NHS Pensions - Claim for a lump sum on death of an active member (AW11)

Transcription

1 NHS Pensions - Claim for a lump sum on death of an active member (AW11) Please read the guidance notes below and the Survivor Guide first Notes Membership number SD / Important: Only complete this form if there is no legal spouse, registered civil partner, qualifying partner, or you are a death benefit nominee. However, if you are the legal spouse, registered civil partner or qualifying nominated partner, to claim the lump sum on death and any adult dependant's pension you only need to complete application form AW9. Please complete Parts 1 and 2 of this form. You can ask someone to help you, for example a relative, or a solicitor. Your NHS employer will complete Parts 3, 4 and 5. NHS Pensions may be able to pay a lump sum on death to the personal representative(s) of the deceased, to be included as part of the member s Estate, or to someone else if the deceased nominated them to receive it i.e by completing a Death Benefit Nomination (DB2). 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 separate claim is required for each nominee. These will be issued by NHS Pensions as appropriate upon receipt of the first claim. 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. 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. Bereavement SAPP LSOD AW (V8) 1

2 Do not send the Will, any Grant of Probate, or Letters of Administration with this form. We will write to you if we need them. 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 Pensions PO Box 2269 Bolton BL6 9JS Member helpline 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) death benefit nominee s birth certificate or passport (if appropriate) decree absolute if the member was divorced dissolution certificate if the member s civil partnership has ended former spouse s /civil partner s/nominated partner s death certificate if they pre-deceased the member 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. 2

3 Part 1 To be completed by the person claiming the lump sum on death 1.1 About the deceased. Please write clearly. Title (e.g. Mr, Mrs, Miss, Dr) Surname Other names Date of birth Date of death Gender Male Female What was the member s marital status? - must be completed in all cases Status Single (never married) Married Formed a civil partnership Divorced Civil Partnership dissolved Widowed What is the name of their last NHS employer? What was their job? 1.2 About yourself. Title (e.g. Mr, Mrs, Miss, Dr) Address Surname Former surname (if applicable) Other names address Post code Contact telephone number National Insurance number Date of birth Your gender Male Female What was your relationship to the person who has died? Death benefit nominee - go to part 1.3 Personal Representative - go to part 1.3 Legal Spouse/Civil Partner Other (please specify) 3

4 1.3 About the personal representative - must be completed in all cases Title (e.g. Mr, Mrs, Miss, Dr) Address Surname Other names Contact telephone number address Post code Part 2 Declaration To be completed by the person claiming the lump sum on death. Please sign and date below. 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 any further or new information at the earliest possible opportunity. I declare that I am the personal representative and/or death benefit nominee of the deceased. I apply for the lump sum on death I declare that I have enclosed the Death Certificate and supporting documentation requested Please sign here Print your full name Date Please return this form and your supporting documentation to the NHS employer that issued it. Do not send it to NHS Pensions unless there is a note in the space below telling you to do so. If you are claiming an allowance for dependent children you will have received application form AW158. Please send it back to the NHS employer (or to NHS Pensions if told to do so) with any children s birth and medical certificates asked for. Your certificates, or other papers, will be photocopied and returned to you as quickly as possible. 4

5 Employers: Please read the notes below before completing Part 3 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 3.2 below and the reason inserted at 3.3. When updating form SD55 on POL 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 If the member had membership in the 2015 Scheme only (i.e no deferred membership in the 1995/2008 Scheme) If before their death the member moved from the 2008 Section to the 2015 Scheme (this includes members who were entitled to Tapered Protection) If before their death the member moved from the 1995 Section to the 2015 Section (this includes members who were entitled to Tapered Protection) If on the date of death the member continued to remain in the 2008 Section because of Full or Tapered Protection If on the date of death the member continued to remain in the 1995 Section because of Full or Tapered Protection Complete Part 3.2 & 3.3, then go to Part 4 Complete Part 3.2 & 3.3, then go to Part 4 Complete Part 3.2 & 3.3, then go to Part 4 Go to Part 3 & 4 Complete Part 3.2 & 3.3, then go to Part 4 Go to Part 3 5

6 Part 3 Pay details - to be completed by the NHS employer. 3.1 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) in the figures shown below. (ii) show the amount of DV s separately at 3.7 below Part time members (i) exclude DV fees from the figures shown below (ii) complete the whole of PART 3.5 Last year From to disallowed days Amount 3.2. inclusive date to which salary will be paid: 3.3. If the answer to 2 above differs from the date of death please say why: 3.4. Now please give details of the two previous years in all cases Middle year From to disallowed days Amount Earliest year From to disallowed days Amount 3.5. 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 From to Amount From to Amount From to Amount 3.6. 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: 3.7. Amount of any domiciliary consultation fees paid in the period shown at item 3.1 above and in the two previous years shown at item 3.4. Final year Middle year Earliest year 3.8. Amount of any deemed domiciliary consultation fees in the best year at item 3.7 above Have domiciliary consultation fees been included in the amounts shown at item 3.1 and/or 3.4 above? No 6

7 Part 4 Membership details to be completed by the NHS employer 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: From to Disallowed days Paid notice Annual leave From to Disallowed days Paid notice Annual leave From to Disallowed days Paid notice Annual leave 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: 4.1. The member s date of birth has been verified by checking their birth certificate or passport Verified date of birth is 4.2 The member s date of death has been verified by checking the death certificate Verified date of death is 4.3 The member divorced before they died. Verified date on the decree absolute is 4.4 The member dissolved their civil partnership before they died Verified date on the dissolution certificate is 4.5 The member s partner is pre-deceased Verified date of death is 4.6 Power of Attorney or Court Protection Order (if appropriate) is attached Dependant children 4.7 Are there any dependent children? No Form AW158 is attached will follow 4.8 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 4.9 The lump sum on death is being claimed by a nominee No The nominees s date of birth has been verified by checking their birth certificate or passport Verified date of birth is 7

8 Part 5 Declaration by the NHS employer I certify that: the information given in parts 3 and 4 of this form is correct; the pay details in part 3 agree with the contributions shown on form SD55 and include details in respect of paid notice and or untaken annual leave; the contributions, pay and hours (if applicable) for any membership after the date of death have been included on SD55; 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. Signature Name in CAPITALS Telephone no: Date Extension: EA/GP Stamp 8