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[null,null,null,null,"HASSRA LOTTERY APPLICATION FORM"]
[null,null,null,null,null,null,"                  Please complete this form electronically"]
[null,"Section 1 - Application Type"]
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[null,"please select from list"]
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[null,"Section 2 - Personal Details",null,null,null,null,"Please complete using BLOCK CAPITALS."]
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[null,"Title"]
[null,"Surname"]
[null,"First Name(s)",null,null,null,null,null,null,null,null,null,null,null," "]
[null,"Date of Birth"]
[null,"National Insurance Number"]
[null,"Home Address"]
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[null,"Post Code"]
[null,"Home or Mobile Tel Number"]
[null,"Work Telephone Number"]
[null,"Home Email Address"]
[null,"Work Email Address"]
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[null,"Section 3 - Employment Details"]
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[null,null,null,"Employer Details",null,null,null,"If Other, Please State"]
[null,"    (please select from list)"]
[null,"Pay/Staff Number"]
[null,"Office Address"]
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[null,{"$f":"IF(E27=B182,\"To receive your lottery numbers please state your one-line courier address:\",\" \")","v":" "}]
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[null,"Section 4 - New Lottery Member - This section to be completed by new lottery members only"]
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[null,"Please indicate the exact amount of tickets at £1.00 each that you require per month (Maximum is 20 i.e. £20 per month)."]
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[null,null,null,null,null,"tickets at £1.00 each per month = ",null,{"$f":"SUM(E38*1)","v":0}]
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[null,"Section 5 - Existing Lottery Member - This section to be completed by existing lottery members only"]
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[null,"Please indicate the exact amount of tickets at £1.00 each that you require per month (Maximum is 20 i.e. £20 per month)."]
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[null,null,null,null,null,"tickets at £1.00 each per month = ",null,{"$f":"SUM(E45*1)","v":0}]
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[null,"If you wish to withdraw from the scheme, please enter 0 for the number of tickets you require."]
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[null,"If you are withdrawing from the lottery scheme you MUST contact your payroll to stop the deductions from your pay.                                                           "]
[null,"DWP employees will need to raise a service request via SOP, attaching an RMG46 form to cancel lottery deductions.                                                           "]
[null,"By submitting this form, we will update our records but this will not stop any deductions being taken. "]
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[null,"Section 6 - Declaration"]
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[null,"I confirm that I am a member of HASSRA and hereby apply for a ticket(s) in the monthly HASSRA lottery draw."]
[null,"I authorise deduction of the sums shown above from my salary each month until further instruction."]
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[null,"Signed (by email) ",null,null,null,null,null,null,null,"Date"]
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[null,"Members of HASSRA participate solely upon the basis of their own assessment and judgement.  The Department of Health, Department for Work and Pensions, Treasury, Paymaster and any other body involved in the authorised deduction of Lottery contributions from members' salaries or pension and payment of these to HASSRA neither offer any assurances to the soundness of the scheme nor warrant, underwrite or accept responsibility or liability in anyway, whatsoever, in connection with the operation of the HASSRA Lottery, or the application of monies so deducted or the allocation or distribution of prizes."]
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[null,null,null,"    Please click here to submit your application. "]
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[null,null,null,"        If you have any queries with this form, please email HASSRA Membership & Lottery Services."]
[null,null,null,null,"HASSRA.MEMBERSHIPANDLOTTERYSERVICES@DWP.GOV.UK"]
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[null,null,null,null,null,"FOR OFFICIAL USE ONLY"]
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[null,"HASSRA NATIONAL LOTTERY VOLUNTARY DEDUCTIONS"]
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[null,"To: Employee Shared Services",null,null,null,null,null,null,null,null,null,null," "]
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[null,"Title",null,null,{"$f":"E11","v":0}]
[null,"Surname",null,null,{"$f":"E12","v":0}]
[null,"First Name(s)",null,null,{"$f":"E13","v":0}]
[null,"National Insurance Number",null,null,{"$f":"E15","v":0}]
[null,"Employer",null,null,{"$f":"E27","v":0}]
[null,"Staff Number",null,null,{"$f":"E29","v":0}]
[null,"Application Type",null,null,{"$f":"E6","v":0},null,null,{"$f":"IF(E6=B177,B189,\" \")","v":" "},{"$f":"IF(E6=B177,H38,\" \")","v":" "}]
[null,{"$f":"IF(E6=B177,\" \",B190)","v":"Amended Amount"},null,null,{"$f":"IF(E6=B177,\" \",H45)","v":0}]
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[null,null,null,null," "]
[null,null,null,null,"Signed:",null,"HASSRA Membership & Lottery Services"]
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[null,null,null,null,"Date:",{"$f":"NOW()","v":"2019-04-15T15:39:57.080"}]
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[null,"New Lottery Member"]
[null,"Increase Lottery Ticket Holding"]
[null,"Decrease Lottery Ticket Holding"]
[null,"Cancel Lottery Membership"]
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[null,"Department for Work and Pensions"]
[null,"Department of Health"]
[null,"Food Standards Agency"]
[null,"Retired"]
[null,"Other"]
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[null,"Amount"]
[null,"Amended Amount"]

{"sheet":"Privacy Notice","index":1,"n_rows":9,"n_cols":2,"rows_kept":9,"cut":false,"hidden":false,"merged":[]}
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[null,"HASSRA Privacy Notice"]
[null,"HASSRA is committed to protecting the privacy of all personal data obtained from you in the course of your membership of HASSRA, whilst providing a personalised service that keeps you up-to-date with information, offers and services. We will at all times respect your privacy and comply with any data protection legislation in force in the UK."]
[null,"You may request a copy of any information we may hold about you, or request any information to be removed from our databases and other records at any time, by contacting Sarah Fairclough our Data Compliance Manager at:"]
[null,"Sarah.Fairclough@dwp.gov.uk"]
[null,"Full details of HASSRA’s data protection policy and processes can be found at: "]
[null,"www.hassra.org.uk "]
[null,"Please read it carefully before proceeding."]
[null,"By submitting this form you hereby agree to the terms of HASSRA’s privacy policy."]