Report a death

Report a Death

Use this form to report the death of a Scheme member. To complete this form you will need the deceased’s:

Scheme name (or Employer name)
National Insurance number
Member reference number (this can be found on any written correspondence from us) and
Scan or photograph of their death certificate

"*" indicates required fields

Your details

Please provide details below about who is reporting the death

Name*

Title First Last

Date of Birth*

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

(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

Please provide details of the deceased member

Name*

Title First Last

Date of Birth*

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*

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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Report a Death

Your details

Main contact

Details about the deceased

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