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  • University of Oxford Staff Pension Scheme (OSPS) : Confirmation of Death in Service

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    Mehran Same
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    This document is a form for confirming death in service details for the University of Oxford Staff Pension Scheme. It requests information such as the deceased member's name, date of death, National Insurance Number, tax years of leaving and before leaving, contributions made by the employee and employer in those years, any additional voluntary contributions, and salary details in the tax year of death and prior year. The employer is asked to sign and date the form to confirm the provided details match their payroll records.

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    This document is a form for confirming death in service details for the University of Oxford Staff Pension Scheme. It requests information such as the deceased member's name, date of death, National Insurance Number, tax years of leaving and before leaving, contributions made by the employee and employer in those years, any additional voluntary contributions, and salary details in the tax year of death and prior year. The employer is asked to sign and date the form to confirm the provided details match their payroll records.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    12 views1 page

    University of Oxford Staff Pension Scheme (OSPS) : Confirmation of Death in Service

    Uploaded by

    Mehran Same
    This document is a form for confirming death in service details for the University of Oxford Staff Pension Scheme. It requests information such as the deceased member's name, date of death, National Insurance Number, tax years of leaving and before leaving, contributions made by the employee and employer in those years, any additional voluntary contributions, and salary details in the tax year of death and prior year. The employer is asked to sign and date the form to confirm the provided details match their payroll records.

    Copyright:

    © All Rights Reserved
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    University of Oxford Staff Pension Scheme (OSPS)

    Confirmation of Death in Service


    Please complete this form in full by using BLOCK CAPITALS and by ticking the appropriate boxes. Please send the completed form to the
    Pensions Office.

    Employer

    To be completed by the employer


    Member

    Surname

    Forenames

    Date of death / / NI Number

    Please enter any further information you have in the box below:

    Tax year of leaving Tax year before leaving


    Lower / Standard / Higher/ Lower / Standard / Higher/
    Cost Plan or Tier
    Tier 1 / Tier2 / Tier 3 Tier 1 / Tier2 / Tier 3
    Employee’s contributions (SalEx) £ £
    Employer’s contributions (SalEx) £ £
    Employee’s contributions (Non-SalEx) £ £
    Employer’s contributions (Non-SalEx) £ £
    AVCs (not Prudential) £ £

    Salary changes in tax year of death and tax year before death (WTE stands for whole time equivalent)

    Date of change Annual Salary Hours worked WTE hours Annual WTE salary
    / / £ £
    / / £ £
    / / £ £
    / / £ £

    I confirm that the above named retired on the date shown above and that the details shown concur with our payroll records.

    Signed Date

    Name Position

    DTH2/May19 OSPS Reference

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