Form AFPS Form 3
Q1. Intentionally left blank
Part A – Your Details
Q2. First Name
Part A – Your Details
Q3. Surname
Part A – Your Details
Q4. Address
Part A – Your Details
Q5. Post code
Part A – Your Details
Q6. Service Number
Part A – Your Details
Q7. National Insurance Number
Part A – Your Details
Q8. Date of Birth (dd/mm/yyyy)
Part A – Your Details
Q9. Telephone Number – including Area code
Part A – Your Details
Q10. Email Address
Part B – Allocation of Benefit
Q11. I wish to allocate a portion of my pension(s) to the person/people below who is/are financially dependent upon me. I acknowledge that, should the allocatee die before me, the amount allocated will not be restored to me. I understand that this allocation becomes payable in the event of my death. I understand that where I have Accrued Rights to one or more a legacy pension schemes I am required to allocate on a per scheme basis. Once my pension(s) become payable, I cannot cancel the allocation(s). (Note: members can apply to surrender up to 37.5% of their pension during their lifetime so that after their death, allocated dependants will receive an income for life.) The scheme actuary calculates the payments which will be based on the dependant’s age and sex.
Part B – Allocation of Benefit
Q12. I have read and understood the statement above
Part B – Allocation of Benefits - continued
Q13. Percentage (to a maximum of 37.5%) % AFPS 05
Part B – Allocation of Benefits - continued
Q14. Percentage (to a maximum of 37.5%) % RFPS 05
Part B – Allocation of Benefits - continued
Q15. Percentage (to a maximum of 37.5%) % AFPS 15
Part B – Allocation of Benefits - continued
Q16. I wish to revoke a previous allocation I have made. (please tick box(es) as appropriate)
Options: AFPS 05; RFPS 05; AFPS 15
Part C – Allocatee Details
Q17. Please Note: Allocatees must be an existing contact on JPA. Please add allocatee(s) to your JPA contacts before submitting this form
If you do not have access to JPA please tick this box
Part C – Allocatee Details
Q18. First Name
Part C – Allocatee Details
Q19. Surname
Part C – Allocatee Details
Q20. Address
Part C – Allocatee Details
Q21. Postcode
Part C – Allocatee Details
Q22. Relationship
Part C – Allocatee Details
Q23. Gender Male Female
Options: Male; Female
Part C – Allocatee Details
Q24. Date of Birth (dd/mm/yyyy)
Part C – Allocatee Details
Q25. Telephone Number – including Area code
Part C – Allocatee Details
Q26. Email Address
Part C – Allocatee Details - continued
Q27. Is this person your legal next of kin? Yes No
Options: Yes; No
Part C – Allocatee Details - continued
Q28. Is this person your additional allocatee? Yes No
Options: Yes; No
Part C – Allocatee Details - continued
Q29. This nominee is to be provided with communications from the Service Welfare Organisations? Yes No
Options: Yes; No
Part D - Data Protection
Q30. How the MOD collects and uses personal information
The Ministry of Defence (MOD) is committed to protecting the privacy and security of your personal data and the MOD Privacy notice explains your rights and provides information that you are entitled to under UK data protection legislation. It is important that you read this notice, together with any other privacy notice that may be provided when we collect or process personal information about you so that you are aware of how and why we are using such information. The MOD Personal information charter contains the standards you can expect when we ask for, hold, or share your personal information and your rights under the law.
Part E - Declaration
Q31. I confirm that
• the information I have given is accurate and complete to the best of my knowledge and belief.
I understand that
• I must immediately tell the MOD of anything that may affect my entitlement to, or the amount of, payment made under any scheme administered by Veterans UK, including any change of address.
• if I knowingly give false information, I may be liable to prosecution.
I agree
• to refund any sum paid as a result of this allocation in the event that an overpayment is made for any reason.
Remember – You must sign this form yourself if you can, even if someone else has filled it in for you. 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 F - Consent for email correspondence
Q32. 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.
• 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 F - Consent for email correspondence
Q33. Do you wish to correspond via email? Yes No
Options: Yes; No
Part G – Signature of Applicant
Q34. Signature
Part G – Signature of Applicant
Q35. Date dd/mm/yyyy