Skip the NI Direct Bar

Members and Former Members

Pensioners and Dependants

Medical Advisors

Your Pension Choice

Forms

Need help viewing our documents?

Forms

You can use the links below to access the scheme forms you will need to complete when members Join, Leave or Retire from the Scheme.

Forms are also available in respect of Ill Health Retirement, Permanent Injury Benefit, Additional Pension Purchase and Internal Disputes Resolution.

Joining The Scheme

Information for Joining or Rejoining the HSC Pension Scheme
Joiner Information Leaflet (PDF 21KB)

Scheme Joining Form - Main HSC Employers
J1 (PDF 36KB)

Scheme Joining Form - GP Practices/OOH Providers/Direction Employers
J2 (PDF 22KB)

Leaving the Scheme

Application to leave the Scheme
SD502 (PDF 47KB)

Application Forms

Pension Application Form - Age,Ill Health, VER (Reduced),Redundancy
AW6 (PDF 170KB)

Pension Application Form - Preserved Members
AW6 (P) (PDF 128KB)

Application to Commute Age Retirement Benefits - Life Expectancy Less Than 1 Year
AW34 (PDF 32KB)

Application for Payment of Child Allowance
AW9 Post 1/4/08 (PDF 31KB)
AW9 Pre 1/4/08 (PDF 94KB)

Claim for Life Insurance Lump Sum-1995 Section Members
AW10 (PDF 134KB)

Claim For Death in Service Benefits - 1995 Section Members
AW11 (MS Word 113KB)

Application for Payment of a Death Gratuity to Personal Representative(s) - Death on Pension or Death on Preservation of Benefits
AW11-3 (PDF 54KB)

Notification of Salary Related Survivor's Pension
AW135 (PDF 33KB)

Claim for Survivor Benefits/Child Allowance (Death of a Scheme Pensioner)
AW11/2 (MS Word 61KB)

Preliminary Application for Purchase of Additional Pension
AP1 (PDF 22KB)

Election to Purchase Additional Pension
AP2 (PDF 32KB)

Application for Ill Health Retirement
AW33-09 (PDF 285KB)

Application for Consideration of Entitlement to Early Payment of Deferred Benefits Due to Ill Health
AW240 (PDF 131 KB)

Permanent Injury Benefit Application Form
PIB1 (PDF 217KB)

Employer Request for Early Retirement Estimate - RPA
RPA1 (PDF 25KB)

Application for a Refund of Contributions
REF(1) (PDF 96KB)

Nomination Forms

Partner Nomination Form
PN1 (PDF 35KB)

Death Benefit Nomination Form
DG3 (PDF 38KB)

Cancellation of Partner Nomination/Death Benefit
Cancel (1) (PDF 25KB)

Pensions on Divorce

Pensions on Divorce - CETV Request/Member Declaration
PD1 (PDF 21.2KB)

Pensions on Divorce - CETV Application Form
PD2 (PDF 92KB)

Internal Disputes

Internal Disputes Resolution - Stage 1
DRP1 (PDF 38KB)

Internal Disputes Resolution - Stage 2
DRP2 (PDF 35KB)

Guidance Notes (MS Word 69KB)

GP Forms

2010/11 GP (and non GP) Providers Annual Certificate of Pensionable Profits 2010/11

Annual Certificate of Pensionable Profit (MS EXCEL 178 KB)

Guidance Notes for completion of certificate (PDF 136 KB)

Frequently Asked Questions (FAQs) (PDF 114 KB)

Creating Pension Overlap Notes (PDF 110 KB)

Calculation of Estimated Monthly Practice Superannuation Payment on Account 2011/12
POA Form (MS Word 67.5 KB)

GP Practice Staff Contributions Record
GP1 (PDF 35KB)

Certificate of GP Locum work and Pay
GP Locum A (PDF 26KB)

Monthly Record of GP Locum Pay and Pension Contributions
GP Locum B (PDF 43KB)

GP Claim for Pensionable GP Ad-Hoc Work
Solo Form (PDF 34KB)

Annual Certificate of Pensionable Profit

End of Year Certificate 2009/10 (MS Excel 147 KB)

End Of Year Certificate 08/09 (7%) (MS Excel 135KB)

End of Year Certificate 07/08 (MS Excel 974KB)

End of Year Certificate 06/07 (MS Excel 97KB)

End of Year Certificate 05/06 (MS Excel 89KB)

End of year Certificate 04/05 (MS Word 133KB)
- Supplementary Notes (MS Word 38KB)

Fast Tracks

Scheme Information