Fillable Printable The Pension Service Claim Form - England

The Pension Service Claim Form - England

Help using this PDF claim form

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If you are having technical difficulties:

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Please contact the DWP Online helpdesk.

Phone: 0345 604 3349

Minicom (textphone): 0345 604 0523

Email: [email protected]

Opening hours

Monday to Friday: 8.00am - 6.00pm

Closed on all Public and Bank Holidays.

For help and advice on the information you need to put on the form or about

the benefit you want to claim, contact the office that deals with the benefit.

International Pension Centre

The Pension Service 11

Mail Handling Site A

Wolverhampton

WV98 1LW

United Kingdom

International Pensions

Direct Payment

Notes to help you fill in Part 9 of IPC BR1 GOV

What is International Pensions Direct Payment?

International Pensions Direct Payment is the Department for Work and Pensions’ way of paying your pension or benefit direct to an account of your choice

outside the United Kingdom.

The advantages

Getting your money paid in this way has many advantages:

•

it is secure

•

it is convenient

•

you will benefit from competitive exchange rates based on bulk buying of currency

•

there are no postal delays

•

there are no cheque clearance delays

•

it is less expensive for us to arrange, which saves taxpayers’ money.

How does it work?

The £ sterling value of your money will be converted to local currency and paid directly to your account. Your pension or benefit will be paid in arrears.

You can choose to be paid at the end of 4 or 13 weeks

If you choose to be paid every 4 weeks

The money will be paid into an account for you in the week following each 4 week period. Your first payment might cover a period of 2 to 5 weeks, but

after this all payments will cover a 4 week period.

If you choose to be paid every 13 weeks

The money will be paid into an account for you in the week following each 13 week period. Your first payment might cover a period of 2 to 14 weeks, but

after this all payments will cover a 13 week period.

But if you are only going to get a small State Pension or benefit you will be paid once a year.

IPC BR1 GOV Banking Notes 12/13

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You can work out what exchange rate has been used for each payment by dividing the amount by the £ sterling value of your money.

About the account you want to use

•

You can use an account in your name, or a joint account.

•

You can use someone else’s account if:

– the terms and conditions of their account allow this, and

– they agree to let you use their account, and

– you are sure they will use your money in the way you tell them.

•

If you are an appointee or a legal representative acting on behalf of the customer, the account should be in your name only.

Finding out how much we have paid into the account

We will tell you when we will make the first payment and how much it will be for in £ sterling. You can check your payments on account statements. The

statements may show your National Insurance number next to any payments we have made. If you think a payment is wrong, get in touch with us

straight away.

Changes in pension or benefit

We will tell you when the money you get from us goes up. The amount of money we send you may change because of currency exchange rates.

If we pay you too much money

If we pay you too much money we have the right to take back any money we pay that you are not entitled to. This may be because of the way the

payment system works. For example, you may give us some information which means you are entitled to less money. Sometimes we may not be able to

change the amount we have already paid you. This means we will have paid you money that you are not entitled to. We will contact you before we take

back any money.

Important additional information

You must tell us straight away when your bank or account details change. If you do not, your payments may be delayed.

If you require further information, please contact us on +44 191 218 7777.

You may find it useful to keep these notes.

Notes to help you fill in Part 9 of IPC BR1 GOV - continued

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State Pension claim form

IPC BR1 GOV 12/13

Part 1 About you

Benefit you can get because of this claim can be paid more quickly if you:

•

answer all the questions on the form that apply to you, and your husband, wife or civil partner if you have one

•

send us all the documents we ask for with this form.

If you cannot do this, get in touch with us, but benefit you can get because of this claim may be delayed.

Surname or family name

All other names, in full

Title

All other surnames or family names you have been

known by or are using now Please include maiden name

all former married names and all changes of family nam

Your permanent address

Phone number Add your national and local area code

What is this number? Please tick

Yes

Please tell us your National Insurance (NI) Number

You can find your NI number on your NI number card,

letters from social security or payslips. But do not delay

sending in this form if you cannot find the number.

If you do not know your NI number, have you ever

had one or used one at any time?

Letters Numbers

Letter

Home Work Mobile Fax

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Part 1 About you - continued

Nature of evidence

For official use only

Verified by

Checked by

Certificate returned by

Date of birth

Please send us your birth certificate

We need the original certificate. If you do not wish to send your original certificate a photocopy may be

acceptable but only if the photocopy has been stamped and signed by any of the following

a civil servant

or a doctor or surgeon registered under the laws of the country where the declaration is made

or a minister of religion

or a barrister, solicitor or advocate authorised to practice in the country where the declaration is made

or a notary public or any person allowed to administer oaths in the country where the declaration is made

or an officer of a bank authorised to sign documents on the customer’s behalf

or a magistrate

If you do not have your birth certificate, and are unable to send it quickly, do not delay sending in this claim

form.

You must remember to send us all the documents we ask for. If you do not, benefit you can get because

of this claim may be delayed.

Other documents on which your date of birth is recorded may be acceptable.

Are you sending your birth certificate with this form?

Yes

We will send the certificate back to you

as soon as we can.

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Part 1 About you - continued

Have you ever lived or worked in the

United Kingdom or the Isle of Man?

Please go to Part 2.

Please tell us about this below.

Yes

Have you, your husband, wife or civil partner

ever claimed any of the following benefits in

or from the United Kingdom or the Isle of

Man? The United Kingdom is England,

Scotland, Wales and Northern Ireland.

•

State Pension

•

Graduated Retirement Benefit

•

Widow's Benefit

•

Bereavement Benefit

Which benefit was claimed?

Who claimed the benefit?

If you are a married woman getting

State Pension you need only fill in

Parts 2, 4, 8 and 11 of this form.

Yes

Please tell us about this below.

You Your husband, wife or civil partner

Please tell us any address(es) you had in

the United Kingdom or the Isle of Man and

the dates that you lived there. If you need

more space use the space in Part 10 at the

end of this form.

Address

Dates

From

If you need more space use the

space in Part 10 at the end of this

form.

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Part 1 About you - continued

Please tell us about any time you spent in

the United Kingdom or the Isle of Man.

Include any holidays. If you need more

space use the space in Part 10 at the end

of this form.

From To

Have you ever been in HM Forces?

Please tell us

the date you enlisted

the date you were discharged

where you were discharged

the Regiment or corps you were in

your service number

your rank

Which service were you in?

Army Navy

RAF

Yes

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Part 1 About you - continued

Did you work for an employer in the

United Kingdom or the Isle of Man?

Employer’s name and address

If you know the wages are dealt

with at a different address, please

give us that address, including

the postcode.

The date you started work for

this employer

The date you stopped work for

this employer if you have stopped

working for them

Payroll, staff or other

reference number

Yes

Please tell us about any employers you have had. If you have

had more than 2 employers, tell us about them in Part 10.

Employer 1 Employer 2

Please go to Part 2.

Do you have any contribution or insurance

record cards or notices that show you were

employed in the United Kingdom?

Yes

Please send us the original documents,

not photocopies.

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Part 2

About your husband, wife or civil partner

For official use only

Husband's status before

marriage

Details of wife immediately

before marriage (status)

Details of wife immediately

before marriage (Surname)

Details of wife immediately

before marriage

eg. maiden name

Yes

What is your current marital or

civil partnership status?

If married more than once give details

of previous marriages in Part 10

Single Please go to Part 4

Married or civil partner

Divorced or civil partnership dissolved

Widowed or surviving civil partner

Marriage or civil partnership annulled

Separated

Tell us about your husband, wife or civil partner

Their surname or family name

Their other names

Any other names by which they have

been known

Their National Insurance (NI) number if

you know it

If you do not know their NI number did

they ever work or live in the United Kingdom?

Their address, if different from yours

Their date of birth

Date of marriage or civil partnership formation

Date of divorce, annulment or

civil partnership dissolution

The date they died, if you are widowed or a

surviving civil partner

Letters Numbers

Letter

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Part 2

About your husband, wife or civil partner - continued

Certificate returned by

Nature of evidence

Verified by

Checked by

Certificate returned by

Nature of evidence

Verified by

Checked by

Certificate returned by

Nature of evidence

Verified by

Checked by

For official use only

1. If you are married or a civil partner please send us

your marriage certificate or civil partnership

certificate.

2. If you are widowed or a surviving civil partner please

send us your late husband’s, late wife’s or

late civil partner’s death certificate and your

marriage certificate or civil partnership certificate.

If you are getting United Kingdom Widow’s Benefit or

Bereavement Benefit there is no need to send these

certificates as we already have these details.

3. If you are divorced or a person whose civil

partnership has been dissolved please send us your

decree absolute or confirmation of dissolution of civil

partnership and your marriage certificate or civil

partnership certificate. In Scotland a decree absolute is

called a decree of divorce.

4. If your marriage or civil partnership was annulled

please send us the certificate of annulment and your

marriage certificate or civil partnership certificate.

Are you sending your marriage or

civil partnership certificate with this form?

Yes

We will send the certificate back as soon as

we can. Please fill in the rest of this form.

You need not fill in Part 3.

Are you sending your decree absolute, decree of divorce,

certificate of annulment or confirmation of dissolution

of civil partnership with this form?

Yes

We will send the certificate back as soon as

we can. Please fill in the rest of this form.

You need not fill in Part 3.

Are you sending your late husband’s, late wife’s or

late civil partner’s death certificate with this form?

Yes

We will send the certificate back as soon as

we can. Please fill in the rest of this form.

You need not fill in Part 3.

You must remember to send us all the documents we ask for. If you do not, benefit you can get because of this claim

may be delayed. Other documents on which dates are recorded may be acceptable.

If you do not wish to send your original certificates photocopies may be acceptable - please see the notes on page 2

of this form.

Please fill in the rest of this form including Part 3

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