Boots Retirement Savings Plan (BRSP)

BRSP Opt out Form

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

If you would like to opt out of the BRSP please fill in the details below and press ‘Submit’.

My details:

Surname:

Title:

Forename(s):

National Insurance no:

Date of Birth:

Email address:

I have considered the information provided and I have decided that I do not wish to remain a member of the BRSP at this time. By opting out of the BRSP I accept and understand that both my own and the Company contributions to my pension policy will cease and I will no longer be covered for life assurance which would have been payable in the event of my death in service.

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:

Address for acknowledgement:

Address 1:

Address 2:

Address 3:

Address 4:

Postcode:

Please note your request to opt out of the BRSP will be actioned at the next available payment date.

Submit