Report a death

Report a Death

Fill out the form below – or open the PDF below to print and send to us.

"*" indicates required fields

Death Benefits Claim Form

Please provide details below about who is reporting the death

Name*

Title First Last

Address*

Address Line 1 Address Line 2 City County / State / Region ZIP / Postal Code

Contact Number (Mobile/ Landline)*

Email*

Enter Email Confirm Email

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Relationship with the Deceased*

(For example – partner, son, daughter, sibling)

Are your the Main Contact who is dealing with the member's affairs*

Yes

(For example – their Spouse’s benefits, Death benefits or over payments)

Main Contact

Please give us the contact details of the person who is dealing with the member’s affairs who we can contact if we have questions about Spouse’s benefits, Death benefits or over payments.

Name*

Title First Last

Address*

Address Line 1 Address Line 2 City County / State / Region ZIP / Postal Code

Contact Number (Mobile/Landline)

Email*

Enter Email Confirm Email

Details about the Deceased

Name*

Title First Last

Address*

Address Line 1 Address Line 2 City County / State / Region ZIP / Postal Code

Scheme Name (or Employer)*

Membership Reference*

Date of Death*

Upload scanned copy/photograph of Death Certificate

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 10 MB.

Consent*

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Contact us

Report a Death

Main Contact

Details about the Deceased

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