I do not wish to remain a member of the Local Government Pension Scheme. I have read the information set out below.

Signed ............................................................................ Date ...........................


Full Name .............................................................................................................
(Block Capitals)


National Insurance Number......................................... Date of Birth ..........................


Where are you/will you be working? ..........................................................................


When did you/ will you start? ...............................................................................

If you “opt-out” of Scheme membership within 3 months of first becoming a Scheme Member, you will be treated as though you had never been a member and any pension contributions paid by you will be refunded. If, however, you have 3 or more months’ Scheme membership, or have transferred-in personal pension rights, your accrued benefits will be preserved until your retirement, or until you request their transfer to another pension arrangement.

Note that, if you start a new employment in which you are eligible to join the Local Government Pension Scheme, you will be brought into the Scheme automatically unless you again decline membership in writing for the new employment. Your employer should provide you with the Pensions Office leaflet called “A Highly Valued Benefit” which you can use to decline Scheme membership for the new employment.

Please return the completed form to: Pensions Office

Shared Services Centre

County Hall

Newport

Isle of Wight

PO30 1UD