NHS Pensions - Claim for payment of children's pension (AW158) This form only applies to member's whose Scheme membership ended before 1 April 2008. Member's surname Other names Membership number SD / What was the name of their last NHS employer? NHS Pensions may be able to pay a pension for any dependent children of a member who dies - see the Survivors Guide available on our website at www.nhsbsa.nhs.uk/nhs-pensions for more information about other possible child dependents. We can pay a pension to: anyone who has care of the children, or the children if they look after themselves. Where Scheme membership ended before 1 April 2008 you can claim a children's pension for anyone who: was dependent on the person who has died, both when membership ended and on death, and is under age 17, or is 17 or over and in full time education or training and has been so continuously since the age of 17, until they reach a maximum age of 23*, or is under age 23 at the time of the member's death and at that time is permanently incapable of earning their own living because of a physical or mental impairment. * If the member retires before 6 April 2006, the maximum age limit of 23 does not apply. 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. 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). Bereavement-SAPP AW158 childrens pension claim form Pre 01.04.08-20180815-(V8) 1
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. 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 2522 From abroad use: +44 191 283 0303 Our contact centre is open 8am to 6pm Monday to Friday. 2
Email address: nhsbsa.pensionsmember@nhsbsa.nhs.uk Fax 01293 604024 Postal address: NHS Pensioner Admin PO Box 2268 Bolton BL6 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. 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 Assessment HM Revenue & Customs BX9 1AS United Kingdom Telephone 0300 200 3300 Text phone 0300 200 3319 Outside UK +44 135 535 9022 3
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 become entitled to a children's pension before 6 April 2006. *** Applicable if you become entitled to a children's pension on or after 6 April 2006 in respect of a member whose membership of the Scheme ended before 1 April 2008. 4
Do you think you can claim for anyone? Please tick the box that applies to you and follow the instructions: Yes. I can claim for someone Complete the application form then return it to the office that sent it to you. I am not sure. I think I may be able to claim for someone Complete the application form then return it to the office that sent it to you. NHS Pensions will write to tell you whether you can have a children's pension No. I cannot claim for anyone Please sign and date the form below then return it to the office that sent it to you. Are you aware of any other dependent children i.e. from a previous marriage/relationship? Please tick the boxes that apply to you and follow the instructions: Yes I am not sure Please provide details below i.e name and address of the person who has care of these children or the children if they look after themselves. Please tell us why in the box below. Please continue on a separate sheet if necessary and attach to the AW158. No I am not aware of any other dependent children. Please sign and date below Title (e.g. Mr, Mrs, Miss, Dr) Address Print name Contact telephone number Signature Email address Date 5
Part 1 Details of the dependants you are claiming for Notes about completing this part of the form. Spaces are provided for you to give information for up to five dependants. If you do not have enough room please continue on a separate piece of paper and attach it firmly to this form. "Relationship" means the relationship of the dependant to the person who has died. If the dependant is under age 17 you only need to write their name and relationship. If the dependant is aged 17 or over you will need to complete the information about either their full time education or their incapacity, whichever is appropriate. "Place of education" means the name of the school, college etc. that the dependant attends. "Incapacitated" means a dependant who is unable to earn there own living due to a permanent physical or mental impairment from which that child was suffering at the date of the member's death. Please write clearly. 1. Name (surname first please) Relationship to the member who has died Date of birth Dependants aged 17 or over in full time education: Please confirm details of education from attaining the age of 17 as set out below. Attach a separate sheet of paper if necessary. Place of education Student reference no. Name of course Full address Date expected to finish Are they on a paid training course? Yes No Amount paid Dependants who are incapacitated: Is the dependant living with you at home? Yes No Reason the child is not living with you at home: (i.e in hospital/other institution. Please continue on a separate sheet if necessary and attach to the AW158) Date their incapacity began Address (if not living with claimant) 6
2. Name (surname first please) Relationship to the member who has died Date of birth Dependants aged 17 or over in full time education: Please confirm details of education from attaining the age of 17 as set out below. Attach a separate sheet of paper if necessary. Place of education Student reference no. Name of course Full address Date expected to finish Are they on a paid training course? Yes No Amount paid Dependants who are incapacitated: Is the dependant living with you at home? Yes No Reason the child is not living with you at home: (i.e in hospital/other institution. Please continue on a separate sheet if necessary and attach to the AW158) Date their incapacity began Address (if not living with claimant) 7
3. Name (surname first please) Relationship to the member who has died Date of birth Dependants aged 17 or over in full time education: Please confirm details of education from attaining the age of 17 as set out below. Attach a separate sheet of paper if necessary. Place of education Student reference no. Name of course Full address Date expected to finish Are they on a paid training course? Yes No Amount paid Dependants who are incapacitated: Is the dependant living with you at home? Yes No Reason the child is not living with you at home: (i.e in hospital/other institution. Please continue on a separate sheet if necessary and attach to the AW158) Date their incapacity began Address (if not living with claimant) 8
4. Name (surname first please) Relationship to the member who has died Date of birth Dependants aged 17 or over in full time education: Please confirm details of education from attaining the age of 17 as set out below. Attach a separate sheet of paper if necessary. Place of education Student reference no. Name of course Full address Date expected to finish Are they on a paid training course? Yes No Amount paid Dependants who are incapacitated: Is the dependant living with you at home? Yes No Reason the child is not living with you at home: (i.e in hospital/other institution. Please continue on a separate sheet if necessary and attach to the AW158) Date their incapacity began Address (if not living with claimant) 9
5. Name (surname first please) Relationship to the member who has died Date of birth Dependants aged 17 or over in full time education: Please confirm details of education from attaining the age of 17 as set out below. Attach a separate sheet of paper if necessary. Place of education Student reference no. Name of course Full address Date expected to finish Are they on a paid training course? Yes No Amount paid Dependants who are incapacitated: Is the dependant living with you at home? Yes No Reason the child is not living with you at home: (i.e in hospital/other institution. Please continue on a separate sheet if necessary and attach to the AW158) Date their incapacity began Address (if not living with claimant) 10
Part 2 Payment information Claim for children's pension Serial number For NHS Pensions use only About yourself Title (e.g. Mr, Mrs, Miss, Dr) Your address Surname Other names Date of birth National Insurance number 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 the payment to be made to an overseas bank and attach it to this form (see Methods of Payment above). 11
Part 3 Supporting documentation required An original or acceptable certified copy of the following documentation is required to support your claim: Birth certificates Send the birth certificates of all the dependants you are claiming for. These will be returned to you as soon as possible. Medical certificates If you are claiming for anyone who is unable to earn a living due to a permanent physical or mental impairment, please send a medical certificate or a doctor's letter that explains their condition. Where applicable an English translation of any certificate/document should be forwarded Important: Your claim cannot be processed until all supporting documentation has been received and verified. NHS Pensions may write to ask you for other papers. 12
Part 4 Declaration Please complete the Declaration below. Ask someone who knows you to witness your signature. Your witness should complete Part 5. 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 the person(s) named in Part 1 were financially dependent on the deceased member at the time of their death. that I am not aware of any other dependent children who may be entitled to a "share" of the total children's pension payable from the NHS Pension Scheme, that are not already listed on this application form. that if I become aware of any other dependents I agree to notify the Scheme Administrator as soon as possible in order to prevent an overpayment. that I shall have care and charge of the person(s) named in Part 1 of this form and any children's pension paid to me will be used for the benefit of those persons. 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 will be provided at the earliest possible opportunity. that I am entitled to a pension from the NHS Pension Scheme. This is my claim for payment of a children's pension. Print your full name Your address Telephone number Email address Signature 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 13
Part 5 Please ask your witness to complete this part. 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. Please send this form and your supporting documentation, as detailed in the notes, to: NHS Pensions PO Box 2269 Bolton BL6 9JS 14