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	About you				About your additional pension
	Date of birth *				Payable at age 65 years *	Yes No
	Gender *	Male Female			Amount required *	£250 £500 £750 £1000 £1250 £1500 £1750 £2000 £2250 £2500 £2750 £3000 £3250 £3500 £3750 £4000 £4250 £4500 £4750 £5000
	Normal pension age *	60 65	years		With dependant cover *	Yes No
					Purchase arrangement *	Payment plan Lump sum
					Length of payment plan	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20	years
	What it will cost				Messages
	Monthly payment Annual amount Total amount				Please complete the fields in the sections "About you" and "About your additional pension". All fields marked with an asterisk, *, must be completed.
					If the form does not appear when you click ‘create form’ please download the AP1 form from the Members Forms section of the website at: http://www.nhsbsa.nhs.uk/2668.aspx.