Ill Health Retirement Application Form - Pensions

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GUS9 ISLE OF MAN GOVERNMENT UNIFIED SCHEMEDEFERRED ILL HEALTH RETIREMENT APPLICATION FORMB1 - Please provide full details to all the questions in this section.Your full nameYour home addressPostcodeYour home telephone number (inc STDcode)Your mobile telephone numberWhat is your GP’s name?DrWhat is the address of your GP’spractice?PostcodeWhat is your GP’s telephone number?Have you seen a consultant orspecialist?NoYesPlease tell us about theconsultantName of consultantName and address of the hospitalwhere you were last seen by theconsultant (or if seen privately, theconsultant’s private address)What does the consultant specialise in?Date when you were last seen by theConsultant?8
GUS9 ISLE OF MAN GOVERNMENT UNIFIED SCHEMEDEFERRED ILL HEALTH RETIREMENT APPLICATION FORMYour Public Service CareerB2 - Describe the training you have had for your public service job including dates. If you are amember of a professional group, give details and dates of your professional qualifications andregistration.B3 - Describe the experience you have gained within your public service career, giving datesand titles of all positions held and the relevant skills required to undertake your job.If necessary, continue on a separate sheet of paper and staple to this page.Other training and jobsB4 - If you have had any other training and / or have held other jobs since being employed inthe public service, please provide details with appropriate dates.9
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Ill Health Retirement Application Form - Pensions

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