Form AFPS Form 22
Part A - Your details
Q1. First name
Part A - Your details
Q2. Surname
Part A - Your details
Q3. Service number
Part A - Your details
Q4. National Insurance number
Part A - Your details
Q5. Date of birth
Part A - Your details
Q6. Please provide the address you want us to send your certificate to
Part A - Your details
Q7. Postcode
Part A - Your details
Q8. Telephone number
Part A - Your details
Q9. Email address
Part B - Benefit Crystallisation Event History
Q10. Date of Pension LTA Protection Type Percentage Amount of Details of evidence
Part B - Benefit Crystallisation Event History
Q10a. BCE Scheme (if applicable)
Part B - Benefit Crystallisation Event History
Q10b. of LTA used tax-free attached payment
Part B - Benefit Crystallisation Event History
Q11. If you have Lifetime Allowance Protection, you must provide a copy of the protection certificate.
Part B - Benefit Crystallisation Event History
Q12. For every Benefit Crystallisation Event you list (except for any paid from the Armed Forces Pension Scheme) you need to provide clear evidence of:
Guidance: • Lifetime Allowance percentage used
• Tax-free lump sum paid
This can be provided in any of the following formats. You may need to provide more than one document for each event:
• Pension Award Letter
• Benefit Crystallisation Event Statement
• Bank Statement showing amount of Tax-Free Amount cash received
• Any other form of statement from the pension with BCE information
Part B - Benefit Crystallisation Event History
Q13. If your only BCE event is from the Armed Forces Pension Scheme, you do not need to provide additional evidence.
Part C - Data Protection
Q14. How the MOD collects and uses personal information
Part D - Declaration
Q15. I confirm that
• I have not taken any Relevant Benefit Crystallisation Event since 6 Apr 24
• I have not applied for a Transitional Tax-Free Amount Certificate from another scheme
Part D - Declaration
Q16. I understand that
• Checks may be conducted to verify this information
• If I have not provided complete evidence this application can be refused
• If I provide false statements I could be subject to a penalty fine
• If as a result of providing inaccurate information any certificate issued could be cancelled and I will be liable for any additional tax as a result of this
Part D - Declaration
Q17. Remember – You must sign this form yourself if you can, even if someone else has filled it in for you.
Part D - Declaration
Q18. If a representative who acts as a Power of Attorney or Appointee for the claimant is signing this form, they must enclose evidence to show that they are the legal representative.
Part E - Consent for Email Correspondence
Q19. I authorise Veterans UK of the MOD to use email whenever possible in its correspondence with me via my nominated email address shown on the front of this claim form. I accept that the information may include my personal details excluding bank account numbers, National Insurance number, medical details and any other information that could compromise my identity
Part E - Consent for Email Correspondence
Q20. I understand that correspondence transmitted by email may be open to abuse because it is transmitting over an unsecured network. I accept that the MOD will not be liable for any loss, interception or unauthorised use of information transmitted this way. I am content for Veterans UK to correspond with me from the email address shown at the front of this claim form
Part E - Consent for Email Correspondence
Q21. Do you wish to correspond by email? Yes No
Options: Yes; No
Part F - Signature of Applicant
Q22. Signature
Part F - Signature of Applicant
Q23. Date