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Purchase Additional Pension (APC)

Additional Pension Contribution (APC) Form

Name(Required)
Forenames Surname
Title(Required)
National Insurance Number(Required)
Date of Birth(Required)
DD slash MM slash YYYY

Please format as dd/mm/yyyy
Payroll reference(Required)
Address(Required)
Street Address Address Line 2 City County Post code Country
Please attach your Application for Additional Pension Contribution (APC) Form you have completed using the external modeller(Required)
Link to: External Modeller
Drop files here or
Max. file size: 4 MB.
Declaration
Please read the following statements
• I understand that my monthly contribution rate may change in the future and due notice will be given. • I understand that if I retire before my State Pension Age or 65 if later my additional pension will be reduced, even if my main scheme benefits are not. • I understand that payment for my APC will only be deducted/requested after my employer has been contacted and confirmed I am in reasonably good health or a medical report has been provided which confirms I am not likely to leave or retire early due to an existing ill health condition.
Health Declaration(Required)
Please confirm one of the following statements
- I declare that I am in reasonably good health and give permission for you to contact my employer to confirm this
- I am not in good health but wish to make an APC purchase and understand that I may have to provide a medical report at my own expense prior to purchase
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Purchase Additional Pension (APC)

Additional Pension Contribution (APC) Form

Declaration