
unclear on any of the points in this section.
Please return the completed PSPA Deferred Benefits Claim Form to:
Public Sector Pensions Authority
Goldie House
1 - 4 Goldie Terrace, Upper Church Street
Douglas
ISLE OF MAN
IM1 1EB
Where can I find more information?
You can find more information using the resources on our website at www.pspa.im
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