Request not to participate in NIC Efficient Pension Arrangements I confirm that I do not wish to participate in the BMI Healthcare NIC Efficient pension Arrangement I understand that by not participating in the BMI Healthcare NIC Efficient pension arrangements I will not benefit from any National Insurance savings. I will, in future, make employee contributions at 2% of my basic salary into the pension scheme. I acknowledge that I will not be able to participate in the NIC Efficient Pension Arrangement unless I subsequently request to opt in under a Lifestyle Event and such request is accepted by BMI Healthcare. In signing this form, please be aware that even if you choose not to participate in the NIC Efficient Pension Arrangements, you will still be a member of the BMI Healthcare Staff Pension scheme and will continue to make payments into the Scheme from your salary. Please complete this form using block capitals Forename(s): Signed: Surname: Hospital or Department: National Insurance number: Date: Once completed, this form should be returned to Lindsay Peake at the Corporate Payroll Office (The Watts Building, 10 Independents Road, Blackheath, London SE3 9LF). Please retain a copy for your own records.