Election Form
to
On my transfer to permanent and pensionable establishment, I hereby elect to buy back my previous agreement service from
as pensionable service and to repay the gratuities and accrued interest by monthly instalments on the terms and conditions set out in the 'Conditions Governing the Refund of Contract Gratuities' attached to this election form, which I have read through and fully understood; and I agree irrevocably to be bound by the said conditions laid down therein.
Signature
Name in BLOCK LETTERS
Rank/Grade
Daté
TOTAL P.05
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