This section of the website has been developed to contain sample forms for use by English and Welsh LGPS administering authorities and employers, including the following:

Opt out form and notes

Sample election form for those members currently in the Scheme who wish to opt out.

Document

Additional information

Date of version

Version 2.0 [tracked]

Version 2.0 [clean]

This version was originally circulated in version 6.1 of the Automatic Enrolment full guide. Please see within document for tracked changes. 4th July 2016

Version 1.0

This version was originally circulated in version 6.0 of the Automatic Enrolment full guide. 31st March 2016

Ill health medical certificates

Example medical certificates for members who have applied for ill health retirement benefits.

Document

Additional information

Date of version

Version 1.0

Certificates originally issued in Circular 277 and subsequently re-issued in Circular 282 and Bulletin 124. 31st March 2016

Transfer declaration forms and advice confirmation form

Sample declaration forms for completion by members wishing to transfer their benefits out of the LGPS and sample form to confirm that member wishing to transfer has obtained independent financial advice.

Document

Additional information

Date of version

Version 3.0 [tracked]

Version 3.0 [clean]

Please see within document for tracked changes. 10th October 2016

Version 2.0 [tracked]

Version 2.0 [clean]

Please see within document for tracked changes. 30th June 2016

Elections to and from the 50/50 section

Election to join the 50/50 section - form

Sample election form for those members currently in the 50/50 section of the Scheme who wish to move to the main section of the Scheme.

Form

Summary of changes

Date of version

Version 1.2 [clean]

Version 1.2 [tracked]

Please see within document for tracked changes. 8th April 2015
Version 1.1 [clean]

Version 1.1 [tracked]

Please see within document for tracked changes. 15th January 2015

 

Election to join the 50/50 section - guidance notes

Sample guidance notes for those members currently in the 50/50 section of the Scheme who wish to move to the main section of the Scheme.

Form

Summary of changes

Date of version

Version 1.2 [clean]

Version 1.2 [tracked]

Please see within document for tracked changes. 8th April 2015

Version 1.1 [clean]

Version 1.1 [tracked]

Please see within document for tracked changes. 15th January 2015

 

Election to join the main section - form

Sample election form for those members currently in the 50/50 section of the Scheme who wish to move to the main section of the Scheme.

Form

Summary of changes

Date of version

Version 1.0 N/A - original version 17th March 2014