Please note that the deadline to make an application for Individual Protection 2014 through HMRC was 5 April 2017. We will still provide Individual Protection valuations for members who submit this form on or after this date but please be aware the charge will still apply even if you are unable to use this valuation to apply for HMRC protection These charges are reviewed annually. Section 3 - Declaration I have referred to the NHS Pensions Schedule of Charges and I agree to pay the applicable charge for provision of the information specified at Part 2 of this form. Signature Name (please print) Date / / Section 4 - Payment Please confirm which of the following payment methods you have chosen: Bank transfer payment Cheque The bank account details for electronic The cheque should be made payments are as follows: payable to ‘NHS Business with Services Authority’, enclosed Sort code: 60-70-80 this form and posted to: Account number: 10021205 NHS Pensions Your reference must include the National PO Box 2269 Insurance number of the member followed Bolton by their surname. Your request cannot be BL6 9JS processed without this information. You need to email a copy of this form to or use the following postal address: NHS Pensions PO Box 2269 Bolton BL6 9JS All charges include VAT at the standard rate of 20% How we use your information The NHS Business Services Authority NHS Pensions will use the information provided for – administering your NHS Pension Scheme membership and processing payment of your NHS pension benefits. We may share your information to administer and pay your NHS pension, enable us to prevent and detect fraud and mistakes, for debt collection purposes, or as required by law. For more information about who we share your information with and how long we keep your personal data and your rights, please visit our website at
Please note that the deadline to make an application for Individual Protection 2014 through HMRC was 5 April 2017. We will still provide Individual Protection valuations for members who submit this form on or after this date but please be aware the charge will still apply even if you are unable to use this valuation to apply for HMRC protection These charges are reviewed annually. Section 3 - Declaration I have referred to the NHS Pensions Schedule of Charges and I agree to pay the applicable charge for provision of the information specified at Part 2 of this form. Signature Name (please print) Date / / Section 4 - Payment Please confirm which of the following payment methods you have chosen: Bank transfer payment The bank account details for electronic payments are as follows: Sort code: 60-70-80 Account number: 10021205 Your reference must include the National Insurance number of the member followed by their surname. Your request cannot be processed without this information. You need to email a copy of this form to or use the following postal address: NHS Pensions PO Box 2269 Bolton BL6 9JS Cheque The cheque should be made payable to ‘NHS Business Services Authority’, enclosed with this form and posted to: NHS Pensions PO Box 2269 Bolton BL6 9JS All charges include VAT at the standard rate of 20% How we use your information The NHS Business Services Authority – NHS Pensions will use the information provided for administering your NHS Pension Scheme membership and processing payment of your NHS pension benefits. We may share your information to administer and pay your NHS pension, enable us to prevent and detect fraud and mistakes, for debt collection purposes, or as required by law. For more information about who we share your information with and how long we keep your personal data and your rights, please visit our website at