Financial Assistance Scheme(FAS) authority form		
Your personal details	
Full name of member:	 

Name of former pension scheme:	

Member’s address 	

Post code:		
	
Member’s date of birth 			
	
Member’s National Insurance Number	

Details of authorised person/company to release information to : 	
Name of authorised person or company. Please print name 	Mr/Mrs/Miss/Ms
(delete as applicable)		
	
Address 	

Post code:		
	
Relationship to member 			
	
Landline telephone number 			
	
Mobile telephone number 			
	
Email address 			

I, (insert name here)____________________________________, authorise the FAS to release information requested by the above named party.

This authority form will be valid for 12 months from the date of my signature.
	
Your signature:	

	Date:	/       /		

 Return to FAS Member Services, Financial Assistance Scheme, PO Box 287, Wymondham, 
NR18 8EZ 	

For more information on how we use your data, please go to www.ppf.co.uk/fasmembers