Part A - Your Details
Service / Unit / Section
Unit phone number and Dial Code
Rank / First Name / Surname (in block capitals) / Service Number
Email address
You should complete this Form if you wish to buy in-scheme AVC’s (apart from Added Years AVC’s - use AFPS Form 5).
Part B - Declaration and Authorisation
1 / I am currently a serving member of the Armed Forces. I am a member of AFPS 75.
2 / I am not under notice of invaliding or premature retirement, nor have I any reason to believe that my health may prevent me from continuing in the Service until the completion of my commission/engagement.
3 / I have read and understood the contents of DIN 2012 01-249 Annex A and Part B of this Form.
4 / I wish to buy an AFPS 75 AVC to purchase one or more of the following:
a / Increase my death in service lump sum to be the greater of four times what my representative rate of pay would have been if I had had the maximum amount of reckonable service permitted or four times my annual pensionable earnings at the date of death. and/or
b / Maximise my Spouse/Civil Partner’s entitlement to a pension, based on representative pay rates for my rank at the date of my retirement or earlier death. and/or
c / Enable my total retirement benefits and all benefits payable to my survivors or estate on my death, other than attributable death or invaliding benefits, to be calculated on the same general basis as AFPS 75 benefits, but derived from my final taxable salary excluding additional pay and allowances, rather than from representative pay for my rank.
5 / I hereby authorise the Ministry of Defence to deduct from my gross pay, the AVC’s contribution required to purchase the benefits indicated in paragraph 4 above in accordance with the Factor tables available at: https://www.gov.uk/pensions-and-compensation-for-veterans
6 / I understand that the Scheme imposes limits on the total tax-deductible contributions that can be made in each tax year towards pension and death benefits of 15% of total taxable salary.
7 / I understand that the deductions will commence in the next available pay period following receipt of this option form by the pension awarding authority shown below, and will continue until I reach the age of 55, or until I retire if earlier.
Note: The decision to commence AVC’s is FINAL and IRREVOCABLE
Part C - Data Protection
The Ministry of Defence (MOD) is a Data Controller for the Data Protection Act (DPA) 1998. Under the act you have a right of access to your personal information held by Veterans UK. If you want to ask for a copy of that information, please write to us quoting your National Insurance number.
The MOD is committed to ensuring that all your personal data is processed in accordance with the DPA1998.
The personal data (including sensitive personal data, for example information about your physical or mental health or condition) collected and contained within this form will be retained on your physical file and may be used for all lawful purposes including
· by the MOD and its agents in connection with any claims made to Veterans UK or any other claims against the MOD.
· by other Government Departments which have a legitimate interest in this information for example for the purposes of research or for the prevention and detection of crime.
Part D - Declaration
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 to me as a result of this nomination in the event that an overpayment is made for any reason
Part E - Consent for email correspondence
Veterans UK is happy to conduct correspondence with customers via a nominated email address if that is their preference. There are some types of personal information we would not be able to include in an email correspondence, which are listed below:
· 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.
Do you wish to correspond via email? / Yes / No
Part F - Signature of Applicant
Signature
Date
IMPORTANT
You must complete and return the completed form; otherwise we will not pay any AVC’s. Please enter your name, address and service number in the boxes provided below. We will acknowledge receipt of the form within 28 days. We cannot start to process your claim until we receive this form.
Note- Once the completed application form has been forwarded to Veterans UK Pensions, and they have processed it, the decision to commence AVC’s is FINAL and IRREVOCABLE.
Fully completed and signed forms should be sent to:
Veterans UK, Process Team, MP 480, Kentigern House, 65 Brown Street, Glasgow G2 8EX
Part G – Acknowledgement
With complimentsYour AFPS Form 4 dated / / has been received / Veterans UK
MP 480
Kentigern House
65 Brown Street
Glasgow G2 8EX
Freephone: 0800 085 3600
Name
Address
Service number
Postcode
4
AFPS Form 4