Retirement forms
You must fill in the retirement form HR107(a) and leaving form HR106.
Need help?
We have included a completed sample retirement form HR107(a) as a guide to help you fill in your details.
Important things to remember:
- use block capitals to fill in the form
- make sure you sign and date pages 3, 4, 5 and 6
- your pension benefits will be delayed if your form is not filled in properly
- your completed form should be returned at least 3 months before your retirement date to your local pensions department
- contact your local pensions department before retiring if they haven't confirmed your retirement date
Who fills out this form?
You and your line manager must fill in the form.
Your line manager will get your general manager or assistant national director of HR to sign the relevant sections.
Pages to sign
We will send the form back to you if you (and your line manager - page 3) do not sign the following pages:
Page 3
- your employee declaration
- line manager signature
- general manager or assistant national director of HR signature
Page 4
- Section 51 declaration
Page 5
- PD1 declaration
Page 6
- PD1(a) declaration
How to fill in the form
Pension start date
Your pension start date is the day after you finish work. Your retirement date should be inclusive of any annual leave owing to you. You can only get paid for annual leave owing to you if you are retiring on the grounds of ill health.
You must give the pension start date on your form. We cannot calculate your pension benefits without this date.
Reasons for retiring
Minimum and maximum retirement ages
Started before 1 April 2004
- minimum age retirement is 60
- maximum age retirement is 70
After 1 April 2004 and before 1 January 2013
- minimum age retirement is 65
- no maximum age
After 1 January 2013
- minimum age retirement is in accordance with state contributory OAP age (currently 66)
- maximum age retirement is 70
Retiring due to ill health
Your occupational health (OH) department must send in a report recommending you retire on grounds of ill health. You need the report to get your retirement date and pension start date.
Cost neutral early retirement (CNER)
Retirement on pension benefits from age 50 (non-new entrants) or from age 55 (new entrants) is allowed with approval from your line manager under the Cost Neutral Early Retirement Scheme (CNER).
CNER enables you to to retire early with payment of pension benefits. Your pension and lump sum payments are actuarially reduced. This means a reduction is made to your built up pension, to take into account early payment of your lump sum and the longer period your pension will be paid.
Fill in the retirement form HR107(a) and the cost neutral early retirement form.
Personal email address
Required to register you for online payslips.
Bank details
Check that your IBAN is correct and readable.
Marital status
If you are married, in a civil partnership, widowed, separated or divorced, we will need a copy of:
- your civil marriage certificate
- your civil partnership certificate
- the death certificate of your spouse
- the death certificate of your civil partner
- the judicial separation or decree of divorce and pension adjustment order, if this applies
Apply online for copies of your certificates - lifeevents.hse.ie
Dependent children
Complete this section if you have:
- children under age 16
- children up to age 22 and in fulltime education or apprenticeship
- adult dependent child age 22 and over, and is not capable of maintaining themselves because of physical or mental disability
Third-party payroll deductions
National Pensions Management Unit can set up deductions from your pension to the following third-party companies:
- VHI
- Hospital Saturday Fund
- New Ireland Assurance
- Irish Life Assurance
Include the company's policy number on the form.
The following deductions can be taken from your pension. However, you must contact the relevant companies when you receive your first pension payment, quoting your new pension or personnel number from your pension payslip.
- AXA insurance - phone 1890 600 600
- Health Service Staff Credit Union - phone 1890 677 864
- Laya Healthcare (new group number 24508) - phone 1890 700 890
- Aviva Heathcare - phone 091 586 500 (Hennelly Finance)
You should contact other third-party companies to continue payments that you currently pay through your salary.
Page 3
Fill in all sections on this page and make sure the signatures are readable.
Employee declaration
You must sign and date the employee declaration. We will send the form back to you if you do not sign and date this section. This will delay your pension benefits payment.
Line manager signatures
Before your form is submitted to your local pensions department, your line manager should ensure that:
- all sections of the form are filled in
- the general manager or assistant national director of HR have filled in both sections
Page 4
Section 51 declaration
Give details of other Irish public or civil service pension entitlements you are applying for. Do not include your HSE pension.
Under Section 51 of the Public Service Pensions Act 2012, the HSE must be given this information.
You do not need to declare the contributory state pension (formerly known as the old age pension) or widow’s pension, if in receipt of either.
Answered yes
If you answer yes to any questions, fill in the details and sign and date the bottom section of the page. We will send back the form if you do not sign and date this section. This will delay your pension benefits payment.
Answered no
Note: If you answer no to all 3 questions, you must still sign and date the bottom section of the page. We will send back the form if you do not sign and date this section. This will delay your pension benefits payment.
Page 5
PD1 declaration
Give details of private or occupational pension plans you have outside of the HSE.
Under Section 787R (4) of the Taxes Consolidation Act 1997 the HSE must get this information.
Note: If you do not have additional pension entitlements, you must still sign and date the bottom section of this page. We will send back the form if you do not sign and date this section. This will delay your pension benefits payment.
Q1: Did you get or are you getting any pension-related payment since 7 December 2005? This does not include the HSE pension benefits you are currently applying for.
Q2: Have you made a payment or transfer to an overseas pension scheme?
Q3: Are you due any pension-related payment from a private or occupational pension plan outside of the Irish Public Service, for example, an AVC?
Q4: Do you intend to make a payment or transfer to an overseas pension scheme?
Q5: Rank your pension benefits in the order that they become payable. For example: 1 is the pension you will get first; 2 the pension you will get second, and so on.
Q6: This normally applies to high earners or those with a number of additional pension arrangements. If the capital value of your combined pension benefits is over the €2 million threshold, you must send in a certificate from the Revenue Commissioners stating the amount of your personal fund threshold.
Page 6
PD1(a) declaration
If you have answered ‘no’ to questions 1-4 on page 5, and confirmed that you do not have any private pension plans, put a line through this page.
Note: If you do not have additional pension entitlements, you must still sign and date the bottom section of this page. We will send back the form if you do not sign and date this section. This will delay your pension benefits payment.
Q1: Give details about the type of additional pension plan you have. You can get this information from your private pension plan provider.
Q2: Put in the name of your private pension plan provider.
Q3: Put in your private pension plan provider's contact details.
Q4: Put in your private pension plan policy or reference number.
Q5: Put in the date you become entitled to payment of your private pension plan. This is normally the date of retirement in AVC cases.
Q6: This only applies if you have paid or transferred money to an overseas pension plan. If you have, put in the amount. If you have not, write N/A.
Q7: This only applies if the payment is for a defined contribution pension scheme, an AVC or PRSA. If you have, put in the amount. If you have not, write N/A.
Q8: This only applies if the payment is for a defined benefit pension scheme. If you have, input the amount. If you have not, write N/A.
Q9: You can decide if you want to give the HSE permission to contact your pension provider if they need more information about your private pension plan.
Checklist
Before you send in your form, check you have:
- entered your retirement date on page 1
- completed your personal details on page 1
- ticked the reason for your retirement on page 1
- completed your bank details on page 1
- completed your marital status on page 2
- completed your dependent children details on page 2, if this applies
- completed third party deductions on page 2, if this applies
- signed the employee declaration on page 3
- signature and details from your line manager on page 3
- signature and details from the general manager or assistant national director of HR on page 3
- completed sections on pages 4, 5 and 6 about additional pension entitlements, if this applies
- signed and dated pages 4, 5 and 6, even if you don't have additional pension entitlements
- included certificates required by the pensions department
Important
Check your retirement form to make sure you have filled it in properly. Send it to your local pensions department at least 3 months before your retirement date.
Contact your local pensions department before retiring if they haven't confirmed your retirement date.