Boots Retirement Savings Plan (BRSP)

SMART Opt out Form

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

If you would like to opt out of SMART please fill in the details below and send to Boots Pensions at the address below.

My details:

Surname:

Title:

Forename(s):

Date of Birth:

Address 1:

Address 2:

Address 3:

Address 4:

Postcode:

Mobile No:

National Insurance no:

Staff No:

Email address:

Employer:

I have considered my situation and I have decided that I do not wish to participate in SMART at this time. By opting out of SMART I accept and understand that it constitutes a change to my employment contract terms and conditions.

Please note this form must be completed and submitted by the 5th of the month that you wish to opt out of paying by SMART. This is due to payroll processing dates. If it is received after the 5th, your request to opt out will be processed at the next available payment date.

Please confirm your details before submitting this form.

I hereby confirm that all of the above details are, to the best of my knowledge, complete and correct at the time of submitting this form.

Date:

Submit