PRD12A Employment Intention Declaration
Pension-Related Deduction
Statement of Potential Employment
This form should be completed if you paid PRD while employed by NUI Galway and one of
the following is relevant:-
On ceasing employment at NUI Galway I declare to the best of my knowledge I do not intend to
take up further public service employment for the remainder of this year
I am taking unpaid leave and I will not be paid any salary for the remainder of the current
year (i.e. Career Break, Unpaid leave following maternity leave, etc.)
Please enter the year the calculation of your PRD liability relates to
On this basis I request that an annual balancing mechanism be carried out on my Public
Service remuneration to date. I confirm that I have provided details of all my Public Service
remuneration to date to the Pensions Office at NUI Galway.
I acknowledge that, in calculating my PRD liability to date, I have been allowed the full set of
annual thresholds this year. I also acknowledge that, should I take up further Public Service
employment during this year, that I may have an underpayment of PRD as a result of being
allowed the full set of annual thresholds. I acknowledge that I will be required to pay any
underpayment which arises on re-employment.
Name:
Payroll / Staff No:
PPS Number
Today’s Date:
X
Signature:
*Your signature is not required if this form is emailed from your email address
Please email this form to: payroll@nuigalway.ie
Or
Post this form to address: Payroll Office, The Quadrangle, NUI Galway