Opt out form - Pensions

GEN P 8/12 1Pension scheme opt out formYou can opt out of the Police Pension Regulations 1991 or the Police PensionRegulations 2010 (the Scheme) using this form. This means you will not be a member of theScheme and will not be using it to save for your retirement.Section 1 – Your personal detailsTitle (Mr, Mrs, Miss, Ms)SurnamePrevious Surname (if applic)Other namesAddressScheme Number (if known)National Insurance numberDate of birthEmployer and locationRankSection 2 – Your declarationI have read the notes overleaf and the related fact sheet and in full knowledge of the potentialbenefits available to me, I declare that I do not wish to remain a member of the Scheme andthat after this election takes effect I will no longer be pensionable under the Scheme and maybe permanently excluded from re-joining the scheme for the remainder of my period of service.I understand that I will not be able to claim any benefits under the Scheme. These include:» A fully inflation-protected retirement pension payable from retirement based on mypay and length of service.» A tax-free lump sum.» A survivor pension paid to my eligible partner if I die.» Death benefits including lump sum payable to my beneficiaries.» Children’s pensions if I die.» Ill-health retirement benefits.Your signatureDate

GEN P 8/12 2Section 3 – To be completed by your Employing Authorities pay officeThe section below is to be completed by your relevant payroll or finance representative once you havecompleted Section 1 and 2 of your form.Date Opt Out form issued toemployeeDate Opt Out form receivedfrom employeeDate current period ofemployment commencedDate current period of schememembership commencedEmployee last day of schememembershipEmployee payroll orassignment numberHas the member paidcontributions in thisemployment?Did you receive this form fromthe employee within the first 3months pay period withoutcrossing a financial year end?YES/NOYes - please refund thecontribution through the payroll systemNo – The PSPA will pay anyrefund due on receipt of themembers leaver form andGen 1/12 from the employerDate Gen 1/12 and Gen 2/12forwarded to PSPA (ifrelevant)Completed by:Name and DesignationEmploying Authority Name andAddressSignatureDate

GEN P 8/12 3Important notes about your decisionPlease read these notes carefully:1. You should only complete this form if you do not wish your future employment to bepensionable under the Police Pension Regulations 1991 or the Police PensionRegulations 2010 (‘the Scheme’), and you are either:a. currently in employment which is pensionable under those regulations; ORb. intending to take up such employment in the future.2. The election will have effect from either of the following:a. If you complete the form within three months after taking up an appointment inemployment which would be pensionable under the Scheme, the first day of thatemployment.b. The first day of the month following the date you sign the form.You will be notified as soon as the election has been processed.3. Any service you do complete after the date the election takes effect will not be pensionableunder the Scheme Regulations. The election will not, however, affect any pension rights youhave built up in respect of service completed before the date on which it takes effect.4. If at any time in the future you wish to consider coming back into the Scheme you canobtain further information about the conditions for rejoining the Scheme by contacting theadministrator.5. Please complete Sections 1 and 2, before returning it to your employer.6. Note to employers: Upon receipt of this form from your employee, action opt out decisionand complete Section 3 and then return the completed form to:Public Sector Pensions AuthorityGoldie House1 - 4 Goldie Terrace, Upper Church StreetDouglasISLE OF MANIM1 1EEOr Email to pensions@pspa.imWhere can I find more information?You can find more information using the resources on our website at www.pspa.im