Any Other Information ACTUAL ACTUAL CONTRIBUTIONS TO BE PAID FOR YEAR SUPERANNUABLE SALARY SUPERANNUABLE SALARY Paid at Source by OOH Provider Employee Employer Added years FOR YEAR 2011/12 FOR YEAR 2011/12 PRO [Yes/No] £ % £ % % [existing GPs] RATA [i.e. GPs who start OUT OF HOURS INCOME during the year] Any Other Information DECLARATION OF EMPLOYER I certify that the information on this form is correct. Employer’s signature: Position in practice:
Any Other Information ACTUAL SUPERANNUABLE SALARY FOR YEAR 2011/12 [existing GPs] OUT OF HOURS INCOME ACTUAL SUPERANNUABLE SALARY FOR YEAR 2011/12 PRO RATA [i.e. GPs who start during the year] CONTRIBUTIONS TO BE PAID FOR YEAR Paid at Source by OOH Provider [Yes/No] Employee Employer Added years £ % £ % % Any Other Information DECLARATION OF EMPLOYER I certify that the information on this form is correct. Employer’s signature: Position in practice: