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Report a Death
"
*
" indicates required fields
Please provide details below about who is reporting the death
Name
*
Miss
Mr.
Mrs.
Ms.
Dr.
Title
First
Last
Date of Birth
*
Day
Month
Year
Address
*
Address Line 1
Address Line 2
City
County / State / Region
ZIP / Postal Code
Contact Number (Mobile/ Landline)
*
Email
*
Enter Email
Confirm Email
Please sign me up for email and online communication
Sign me up
Relationship with the Deceased
*
(For example – partner, son, daughter, sibling)
Are your the Main Contact who is dealing with the member's affairs
*
Yes
No
(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
*
Miss
Mr.
Mrs.
Ms.
Dr.
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
*
Miss
Mr.
Mrs.
Ms.
Dr.
Title
First
Last
Date of Birth
*
Day
Month
Year
Address
*
Address Line 1
Address Line 2
City
County / State / Region
ZIP / Postal Code
Scheme Name (or Employer)
*
Membership Reference
*
National Insurance Number
*
Date of Death
*
Day
Month
Year
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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