Q's on Fire Retirement Form October 2024
Last date of service * Drop down calendar (dd/mm/yyyy)
Pay retirement benefits from Drop down calendar (dd/mm/yyyy)
Type of Retirement *
Early (50/25) Maximum Lump Sum
Early (50/25) Restricted Lump Sum
Employer Initiated Retirement
Ordinary (30 Years)
Partial Retirement (2015 Scheme only) - Permanent Lower Tier III Health PLUS Injury on Duty
Permanent Ill Health (Lower Tier)
Permanent Ill Health (Upper Tier)
Degree of disablement *
Permanent Lower Tier Ill Health PLUS Injury on Duty
Permanent Upper Tier Ill Health PLUS Injury on Duty
Voluntary (Age 55)
Degree of disablement*
• Permanent Upper Tier III Health PLUS Injury on Duty
Degree of disablement *
Extra contributions - Were there any contributions outstanding at the date of leaving?
No – Move onto next question
Yes – Further question below
Please give details of the outstanding contributions here £
How are these arrears being recovered?
Please provide any strike information that has not yet been notified to WYPF.
Date of strike (dd/mm/yyyy)
Hours on strike
Add another?
Total number of days strike
Strike contributions being repaid?
No/Yes
No/Yes
Please provide strike information based on strike only in the last 12 months up to the last day of employment/active membership.
Total number of hours strike
Pay lost due to strike £
Additional Pension Benefits*
Was member in receipt of Long Service Increment (LSI) at 30 June 2007?
Is member in receipt of CPD?
No/Yes
No
Yes - Total pension contributions relating to the CPD payment (Employee, Employer & Notional III Health percentages) from 1 July to date of leaving £