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NHS Pensions - Application for a refund of pension contributions (RF12)
(after you have stopped paying into the NHS Pension Scheme)
Part A - to be completed by the member/claimant
Employers please tick one of the following: Form keyed by employer Form not keyed by employer
as no access to Pensions Online
Title (e.g. Mr, Mrs, Miss, Dr)
Surname
Former surname (If applicable)
Other names
Date of birth
Address
Country
(Please complete this box if you live outside the UK)
National Insurance number
/ /
Post code
Your application - I apply for a refund of pension contributions.
I paid into the NHS Pension Scheme until: While I worked at:
My pay/staff/assignment number:
How you want the refund paid (Tick one box)
Bank or building society account Nominee.
I have written their name and address in the boxes below
Authorised employer
Home address
(only available if you live overseas and do not have a UK bank account)
Please forward a copy of the signed Rf12 and a signed letter of authorisation from the member.
/ /
Bank/Building Society account details:
Name(s) of account holder
(either applicant's own account
or a joint account with someone else)
Branch sort code
Account number to be credited
and/or Building Society Roll No.
I can conrm I have read the guidance notes
Signature Date
Now send this form to your last NHS employer. They will complete Part B.
Do NOT send it to NHS Pensions unless asked to do so.
Full name and address of your bank or building society
OR the full name and address of your nominee
Name:
Address:
Type of account:
Current account - enter 0 Deposit account - enter 1
Post code
- -
/ /
RF12 - (V12) Digital 11/2019
Before you complete the form make sure you have read the notes on pages 3 and 4 of this form.
Please type in the elds below in Part A then print off and sign, or print and complete in CAPITAL LETTERS using
BLACK INK. Insert account details as they appear on your statement.
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Part B
To be completed by the Employing Authority / GP Practice
Last day of membership
(extended by any untaken annual
leave days)
EA / GP Code
/ /
SD
/
Reason for termination.
01 - Voluntary resignation/termination of employment
02 - Dismissal (only use if loss to public funds)
03 - Redundancy
04 - Sickness
16 - Opting Out
Please enter correct code
If there is membership prior to 06.04.2016 that spans three tax years, please enter rst year NI earnings
(enter 2nd and 3rd year on SD55). If C rate enter £00.00. If E rate enter E £amount. Others enter £amount.
If all the membership is on or after 06.04.2016 please do not complete this box.
Enter 1 here if an election to pay reduced rate NI contributions has ended in the last 12 months
Please tick whichever applies
Only complete this section if you do not have access to Pensions Online
£ .
Form SS10 / SS10(GP) is attached sent to NHS Pensions
/ /
Form SD55 / SD55(Man) is attached sent to NHS Pensions
/ /
The joiner information was sent to NHS Pensions on Magnetic Tape on
/ /
All employers must complete these details
Name
Date
EA / GP Stamp
Please retain this form for audit purposes. We may approach you at a later date to obtain a copy of it.
/ /
Signature
Telephone number
Pension membership number
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NHS Pension Scheme - Refund of pension contributions (RF12)
Guidance Notes for Applicants
IMPORTANT - Please read these notes carefully before you complete the form, then return
it to the Pensions Ofcer or Practice Manager at the place where you last paid pension
contributions
These notes only set out the main rules very briey. For further details you should refer to the Member Guide,
which you can view or download from the website at: www.nhsbsa.nhs.uk/nhs-pensions
The Member Guide explains what else you can choose to do instead of having a refund of contributions. For
example, you may be able to transfer your membership rights to another scheme.
Briey these are the main rules.
You cannot have a refund of contributions if at the date you last paid contributions:
you are age 60 or over in the 1995 Section
you are age 65 or over in the 2008 Section
you have reached your Normal Pension Age in the 2015 Scheme
you are already in receipt of a NHS pension
you continue to do any pensionable work (including bank employment) in the NHS without having a total
break of at least 24 hours
you have had a transfer of pension rights into the scheme from a dened contribution scheme (such as
a personal pension, self invested personal pension or a stakeholder pension) regardless of the length of
membership.
You can have a refund of your contributions if:
your total membership in the NHS Pension Scheme is less than two years. The two years includes any
qualifying membership. Qualifying membership includes:
- any previously refunded membership which ended less than a month before your current membership
- the total of any membership you have in the 1995 Section, the 2008 Section and the 2015 Scheme
Any Additional Voluntary Contributions (AVCs) you have paid will automatically be refunded with your main
Scheme contributions.
Applying for a refund
If you want to apply for a refund of your contributions please complete Part A on page 1 of this form. Then
separate off page 1 and 2 and give it, or send it, to the Pensions Ofcer or Practice Manager at the
place of work where you last paid NHS pension contributions. Keep pages 3 and 4 of the form for
yourself. You may want to look at them again.
What happens then
Your employer will complete Part B of this form and send it to us or input it online. We will deal with your
application as quickly as possible. In some cases we have to make further enquiries before we can pay the
refund. We are unable to take any action until we receive the refund form.
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Payment of your refund
We can pay your refund in one of four ways.
1. Directly into your bank or building society. This is by far the safest method of payment. Tick the
box which applies on page 1 and ll in your account number, the sort code, account type and
roll number if payment is to be made to a Building Society. We also need the name of your
bank or building society.
2. To another person of your choice (a nominee). Tick the box which applies, on page 1, and ll in
the name and address of your nominee. The payable order will be made out in their name not
yours and will be sent to their address.
3. Payment to an authorised employer. Tick the box which applies on page 1 if you wish to be
paid by this method and attach a letter of authorisation detailing the name and address of
the employer who you wish this money to be paid to.
4. To you at your home address if you live overseas and do not have a UK bank account. Just
tick the box which applies on page 3. Payment by this method can take up to two weeks longer
than payment into a bank account.
When we send your payment, we will also send a statement to your home address, which will give details of
your refund. We will aim to pay your refund within our statutory target of one month.
Deductions from your refund
Income tax at 20% will be deducted on refunds up to £20,000. If any of your membership was before 6 April
2016 a deduction will also be made for your share of the cost of buying you back into the State Second
Pension Scheme.
Changes you should tell us about
If you change your address, bank details or your name before we have nished dealing with your
application, please tell us straight away so we can make your payment correctly. Please tell us your
membership (SD) number and your National Insurance number. If you do not know what these numbers
are check your payslip or ask your NHS employer where you last worked, who will be able to tell you.
Our contact details are:
NHS Pensions
PO Box 2269
Bolton
BL6 9JS
Member helpline: 0300 330 1346
Website: www.nhsbsa.nhs.uk/nhs-pensions
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 benets. 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
www.nhsbsa.nhs.uk/yourinformation
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