Get Certificate Examinations 2005Scruduithe Teistimireachta 2005

Ie SECPRD10 PUBLIC SERVICE PENSION RELATED DEDUCTION PRD 2013 Please read the leaflet Financial Information for Examinations Contract Staff FS012013 prior to completing this form. Complete the form in block capitals with the exception of the signature fields. Coimisi n na Scr daithe St it State Examinations Commission Corr na Madadh Baile tha Luain Co. na hIarmh Cornamaddy Athlone Co. Westmeath Telephone 353-90-644 2877/2805/2802. Fax 353-90-644 2807 Web www. examinations. ie. E-mail financial examinations. Complete Section A in all cases and Section B or C as appropriate. The SEC reserves the right to verify the information submitted* SECTION A. PERSONAL DETAILS First Name BLOCK CAPITALS Surname PPSN Address Mobile Number Email SECTION B. CLAIM FOR EXEMPTION FROM PRD I hereby claim exemption from PRD as outlined in Financial Information for Examinations Contract Staff FS012013 as I declare that A. I am not employed in any other public service body full-time part-time or otherwise. AND B. I am not a member of a Public Service Pension Scheme. NOR Am I in receipt of a pension from a Public Service Pension Scheme Have I opted out of a Public Service Pension Scheme Do I receive payment in lieu of membership of a Public Service Pension Scheme Signature Date / / SECTION C DESIGNATION OF STATE EXAMINATIONS COMMISSION AS EITHER MAIN OR SUBSIDIARY EMPLOYMENT FOR THE PURPOSES OF PRD Having read and understood Section 6 e of Financial Information for Examinations Contract Staff FS012013 I hereby designate the State Examinations Commission as my insert Main or Subsidiary as appropriate I confirm that I am not in full time employment and am liable to PRD. If retired please state date of retirement The completed form should be returned to the Finance Section PRD Queries of the State Examinations Commission at the address shown above. Coimisi n na Scr daithe St it State Examinations Commission Corr na Madadh Baile tha Luain Co. na hIarmh Cornamaddy Athlone Co. Westmeath Telephone 353-90-644 2877/2805/2802. Fax 353-90-644 2807 Web www. examinations. ie. E-mail financial examinations. Complete Section A in all cases and Section B or C as appropriate. The SEC reserves the right to verify the information submitted* SECTION A. PERSONAL DETAILS First Name BLOCK CAPITALS Surname PPSN Address Mobile Number Email SECTION B. CLAIM FOR EXEMPTION FROM PRD I hereby claim exemption from PRD as outlined in Financial Information for Examinations Contract Staff FS012013 as I declare that A. PERSONAL DETAILS First Name BLOCK CAPITALS Surname PPSN Address Mobile Number Email SECTION B. CLAIM FOR EXEMPTION FROM PRD I hereby claim exemption from PRD as outlined in Financial Information for Examinations Contract Staff FS012013 as I declare that A. I am not employed in any other public service body full-time part-time or otherwise. AND B. I am not a member of a Public Service Pension Scheme. I am not employed in any other public service body full-time part-time or otherwise. AND B. I am not a member of a Public Service Pension Scheme. NOR Am I in receipt of a pension from a Public Service Pension Scheme Have I opted out of a Public Service Pension Scheme Do I receive payment in lieu of membership of a Public Service Pension Scheme Signature Date / / SECTION C DESIGNATION OF STATE EXAMINATIONS COMMISSION AS EITHER MAIN OR SUBSIDIARY EMPLOYMENT FOR THE PURPOSES OF PRD Having read and understood Section 6 e of Financial Information for Examinations Contract Staff FS012013 I hereby designate the State Examinations Commission as my insert Main or Subsidiary as appropriate I confirm that I am not in full time employment and am liable to PRD.