Unmarried partner nomination form - Pensions

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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. 4
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 5
Page 1 and 2: GUS 4 Public Sector Pensions Author
Page 3: 3.2 Benefits - If you need a pensio
Page 7 and 8: An allowance may be paid if the chi
Page 9: If you are claiming benefits from t

Unmarried partner nomination form - Pensions

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