1 Bereavement-SAPP AW9 active member adp claim form-20180815-(V12) NHS Pensions - Claim for Adult Dependant Pension on death of an active member (AW9) Please read the guidance notes below and the Survivors Guide first which is available on our website at www.nhsbsa.nhs.uk/nhs-pensions Membership number SD / Important: Only complete this form if you are the member’s legal spouse, registered civil partner or qualifying nominated partner. Please complete Parts 1 and 2 of this form. You can ask someone to help you do this, for example a relative or a solicitor. Your NHS employer will complete Parts 4 and 5. Someone who knows you should sign at Part 3. NHS Pensions must inform the personal representative of any lump sum on death paid. This is because the payment may be subject to a Lifetime Allowance Charge (LTAC), please see the Survivors Guide for more details. The liability to pay any tax charge lies with the person or organisation receiving the lump sum on death. The personal representative is the person responsible for administering the Estate of the deceased. This is a wide definition, and does not have to be a formal appointment. The surviving partner is not necessarily the personal representative. A HM Revenue & Customs (HMRC) requirement is that NHS Pensions must inform the personal representative of the following information within three months of the final payment: • The amount and date of the lump sum on death paid in respect of the member • The percentage of the standard Lifetime Allowance used by the lump sum on death in respect of the member. Any adult dependant's pension or children's pension does not form part of the member's Lifetime Allowance. Do not delay your claim as the lump sum on death benefit must be paid within two years of the date upon which the Scheme Administrator was first notified of the member’s death otherwise it will be subject to a HMRC tax charge of up to 45%. NHS Pensions has no discretion and must deduct this tax charge from the lump sum payment. The deceased member may have a valid declaration that they wish the lump sum on death to be paid to their personal representatives or to one or more nominees i.e by completing a Death Benefit Nomination (DB2). Even if this is the case you should still complete this form to claim the adult dependant's pension. • If the late member made a valid declaration that they wish the lump sum on death to be paid to one or more nominees a seperate claim is required for each nominee. These will be issued by NHS Pensions as appropriate upon receipt of the first claim. Notes
Transcript
1Bereavement-SAPP AW9 active member adp claim form-20180815-(V12)
NHS Pensions - Claim for Adult Dependant Pension on death of an active member (AW9)Please read the guidance notes below and the Survivors Guide first which is available on our website at www.nhsbsa.nhs.uk/nhs-pensions
Membership number SD /
Important: Only complete this form if you are the member’s legal spouse, registered civil partner or qualifying nominated partner.
Please complete Parts 1 and 2 of this form. You can ask someone to help you do this, for example a relative or a solicitor. Your NHS employer will complete Parts 4 and 5. Someone who knows you should sign at Part 3.
NHS Pensions must inform the personal representative of any lump sum on death paid. This is because the payment may be subject to a Lifetime Allowance Charge (LTAC), please see the Survivors Guide for more details. The liability to pay any tax charge lies with the person or organisation receiving the lump sum on death.
The personal representative is the person responsible for administering the Estate of the deceased. This is a wide definition, and does not have to be a formal appointment.
The surviving partner is not necessarily the personal representative.
A HM Revenue & Customs (HMRC) requirement is that NHS Pensions must inform the personal representative of the following information within three months of the final payment:
• The amount and date of the lump sum on death paid in respect of the member • The percentage of the standard Lifetime Allowance used by the lump sum on death in respect of the
member.
Any adult dependant's pension or children's pension does not form part of the member's Lifetime Allowance.
Do not delay your claim as the lump sum on death benefit must be paid within two years of the date upon which the Scheme Administrator was first notified of the member’s death otherwise it will be subject to a HMRC tax charge of up to 45%. NHS Pensions has no discretion and must deduct this tax charge from the lump sum payment.
The deceased member may have a valid declaration that they wish the lump sum on death to be paid to their personal representatives or to one or more nominees i.e by completing a Death Benefit Nomination (DB2). Even if this is the case you should still complete this form to claim the adult dependant's pension.
• If the late member made a valid declaration that they wish the lump sum on death to be paid to one or more nominees a seperate claim is required for each nominee. These will be issued by NHS Pensions as appropriate upon receipt of the first claim.
Notes
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If the deceased member had a NHS Money Purchase Additional Voluntary Contributions (MPAVC) death cover contract, please send a copy of the death certificate to their NHS MPAVC provider. The NHS MPAVC provider can only make payment of any MPAVC benefit after NHS Pensions has issued payment of the lump sum on death.
Before you return this form, write down our address, member helpline and the membership number (beginning SD).
Our address is:
NHS PensionsPO Box 2269BoltonBL6 9JS
Member helpline is: 0300 330 1346Outside UK: +44 191 279 0571
Important: If you change your address please tell us right away, quoting the membership number. Supporting documentation
An original or acceptable certified copy of the following documentation is required to support your claim:
• member’s birth certificate or passport (if this has not already been seen)• member’s death certificate (if this has not already been seen)• marriage certificate (if the deceased member was married before they died)• civil partnership certificate (if the member had formed a civil partnership before they died)• spouse’s, civil partner’s or qualifying nominated partner’s birth certificate or passport• proof of financial interdependency if the member had a qualifying nominated partner (see below for
further details)• proof that both the member and their nominated partner were not prevented from marrying each other
or entering into a civil partnership together, for a continuous period of at least two years ending with the member’s date of death (see below for further details)
• Power of Attorney or Court Protection Order (if appropriate)
Where applicable an English translation of any certificate should be forwarded.
Important: Your claim cannot be processed until all supporting documentation has been received and verified.
Proof of financial interdependency (qualifying nominated partners only)
If you are claiming as a qualifying nominated partner you will need to provide at least two forms of original supporting documentation (no photocopies) from the list below:
• loan or mortgage in joint names• joint tenancy agreement if you lived in rented accommodation• confirmation of shared household expenditure i.e water rates, telephone, gas, electric, council tax, Sky,
tv licence, house insurance in joint names, or individual names at the same address• shared bank accounts or investments• wills naming each other as the main beneficiary• a mutual power of attorney• your partner being nominated as the main beneficiary of life assurance
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Proof of marital status (qualifying nominated partners only)
If you are claiming as a qualifying nominated partner you will also need to provide the following (please provide original certificates or acceptable certified copies):
• A written statement and or documentary evidence that confirms your marital status when you jointly completed the PN1 and when the member died i.e were you (i) single (never married) (ii) divorced (iii) civil partnership dissolved (iv) once married or in a civil partnership but your former spouse/civil partner has died;
• A written statement and or documentary evidence that confirms the member’s marital status when they jointly completed the PN1 and when they died i.e were they (i) single (never married) (ii) divorced (iii) civil partnership dissolved (iv) once married or in a civil partnership but their former spouse/civil partner has died;
• If (i) applies provide a written statement for both you and the member;• If (ii), (iii) or (iv) apply provide a written statement and also original documentary evidence i.e decree
absolute, a dissolution certificate or death certificate for each person.
These notes explain how we will pay your pension. Please keep them in a safe place, you may need to look at them again. Please complete the form and return it with any other claim forms that have been sent to you.
Methods of payment.
We will pay the pension by direct credit into your bank or building society account. This is by far the safest method of payment. The account can be with a bank or building society:
• in the United Kingdom (we cannot pay to mortgage accounts or to National Savings Bank accounts) ,or • in the Channel Isles, Isle of Man or Irish Republic, or • overseas (provided it is one of the countries listed in the Survivors Guide and it is capable of receiving
secure electronic payments of funds).
You will need to complete the bank mandate for the payment to be made to an overseas bank account and attach it to this claim form. The overseas bank mandates are available from our website at:www.nhsbsa.nhs.uk/nhs-pensions
If your bank is in a country that is not listed, you will need to make arrangements to have your pension paid into a bank in one of the countries listed. Your chosen bank will be able to help you in arranging for the funds to be forwarded to you.
If you do not have a suitable account, you will need to open one.
We will normally pay the pension monthly (one twelfth of the yearly rate, to the nearest penny), on the same day each month. We will tell you what the payment date is. This may not be the last day of the month.
When the payment date falls on a weekend or on an English or Welsh public holiday, the payment will go into the account on the last working day before the weekend or holiday.
A 'pension month' is the period between one payment date and the next. If a pension starts part way through a 'pension month', the first payment will be for the amount due for the number of days in the part pension month.
We will not send details of the pension each time a payment is made, but we will write when your pension begins and each time there is a change in your tax code or in the yearly rate, for example because of a cost of living increase.
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Weekly payment
(This applies only to people living in the UK)
Where the late member’s pension had been paid weekly, we may exceptionally pay a pension weekly to a bank or building society.
If you must be paid weekly, please say so in a covering letter and attach it firmly to the claim form.
We will send you an advice slip every 12 weeks showing details of the next 12 weeks payments. Changes you should tell us about
You should tell us immediately if:
• you change your address• your bank or building society account details change• you remarry, form a civil partnership or start living with someone as their spouse• you are living with someone else at the time of your spouse's death*• a child ceases full time education or a training course**• a child reaches age 23***• a child is admitted to hospital or other institution for a period exceeding one month• a child moves out of the family home and wishes to claim the pension in their own right
If a pension is overpaid because you do not tell us about any of the above changes, you will have to pay back any money overpaid.
You should also tell someone to let us know of your death.
You can contact us using the following details:
Telephone: 0345 121 2522From abroad use: +44 191 283 0303Our contact centre is open 8am to 6pm Monday to Friday.
Postal address:NHS PensionsPO Box 2268BoltonBL6 9JR
Pensions Increase
NHS pensions are increased to keep pace with rises in the cost of living. They are increased by the same percentage as the increase to the State Earnings Related Pension Scheme.
Increases are normally paid from April, so in the first year the amount of increase you will get will depend on when the pension starts.
For example, if the full increase is 3% but your pension has only been in payment for 6 months, the increase you will get will be 1.5%. A part month of 16 days or more will count as if it was a full month, but a part month of 15 days or less will not count. So, a pension that begins 15 days or less before an increase date will not get an increase until the following year.
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Increase dates will often fall part way through a month. Where this happens your pension for that month will be partly at the rate before the increase and partly at the new rate. The pension for the following month will be at the new rate.
If your pension becomes payable because a former member with preserved benefits dies, all the increases made since the member left the Scheme will be given.
If your pension becomes payable because a Scheme pensioner dies, all the increases they were receiving will be added to your pension.
In some cases the increase may be paid partly by the Department for Work and Pensions at Newcastle upon Tyne and partly by us. If this applies in your case, you will still get the full amount of the increase.
Income Tax
Your pension is treated for tax purposes as earned income. At first, we will deduct tax under a temporary code until we get the right code from the Tax Office. The Tax Office will decide what your tax code should be.
If you want to query your tax code you should write to the address given below.Tell them your National Insurance number and your NHS Pensions membership number.
Pay As You Earn and Self AssessmentHM Revenue & CustomsBX9 1ASUnited Kingdom
If tax has been deducted, we will send you a form P60 after the end of each tax year to show the total pension paid and the amount of tax deducted in that year.
When we send payments to your bank etc, it includes details of any income tax deducted, but not your tax code. Most banks will show on your statement the tax deducted from your pension payment.
If you prefer details of your tax deductions not to be included with the payment information sent to your bank, please say so in a covering letter and attach it firmly to the claim form.
* Applicable if you receive an adult dependant's pension following the death of a member who retired, or whose Scheme membership ceased, before 1 April 2008.
** Applicable if you receive a children's pension following the death of a member who retired, or whose Scheme membership ceased, before 6 April 2006.
*** Applicable if you receive a children's pension following the death of a member who retired after 5 April 2006 but before 1 April 2008.
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Part 1 To be completed by the adult dependant
1.1 About your late spouse, civil partner or partner. Please write clearly.
Title (e.g. Mr, Mrs, Miss, Dr)
Surname
Other names
What is the name of their last NHS employer?
What was their job?
Date of birth
Date of death / /
/ /GenderMale Female
1.2 About the personal representative - must be completed in all cases (see guidance notes)
Title (e.g. Mr, Mrs, Miss, Dr)
Surname
Other names
Contact telephone number
Address
Email address
Post code
1.3 About yourself.
Title (e.g. Mr, Mrs, Miss, Dr)
Surname
Other names
Date of birth
Contact telephone number
Date of marriage/civil partnership (if applicable)
What was your relationship to the person who has died?
spouse civil partner qualifying nominated partner
Pensions are paid monthly, but if your late spouse, civil partner or partner was a weekly wage earner you can choose to have your pension paid weekly. If this applies to you, please tell us how you would like your pension paid: Monthly Weekly
Address
Email address
National Insurance number
Your genderMale Female
Post code
/ /
/ /
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To be completed only if you are claiming a dependants’ pension
About yourself
Title (e.g. Mr, Mrs, Miss, Dr)
Surname
Other names
Date of birth
National Insurance number
1.4 Payment details
Claim for adult dependant's pension Serial number
For NHS Pensions use only
Post code
Your address
Telephone number
Email address/ /
Bank or Building Society account details:
Name of account holder(either pensioner's own account or a joint account with someone else)
Full name and address of your bank or building society
Branch sort code
Account Number and/or Roll No
Bank/Building Society account type
Current account - enter 0 Deposit account - enter 1
If your bank is outside the UK, please indicate which country your pension will be paid to:
You will need to complete the mandate for payment to be made to an overseas bank and attach it to this form (see Methods of Payment above).
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Part 2 Declaration
To be completed by the person claiming the adult dependant's pension and/or the lump sum on death. Please sign and date this part with your witness present.
I apply for my adult dependant's pension and/or lump sum on death.
I have read the Notes that came with this form.
I have read the Survivors Guide to the NHS Pension Scheme available on the website.
I understand that I will have to repay any overpayment of pension.
I understand that I must tell NHS Pensions about any changes that may affect my entitlement.
I declare that I am entitled to a pension from the NHS Pension Scheme.
I declare that the information I have given on this form is correct and complete to the best of my knowledge and belief. If I become aware of any change in the information given on the form, or any further new information relevant to the form, after I have sent it I hereby agree to notify the Scheme Administrator of those changes and that further or new information at the earliest opportunity.
I declare that I am the surviving partner of the person who has died.
Please sign here Print your full name
Date
How we use your information
The NHS Business Services Authority – NHS Pensions will use the information provided for administering your NHS Pension Scheme membership and processing payment of your NHS pension benefits. We may share your information to administer and pay your NHS pension, enable us to prevent and detect fraud and mistakes, for debt collection purposes, or as required by law. For more information about who we share your information with and how long we keep your personal data and your rights, please visit our website at www.nhsbsa.nhs.uk/yourinformation
/ /
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Part 3 Please ask your witness to complete this part in your presence.
Please send this form and your supporting documentation, as detailed in the notes, back to the NHS employer who issued it. Do not send it to NHS Pensions unless you have been notified to do so.
If you are claiming a children's pension you will have received application form AW158. Please send it back to the NHS employer (or to NHS Pensions if you are told to do so) with any children's birth and medical certificates asked for. Your certificates will be photocopied and returned to you as quickly as possible.
I certify that I saw this person sign the above declaration
Print your full name Your address
Telephone Number
Email Address
Signature Date
If you are witnessing outside the United Kingdom and you are not a U.K. voter, please write your qualification in this box from the list below.
Persons who may witness outside the U.K.
A registered United Kingdom voter.A listed or retired officer of Her Majesty's armed forces. A permanent or retired civil servant of any country in the British Commonwealth or Irish Republic.A member of Her Majesty's diplomatic service. An authorised bank official.A physician or surgeon registered where the Declaration is made. A minister of religion.A merchant ship master who is a British subject. A Commonwealth or Irish Republic university graduate.A magistrate. A barrister, solicitor or advocate authorised to practise where this Declaration is made. A Notary Public or other person qualified to administer oaths where this Declaration is made. In the Channel Islands.A registered Channel Island voter.
In the Isle of Man.A registered Isle of Man voter.
Post code
/ /
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Employers: Please read the notes below before completing Part 4
Employers with access to Pensions Online (POL) – Please terminate the employment using SD55. Enter full details of any events during the pay periods (such as unpaid sick leave, bonus or special duty payments) which affect pay or contributions.
Because NHS Pensions does not have access to payroll records, it relies entirely on the employer to provide accurate pay/earnings information when completing benefit application forms.
Any paid notice and or untaken annual leave at the date of death will effectively extend the last day of membership. Remember to deduct contributions for these days and ensure the extended date is shown at Part 4.2 and the reason inserted at Part 4.3.
When updating form SD55 on POL please terminate the employment using the date of death and exit code 14. Ensure the contributions, pay/earnings and pensionable hours (if applicable) for any untaken annual leave etc are included on the SD55 and in the Total Pensionable Pay (TPP) calculations (1995 Section).
Important (1995 Section): Where there is a period of unpaid leave, the period over which pay for benefit purposes would normally be calculated will need to be extended backwards into the previous period, for a period equal to the unpaid sick leave. This will have the effect of making up the TPP period to 365 paid days. This is commonly referred to as ‘stepping back’. The number of days unpaid leave should be shown in the disallowed days column for the relevant year.
If the member was a Type 1 or Type 2 practitioner in the 1995/2008 Scheme or 2015 Scheme
Complete Part 4.2 & 4.3, then go to Part 5
If the member had membership in the 2015 Scheme only (i.e no deferred membership in the 1995/2008 Scheme)
Complete Parts 4.2, 4.3 & 4.10 then go to Part 5.
If before their death the member moved from the 2008 Section to the 2015 Scheme (this includes members who were entitled to Tapered Protection)
Complete Parts 4.2, 4.3 & 4.10 then go to Part 5.
If before their death the member moved from the 1995 Section to the 2015 Section (this includes members who were entitled to Tapered Protection)
Complete Part 4 (including 4.10) then go to part 5
If on the date of death the member continued to remain in the 2008 Section because of Full or Tapered Protection
Complete Part 4.2 & 4.3, then go to Part 5
If on the date of death the member continued to remain in the 1995 Section because of Full or Tapered Protection Go to Part 4 and 5
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Part 4 Pay details - to be completed by the NHS employer. 4.1 Fill in the TPP for the last 365 days of paid membership ending on the member's date of death or if later date to which salary will be paid e.g including any period of deemed membership for untaken annual leave or paid notice (see previous notes).
Whole time members (i) include Domiciliary Visit Fees(DV's) figures shown below. (ii) show the amount of DV’s separately at 4.7 below
Part time members (i) exclude DV fees from the figures shown below (ii) complete the whole of Part 4.5 Last year (1995 Section) - stepped back to take account of any disallowed days.
4.2. inclusive date to which salary will be paid:
4.3. If the answer to 2 above differs from the date of death please say why:
4.4. Now please give details of the two previous years in all cases
Middle year
Earliest year
4.5. If the person who has died was working part time please give the notional whole time equivalent pay for each of the last 3 years of paid employment.
Last year
Middle year
Earliest year
4.6. Amount of any deemed pay for sick leave (not SSP),deemed bonus and special duty payments included in pay shown above for the best year only: £
4.7. Amount of any domiciliary consultation fees paid in the period shown at item 4.1 above and in the two previous years shown at item 4.4. Final year £ Middle year £ Earliest year £
4.8. Amount of any deemed domiciliary consultation fees in the best year at item 4.7 above. £
4.9. Have domiciliary consultation fees been included in the amounts shown at item 4.1 and/or 4.4 above? Yes No
4.10. Fill in the total pensionable earnings for the last 365 days ending on the date of death or date shown at 4.2 above without stepping back for any disallowed days. This is required for the lump sum on death calculations.
From / / to / / disallowed days Amount £
/ /
From / / to / / disallowed days Amount £
From / / to / / disallowed days Amount £
From / / to / / Amount £
From / / to / / Amount £
From / / to / / Amount £
From / / to / / Amount £
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Part 5 Membership details – to be completed by the NHS employer
5.1 For 1995/2008 Scheme and 2015 Scheme, please set out below the exact dates of any disallowed days, dates of paid notice and or dates of annual leave made after the unpaid sick leave in the boxes below:
Part 6 To be completed by the NHS employer
Important: Please tick to confirm and insert verified dates in the boxes provided.NHS Pensions are unable to pay benefits without confirmation that you have verified all relevant dates as set out below.
I certify:
6.1. The member’s date of birth has been verified by checking their birth certificate or passport Yes Verified date of birth is
6.2 The member’s date of death has been verified by checking the death certificate
Yes Verified date of death is 6.3 The member’s date of marriage has been verified by checking the marriage certificate
Yes Verified date of marriage is
6.4 The member’s date of civil partnership has been verified by checking the civil partnership certificate
Yes Verified date of civil partnership is 6.5 The surviving partner's date of birth has been verified by checking their birth certificate or passport.
Yes Verified date of birth is
6.6 Power of Attorney or Court Protection Order (if appropriate) is attached
Dependent Children
6.7 Are there any dependent children?
Yes No
Form AW158 is attached will follow
The child/children’s date(s) of birth has been verified by checking their birth certificate(s) or passport(s) Verified date(s) of birth is/are
From / / to / / Disallowed days Paid notice Annual leave
From / / to / / Disallowed days Paid notice Annual leave
From / / to / / Disallowed days Paid notice Annual leave
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
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6.8 Initial/limited surviving adult dependant's pension details from form AW135 are:
below to follow not applicable
The pension ticked below is being paid to the legal spouse/registered civil partner
Initial pension for 6 calendar months
Payment dates from / / to / / (should be day after date of death only).
At the rate of £ a week a month
Limited pension for 6 calendar months
Payment dates from / / to / /
At the rate of £ a week a month
Practitioners only - The pension is based on remuneration ending on / /
6.9 Please state the amount of initial surviving adult dependant pension to be put into payment for a valid qualifying nominated partner £
Part 7 Declaration by the NHS employer
I certify that:
the information given in parts 4, 5 and 6 of this form are correct;
the pay details in part 4 agree with the contributions shown on form SD55 and include details in respect of paid notice and or untaken annual leave;
all contributions to the NHS Pension Scheme have been or will be deducted from pay;
all relevant certificates and any other original papers have been seen and returned to the claimant;
the members date of birth has been verified online;
for qualifying nominated partners the relevant supporting original documentation and evidence has been seen and a copy is included.
