Severance payments at NHS foundation trusts: approval form

Apply for approval for a special severance payment for an NHS foundation trust staff member.

Applies to England


Template for Monitor and HM Treasury approval for special payment cases

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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.

You should read Managing Public Money Annex 4.13 before completing this form.

Completed forms should be submitted by email to

Published 26 April 2013