Application Forms

The following are a range of forms which should be completed by former police officers or adult survivors who wish to be considered for any benefit by the Policing Board.

As you may wish to forward additional information in support of your application, and for security reasons, please return your completed forms to the Board at the following address, either by post or hand delivered.  

The forms should not be returned by fax or e-mail.
Police Administration Branch
Northern Ireland Policing Board
Waterside Tower
31 Clarendon Dock
BELFAST
BT1 3BG

A.  RETROSPECTIVE ILL-HEALTH RETIREMENT PENSION / INJURY ON DUTY AWARD

If you are a former RUC/PSNI officer and wish to apply for a retrospective Injury On Duty award, you should complete the following application and consent forms and return them to the Policing Board's Police Administration Branch.

1.   Application Form (Retrospective IOD Award) (PDF 286 KB)

 

3.   NIPB Consent Form (SMP2) (PDF 177 KB)

B.  DEFERRED PENSION PAID EARLY DUE TO ILL-HEALTH

If you are a former RUC/PSNI officer and wish to apply to have your Deferred Pension Paid Early Due To Ill-Health, you will need to complete the following application and consent forms and return them to Policing Board Police Administration Branch.

1.  Application for Deferred Pension (PDF 198 KB)

2.  NIPB Consent Form (SMP2) (PDF 177 KB)

C.  REASSESSMENT OF INJURY ON DUTY AWARD

Please note – if the Selected Medical Practitioner has stated that your Injury on Duty Award is to be reviewed, Police Administration Branch will send you a Disablement Review Information Sheet (Form PDR 1) and appropriate consent forms to complete when your Injury On Duty award is due for review.  You do not need to request these forms

1.   Requested Reassessment Application Form (PDR2) (PDF 221 KB)

2.   NIPB Consent Form (SMP2) (PDF 177 KB)

D.  ADULT SURVIVOR AWARDS

If you are a widow, civil partner or adult partner of a deceased PSNI / PSNI Reserve officer (or former RUC / RUC Reserve officer) and wish to apply for an Adult Survivor Award, you will need to complete the following application and consent forms and return them to Police Administration Branch.

1.    Adult Survivor Special / Augmented Award (ASC1) (PDF 27 KB)

E.  APPEALS

If you are a serving PSNI officer or former RUC/PSNI officer and wish to appeal the Policing Board’s decision regarding a refusal of an Ill-health Retirement Pension and/or Injury on Duty Award, you should complete one of the following application forms (as appropriate) and return it to the Policing Board's Police Administration Branch.