NHS Pensions Overseas mandate form – Pension Reference: Dominica Application for payment of pension in XCD currency by direct deposit to: Part 1 - Personal details please complete in full – Forename: Family name: Address: Contact telephone number: Email address: Part 2 Overseas Bank Details Please complete in full – – Full name of bank or financial institution: Full address of bank or financial institution: Full name of account holder (as quoted on the bank account) max 18 characters Bank code Branch code All 8 digits are required, no hyphens, slashes or alpha characters to be entered. The Swift/BIC code is not required. Account number (13 numeric digits, no hyphens, slashes or spaces to be entered) Account Type (0 = Cheque/Current, 1 = Savings) Part 3 Please sign below: – Signed: Date: 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
NHS Pensions – Overseas mandate form Pension Reference: Application for payment of pension in XCD currency by direct deposit to: Dominica Part 1 - Personal details – please complete in full Forename: Family name: Address: Contact telephone number: Email address: Part 2 – Overseas Bank Details – Please complete in full Full name of bank or financial institution: Full address of bank or financial institution: Full name of account holder (as quoted on the bank account) max 18 characters Bank code Branch code All 8 digits are required, no hyphens, slashes or alpha characters to be entered. The Swift/BIC code is not required. Account number (13 numeric digits, no hyphens, slashes or spaces to be entered) Account Type (0 = Cheque/Current, 1 = Savings) Part 3 – Please sign below: Signed: Date: 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
Dominica%20Mandate%20%28V7%29%2005.2018.docx