Contents Have you checked that WYPF have the correct address on record? * ..... 2 Rank* ..... 2 Marital Status ..... 2 Split Pension applies? ..... 2 2015 Protected Pensionable Pay (Final Salary) applies? ..... 2 Last date of service * ..... 3 Pay retirement benefits from ..... 3 Type of Retirement * ..... 3 Extra contributions - Were there any contributions outstanding at the date of leaving? ..... 3 Please provide any strike information that has not yet been notified to WYPF..3 Please provide strike information based on strike only in the last 12 months up to the last day of employment/active membership ..... 3 Additional Pension Benefits* ..... 3 Please provide annual rates of pay for the last 12 months in all cases: Any pay treated as temporary for pension purposes should be excluded but pensionable elements such as FDA included. CPD is also excluded ..... 4 Was pay higher in any of the earlier 2 years? ..... 4 Is/was the firefighter a retained member of one of the final salary schemes (1992, 2006, RDS Modified) * ..... 4 Member made RDS modified election? ..... 4 CARE Pay - for leavers from 1 April 2015 who are members of the 2015 scheme, you will need to provide pensionable pay received including APP treated as having been received ..... 4 Is member in 2015 scheme? ..... 5 Assumed Pensionable Pay (APP) ..... 5 Do you need to send revised CPP/APP for any previous financial year? ..... 5 Additional Information ..... 5

Fields marked with a * are compulsory