Alliance Healthcare and Boots Retirement Savings Plan (AHBRSP)

Change of Contributions Form

If you need any help completing this form please call 0115 959 1670 (internal 72 16 70).

Use Box A if you want to change your regular contributions and Box B if you wish to set up a one-off increase in contributions (for example, when you receive a bonus). This form does not apply to the Auto-Enrolment Scheme.

My details:

Box A: Change of contributions (regular):

Until further notice I wish to take the following action in relation to my payments to the AHBRSP:

 % of my Retirement Savings Pay (minimum 3%)

Please note the request to change your contributions will be actioned at the next available payment date.

Box B: Change of contributions (one-off/bonus):

I wish to take the following action in relation to my contributions to the AHBRSP:

 % of my Retirement Savings Pay  /   / 

 % of my Retirement Savings Pay  /   / 

Please note this form must be completed and submitted by the 1st of the month that you wish the one-off/bonus contribution to be made. This is due to payroll processing dates. If it is received after the 1st, your request will be processed at the next available payment date.

Please confirm your details before submitting this form.

Address for acknowledgement:

This form does not apply to the Auto-Enrolment Scheme.