Form AFPS15 – Added Pension Purchase or Cancellation
Part A – Your Details
Q1. Service Unit Section
Part A – Your Details
Q2. Unit Phone Number and Dial Code
Part A – Your Details
Q3. Rank First Name Surname (in block capitals) 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 correspondence to
Part A – Your Details
Q7. Postcode
Part A – Your Details
Q8. Telephone Number
Part A – Your Details
Q9. Email Address
Part A – Your Details
Q10. If you wish to start Added Pension payments, please complete Part B.
Part A – Your Details
Q11. If you wish to stop Added Pension payments, please complete Part C.
Part B – Added Pension request to start my payments
Q12. I want to purchase Added Pension for myself.
Part B – Added Pension request to start my payments
Q13. I want to purchase Added Pension for myself and my dependants.
Part B – Added Pension request to start my payments
Q14. I want to start my Added Pension monthly to DD/MM/YYYY
Part B – Added Pension request to start my payments
Q15. deductions from*
Part B – Added Pension request to start my payments
Q16. Please choose ONE of the options below You must complete the Method of payment so we can process your request of Added Pension
Options: I want to purchase £ monthly by lump sum and pay Lump sum will be deducted from salary unless a cheque is attached, made payable to HMG3601 (Please refer to your form 6 Quotation for details of the amount).; I want to pay £ a month via my salary; My preferred method is to pay in a lump sum via salary transfer By bank transfer using the details below: Account Name: MOD DBS MIL PERS UK RECEIPTS Sort Code: 60-70-80 Account Number: 10021116 If paying from abroad, please use the following: IBAN Number: GB87NWBK60708010021116 SWIFT Code: NWBKGB2L In all bank transfers please use your service number followed by the reference Added Pension in all cases, as in Service Number/Added Pension. Cheques must be made payable to HMG3601
Part B – Added Pension request to start my payments
Q17. I have previously purchased Added Pension through another public Service scheme to a value of £
Part B – Added Pension request to start my payments
Q18. I confirm that I am in scope for Remedy, and I am re-purchasing Added Pension. I wish to apply for compensation due to the lower value of Added Pension I will now receive due to the change in valuation factors and loss of growth since my original purchase. I understand the compensation I will receive will be in the form of an Added Pension top-up.
Part C – Added Pension – request to stop my payments
Q19. I want to stop my monthly payments for Added Pension on DD/MM/YYYY subject to payroll cycles. I understand that I cannot re-start payments for Added Pension until the 1st April of the next scheme year.
Part F - Consent for email correspondence
Q20. 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 F - Consent for email correspondence
Q21. 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
Q22. Do you wish to correspond via email? Yes No
Options: Yes; No
Part E - Declaration
Q23. I confirm that: the information I have given is accurate and complete to the best of my knowledge and belief. this supersedes any previous allocation that I have made.
Part E - Declaration
Q24. 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.
Part E - Declaration
Q25. if I knowingly give false information, I may be liable to prosecution.
Part E - Declaration
Q26. 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 G – Signature of Applicant
Q27. Signature
Part G – Signature of Applicant
Q28. Date