Application to the Board of the Pension Protection Fund to Informally Review an Experian

Application to the Board of the Pension Protection Fund to informally review an Experian Appealable Score

Please complete all sections of the form, unless otherwise indicated.

1. Experian appeal details

Have you raised an appeal of your Employer’s Appealable Score with Experian?

 Y  N

If you answered no above, please note that you must first raise an appeal with Experian before doing so with the Board.

If you answered yes above, please enter your Experian appeal reference number in the box below:

2. Your Details

Title: Full Name: Address:

Email address: Telephone number:

3. Pension Scheme details

Name of Pension Scheme: Pension Scheme Registration Number:

4. Applicant’s status

Are you a trustee? Please tick the answer which applies

 Y  N

If you have answered no to Q4, please complete section 7, and ensure that it is your address details that are included in Part 2 of this form.

If you have answered yes to Q4, please complete the declaration below:

“I am/am not authorised by the other trustees to made this application collectively on behalf of the trustees of the Scheme [delete as applicable]”

5. Grounds for Review

Please set out the grounds on which you are requesting an informal review of Experian’s decision regarding your Appealable Score:

Please indicate whether you have enclosed supplementary pages or attachments with this application form

 Y  N

6. Attestation

Applicant’s Signature: Date:

7. Representation Details (complete only if you answered no to Q4)

If you are not a trustee of the Scheme, you must be appointed by the trustees of the scheme as their representative for the purpose of this application to empower the Board of the Pension Protection Fund to take the review application forward.

Please complete either part A or Part B of this section if you are representing the trustees of the Scheme.

Part A

 I enclose a copy of the written authority from the trustees of the Scheme authorising me to represent them for the purpose of this application.

Part B

 I appoint the person named in part 1 of this form to act as the trustees’ representative in this Application and I have the authorisation of the trustees of the scheme to make this appointment

Signature of Trustee: Name of Trustee (please print):

Address of Trustee:

Once you have completed this form, please send it by e-mail to [email protected].

If you are not satisfied with the outcome of the informal review, you may apply to the Board for a formal levy review once you have received your levy invoice.

Please note that the Board’s informal review of your Experian Appealable Score is a non-statutory process. You will not therefore be able to appeal the outcome to the Board’s Reconsideration Committee.