If you use assistive technology (such as a screen reader) and need a
version of this document in a more accessible format, please email email@example.com.
Please tell us what format you need. It will help us if you say what assistive technology you use.
Use this form to apply to HM Treasury for a special severance payment for someone leaving their job at an NHS foundation trust.
It is for payments outside someone’s normal contractual entitlement.