Estimate Request Form
Section 1
To be completed by a HR Officer
Personal Details
Title: (Please ) / Mr / Miss / Mrs / Ms / Other
Full Name:
NI Number: / Date of Birth:
Home Address:
Post Code:
Personal Email Address:
Employing Authority:
Employee Number:
Post Number / Description:
Date of continuous Local Government Service:
Salary Grade/Spinal Column Point/Annual Salary:
Requested by: / Tel No: / Date:
Pensionable LONG SERVICE AWARD Details
Long Service Award: / Pensionable Amount: / £
Termination Details
(Please ‘’ as appropriate)
Last Day of Employment: / Less than 2 Years membership?
Please indicate the reason for termination:
Normal Retirement from NPA / Ill Health Retirement
Voluntary Retirement before NPA / Flexible Retirement
Redundancy / Business Efficiency Retirement / Voluntary Resignation
Death in Service / Employer’s Consent
Dismissal / / Attaining Age 75
Transfer to another LG Pension Fund
(Please specify if known) / Resigned
Resignation after a period of maternity / adoption / parental leave
(Please provide details of leave period) / Other(Please describe
Section 2
To be completed by Payroll Section
Pensionable Pay from 1 April to Date of Termination under 2014 Scheme(including any assumed pensionable pay due to receipt of reduced pay due to sickness or paid child related leave – maternity, adoption, paternity leave)
Pensionable Pay Calculation Period:
(Please include any Pensionable Long Service Award)
MAIN Section 50/50 Section: / Appropriate Period: / Pensionable Pay
(£)
Total
ANNUAL ASSUMED PENSIONABLE PAYcalculated under the 2014 Scheme (for Ill Health Retirements and Death in Service). Please calculate using the average of the last 12 week/3 month complete pay periods prior to date of termination/death. Including any payment which is determined as ‘reasonable expectation’.
Pensionable Pay Calculation Period:
Appropriate Period / Pensionable Pay: (£)
Total
Final Pay Calculation’ under 2008 Scheme
(Please use a separate Calculation Sheet if more space is needed)
Final Pay for the period shown below
(including anyPensionable Long Service Award, fees or emoluments)
Period / Basis for Calculation / Final Pay
Less than 365 days:
Rate of Pensionable Pay on Termination:
1. /
  1. Pensionable Remuneration:
Amount of pay received during the last 365 days up to date of termination on which pension contributions have been paid (or best of last 3 years).
2. / If employee has ever worked on part time basis, please state hours, together with proportion of full time. See below.
Certified: / Date:
PART TIME SERVICE
Date From / Date To / Hours Worked / Full Time Equivalent
BREAKS IN SERVICE:
LEAVE OF ABSENCE/MATERNITY LEAVE WHERE PENSION CONTRIBUTIONS NOT PAID
DATE FROM / DATE TO

PLEASE NOTE THAT THE INFORMATION WILL BE FORWARDED BY THE PENSIONS

SECTION WITHIN 7 WORKING DAYS OF RECEIPT OF THIS FORM

REQUESTS FOR MORE THAN 10 ESTIMATES AT ANY ONE TIME MAY EXCEED THE ABOVE TIMESCALE. IN SUCH CASES, PLEASE CONTACT THE PENSION SECTION BEFORE FORWARDING THE REQUEST FORMS