Form Bb1 PDF Details

Navigating the complexities of bereavement can be overwhelming, especially when it comes to understanding the financial support available. Bereavement benefits in the UK serve as a vital aid for individuals facing the loss of a spouse or civil partner, offering a semblance of financial stability during a turbulent time. These benefits, contingent upon the deceased partner's National Insurance contributions, include Bereavement Payment, Widowed Parent's Allowance, and Bereavement Allowance. Each type of support caters to different needs, whether as a one-time payment to ease immediate financial pressures or ongoing assistance for those with children. Importantly, eligibility hinges on a variety of factors including marital status, childcare responsibilities, and the age of the surviving partner and their deceased spouse or civil partner. Moreover, changes in how HM Revenue and Customs collects National Insurance contributions and the nuances of claiming benefits underscore the importance of guidance and clarity in this process. With resources and helplines available for assistance, those grieving are not alone; there is help available to navigate through these financial considerations after loss, ensuring survivors are supported in understanding and accessing the bereavement benefits they're entitled to.

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Form NameForm Bb1
Form Length24 pages
Fillable?No
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Avg. time to fill out6 min
Other namesform bb1, how to form bb1, dwp forms download download, form bb1 bereavement

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BEREAVEMENT

BENEFITS

Help for widows, widowers and surviving civil partners

lBereavement Payment

lWidowed Parent’s Allowance

lBereavement Allowance

This pack contains

more information about bereavement benefits

a bereavement benefits claim form.

BB1 Notes 05/16

What are bereavement benefits?

We use bereavement benefits to mean any of these

lBereavement Payment

lWidowed Parent’s Allowance

lBereavement Allowance.

They are all based on your spouse or civil partner’s National Insurance (NI) contributions.

By your spouse or civil partner we mean the person you were legally married to, or were in a civil partnership with, at the time of their death.

For people who live or have lived in Scotland

Please get in touch with us if you live or have lived in Scotland and you are not sure if you were legally married.

Can I get bereavement benefits?

You may be able to get bereavement benefits if your spouse or civil partner had paid enough NI contributions.

You cannot get bereavement benefits if at the time of death

lyou were divorced from your spouse, or

lyour civil partnership had been dissolved, or

lyou were living together as if you were married, but you were not legally married, or

lyou had remarried or formed a civil partnership, or

lyou were living with another person as if you were married.

The information in these notes will help you see if you are able to get any of the bereavement benefits.

You can find out more about bereavement benefits at

www.gov.uk/browse/benefits/bereavement

But if you are still not sure if you can get bereavement benefit, claim anyway.

2

Bereavement Payment

Answer these 3 questions to find out if you may be able to get a Bereavement Payment.

1

Were you under state pension age when your spouse or

No

 

civil partner died?

Yes

 

 

 

 

 

2

Was your spouse or civil partner under state pension age

No

 

when they died?

Yes

 

 

3Was your spouse or civil partner over state pension age when they died and not entitled to a basic pension based on their own contributions?

We call this a category A pension.

No Yes

You may be able to get a Bereavement Payment

lif you have answered Yes to at least one of these questions, and

lif your spouse or civil partner had paid enough NI contributions.

The way HM Revenue and Customs (HMRC) collects Class 2 NI contributions has changed from the 2015/16 tax year.

This means the contributions will be collected as part of the Self-Assessment Tax return for the majority of customers and HMRC will no longer collect Class 2 NI contributions during the tax year. This may affect how much bereavement benefit we can pay you.

HMRC can give you information on your late spouse or civil partner's NI records and about paying Class 2 NI contributions for your late spouse or civil partner for benefit purposes. There is more information at www.gov.uk

If you are entitled to a Bereavement Payment, it will be paid as a lump sum.

You may be able to get Widowed Parent’s Allowance or Bereavement Allowance as well as a Bereavement Payment.

3

Widowed Parent’s Allowance

Please answer these questions to find out if you may be able to get Widowed Parent’s Allowance.

1

Are you entitled to Child Benefit for one of your children or

No

 

 

one of your spouse or civil partner’s children?

Yes

 

 

 

 

 

 

 

 

 

 

 

 

 

2

Are you entitled to Child Benefit but not getting it because

No

 

 

you or your late spouse or civil partner fell into the High

Yes

 

 

 

 

Income Child Benefit charge group?

 

 

 

 

 

 

 

 

3

Was your spouse or civil partner getting Child Benefit?

No

 

 

 

 

 

 

Yes

 

 

 

 

 

4

If you are a woman, are you pregnant?

 

No

 

 

 

 

 

 

Yes

 

 

 

 

 

You may be able to get Widowed Parent’s Allowance if

lyou have answered Yes to at least one of these questions, and

lyour spouse or civil partner had paid enough NI contributions.

But if you have answered No to all these questions, you may still be able to get Bereavement Allowance.

If you are entitled to Widowed Parent’s Allowance, the amount that you can get is based on the NI contributions of your spouse or civil partner. It may include an Additional Pension based on their earnings since 1978. It may also include an Additional Pension based on caring responsibilities contribution-based Employment and Support Allowance, or Incapacity Benefit since April 2002.

You can usually get Widowed Parent’s Allowance as long as you are entitled to Child Benefit.

If you fall into the High Income Child Benefit charge group and you have not claimed Child Benefit, you must do so for your claim for a Widowed Parent's Allowance to be considered.

If you fall into this group please contact HMRC to make your claim.

4

Widowed Parent’s Allowance continued

If you stop being entitled to Child Benefit within 52 weeks of the death of your spouse or civil partner, you may be able to receive Bereavement Allowance for the remainder of the 52 weeks. This does not apply to you if you are a man whose wife died before

9 April 2001.

If your late spouse or civil partner was claiming Child Benefit and you have not yet made a claim to transfer the Child Benefit to your name, you must do so for your claim for a Widowed Parent's Allowance to be considered.

If you fall into this group please contact HMRC to make your claim.

More information

For more information

lgo to www.gov.uk/child-benefit/how-to-claim

ltelephone the HMRC Helpline on 0300 200 3100. Lines are open Monday to Friday 8am to 8pm, Saturday 8am to 4pm. If you have speech or hearing difficulties and use a textphone, the number to use is 0300 200 3103.

Bereavement Allowance

Answer this question to find out if you may be able to get Bereavement Allowance.

1 Were you aged 45 or over when your spouse or civil

No

partner died?

Yes

 

 

 

You may be able to get Bereavement Allowance

lif you have answered Yes to this question, and

lif your spouse or civil partner had paid enough NI contributions.

If you are entitled to Bereavement Allowance, the amount that you can get depends on your age when your spouse or civil partner died and your spouse or civil partner’s NI contributions.

If you were aged 55 or over, you may get the full rate of Bereavement Allowance. But if you were aged under 55, you will get less than the full amount.

5

Bereavement Allowance continued

Bereavement Allowance cannot include any Additional Pension and is paid at the basic rate only.

You can usually get Bereavement Allowance for 52 weeks. It will stop if you become entitled to State Pension before the end of the 52 weeks.

To find out when you can get State Pension visit

www.gov.uk/calculate-state-pension

If you were getting Widowed Parent’s Allowance for less than 52 weeks and it stops because you are no longer entitled to Child Benefit, you may be able to get Bereavement Allowance which is paid at the basic rate only

lfor the remainder of the 52 weeks, or

luntil you are entitled to State Pension whichever comes first.

How to claim

Just fill in claim form BB1.

We are sorry that we have to ask you some questions about your spouse or civil partner. This is because bereavement benefits are based on your spouse or civil partner’s NI contributions.

If you have any difficulty filling in this claim form, someone else can do it for you. You can ask a friend, a relative or an advice centre. Or ask at your Jobcentre Plus office.

Please make sure that you sign the Declaration in Part 7 of the claim form, if you can.

When to claim

You should send us the claim form BB1 as soon as possible.

lYou must send us your claim form within 3 months of the death of your spouse or civil partner. Failure to do so may affect your entitlement to benefit.

lIf your spouse died on or after 1 April 2003 your claim for a Bereavement Payment can be accepted for up to 12 months.

lIf your civil partner died on or after 5 December 2005 your claim for a Bereavement Payment can be accepted for up to 12 months.

6

More about benefits for widows, widowers and surviving civil partners

Are benefits for widows, widowers and surviving civil partners affected by earnings?

No – if you work, your bereavement benefit will not go down because of the money that you earn.

Are benefits for widows, widowers and surviving civil partners taxable?

Bereavement Payment

This benefit is paid as a lump sum and is tax-free.

Widowed Parent’s Allowance or Bereavement Allowance

These benefits are taxable. If you have to pay tax, they are counted as part of your income when tax is worked out.

What happens if you are also entitled to contribution-based Employment and Support Allowance or Incapacity Benefit?

If you are getting contribution-based Employment and Support Allowance or Incapacity Benefit and

lthe amount that you get is less than your bereavement benefit, or

lyour contribution-based Employment and Support Allowance

stops because you have received it for 365 days

you will not lose money. We will pay you an amount of benefit to make up your full entitlement.

You will pay tax on contribution-based Employment and Support Allowance from the first day you get it.

7

Help and advice

If you want more information about bereavement benefits, or any other benefit, or if you would like advice about employment and training opportunities, please get in touch with your Jobcentre Plus office.

You can find the phone number and address on the advert in the business numbers section of the phone book. Look under Jobcentre Plus.

You can get a bereavement benefits claim pack (form BB1) by phoning 0345 606 0265. If you have speech or hearing difficulties and use a textphone, call on 0345 606 0285.

You can download a claim pack at

www.gov.uk/browse/benefits/bereavement

Please complete the form and send to the Jobcentre Plus address on the claim form or to your nearest Jobcentre Plus office as soon as possible.

Voluntary organisations that may be able to advise you

lYour local Citizens Advice Bureau.

lCruse Bereavement Care offers emotional support to the bereaved. You can contact them on

Helpline 0844 4779 400

Email helpline@cruse.org.uk Website www.cruse.org.uk

This organisation is not able to give advice on bereavement payments, other benefits or financial matters.

Printed on recycled paper

8

BB1_052016_013_002

Bereavement benefits

Your claim for bereavement benefits

lYour benefit payments may be delayed if you do not

answer all the questions on this form that apply to you and your spouse or civil partner

send us all the documents we ask for.

If you cannot do this, get in touch with us straight away.

lPlease tell us about any other personal details you think we should know about in Part 6. For instance, other names or recent previous addresses.

Other organisations who might be able to help you

lYour local Citizens Advice Bureau.

lCruse Bereavement Care offers emotional support to the bereaved. You can contact them on

Helpline 0844 4779 400

Email helpline@cruse.org.uk Website www.cruse.org.uk

This organisation is not able to give advice on bereavement payments, other benefits or financial matters.

How the Department for Work and Pensions collects and uses information

When we collect information about you we may use it for any of our purposes. These include dealing with:

lsocial security benefits and allowances

lchild support

lemployment and training

lfinancial planning for retirement

loccupational and personal pension schemes.

We may get information about you from others for any of our purposes if the law allows us to do so. We may also share information with certain other organisations if the law allows us to.

To find out more about how we use information, visit our website at

www.gov.uk/dwp/personal-information-charter or contact any ofBB1 05/16 our offices.

Part 1: About you

Please fill in this form with BLACK INK and in CAPITALS.

National Insurance (NI) number You can find this on your National Insurance (NI) numbercard, letters from the Department for Work and Pensions or payslips.

If you do not know your NI number, have you ever had one or used one at any time?

Surname or family name

All other names, in full

All other surnames or family names you have been known by or are using now.

Please include maiden name, all former married or civil partnership names and all changes of family name where appropriate.

Address

Home phone number

Mobile phone number

Email address

where we can contact you

Please confirm if this email address is

Date of birth

Letters Numbers

 

 

 

 

 

Letter

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

No

Yes

Mr/Mrs/Miss/Ms

Postcode

Code Number

personal

 

private

 

secure

/ /

Please send us your original birth certificate, if you have it. Do not send us a photocopy. But if you do not have your birth certificate, do not delay sending in this claim form. If you prefer, you can take your birth certificate to your Jobcentre Plus office. Take this form as well. They will sign this form to show that they have seen your certificate.

Are you sending your birth certificate with this form?

No

Yes

We will send your birth certificate back to you as soon as we can.

2

BB1 05/16

Part 1: About you continued

What was the date of your marriage or civil partnership? If you converted or changed your civil partnership into a marriage or married your civil partner, enter the date your marriage is treated as starting on.

/ /

Please send us your original marriage or civil partnership certificate, if you have it. Do not send us a photocopy. But if you do not have your marriage or civil partnership certificate, do not delay sending in this claim form. If you prefer, you can take your marriage or civil partnership certificate to your Jobcentre Plus office. Take this form as well. They will sign this form to show that they have seen your certificate.

Are you sending your marriage or civil partnership certificate with this form?

Under what law/religion was the ceremony conducted?

Please tell us the country where your marriage or civil partnership took place.

Did your marriage end in divorce or has your civil partnership been dissolved?

Are you legally separated?

Are you, or have you been living with someone else as if you were married to them, or as if you are civil partners?

No

Yes

We will send your marriage or civil partnership certificate back to you as soon as we can.

No

Yes

No

Yes

No

Yes Please tell us about this at Part 6.

BB1 05/16

3

Part 2: About your spouse or civil partner

Your spouse or civil partner’s National Insurance (NI) number

Your spouse or civil partner’s surname

Your spouse or civil partner’s other names

Address

if it was different from your address. If you do not know their address, write Not known.

Your spouse or civil partner’s date of birth

What date did your spouse or civil partner die?

Letters Numbers

 

 

 

 

 

Letter

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mr/Mrs/Miss/Ms

Postcode

/ /

/ /

Please send us the Certificate of Registration of Death if you have not already sent it to us. You can get this from the registrar, for free, in Great Britain only. If you have an interim death certificate or a letter from the coroner confirming the death, please send it to us.

Did your spouse or civil partner die more than 3 months ago?

No

Yes Please tell us below why you did not claim earlier. If you need more space, please use Part 6.

Were they getting a State Pension or any other benefits?

No

Yes Please say which benefits.

4

BB1 05/16

Part 2: About your spouse or civil partner continued

Did they pay NI contributions during the 2 years up to 5 April before they died?

Did they pay these contributions through an employer?

Employer’s name and address

If you know that pay is dealt with at a different address, please give us this address and phone number.

No

Yes Please tell us about this.

No

Yes Please tell us about any employers they had during this period.

Employer 1

Employer 2

Clock or payroll number

If not known, tell us their job or department.

Date they started work for this employer

Date they stopped work for this employer

Postcode

/ /

/ /

Postcode

/ /

/ /

If they had more than 2 employers, tell us about them in Part 6. We may have to get in touch with their employers. We will tell them if they have to pay you a pension from your spouse or civil partner’s pension scheme.

Were they self-employed?

No

 

 

 

 

Yes

 

Please tell us about this.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Were they a member of HM Forces when they died?

Were they getting a War Pension when they died?

No

Yes

No

Yes Please tell us their reference number. This is on any letters about their War Pension.

BB1 05/16

5

Part 2: About your spouse or civil partner continued

If your spouse or civil partner died because of an accident at work, or because of a disease or illness connected with their work, you may be entitled to a bereavement benefit even if they had not paid enough NI contributions. You can find out which diseases and illnesses you can claim for at www.gov.uk/industrial-injuries-disablement-benefit/further-information or by using the contact information given there to telephone or write for further information.

Do you think your spouse or civil partner died because of an accident at work, or because of a disease or illness connected with their work?

No

 

 

Yes

 

May we get medical reports from their

 

 

 

doctor and any hospital, if we need them? No

Yes

We need to know about any time that your spouse or civil partner lived or worked outside the United Kingdom (UK). This is because if they paid into the social security scheme in another country, it may count towards your bereavement benefits. The United Kingdom is England, Scotland, Wales and Northern Ireland.

Please tell us about any time that they lived in

a country outside the UK, or

the Channel Islands, or

the Republic of Ireland.

Did your spouse or civil partner ever live outside the UK?

If they only ever lived in England, Scotland, Wales or Northern Ireland, tick No.

Which country or crown dependency did they live in? If they lived in the Isle of Man, tell us here.

No Please go to Part 3.

Yes Tell us about the time they spent outside the UK.

Country 1

 

Country 2

 

 

 

 

 

 

When did they live there?

Did they pay into the social security scheme of the country they lived in?

From

/

/

 

 

 

 

 

 

 

 

 

 

 

To

/

/

 

 

 

 

 

 

Don’t know

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

Yes

 

What was their

 

 

 

social security

 

 

reference number?

 

 

 

 

 

 

 

 

 

 

From

/

/

 

 

 

 

 

 

 

 

 

 

 

To

/

/

 

 

 

 

 

 

Don’t know

 

 

 

 

 

 

 

 

No

 

 

 

 

 

 

 

 

Yes

 

What was their

 

 

 

social security

 

 

reference number?

 

 

 

 

 

 

 

 

 

 

If they lived in more than 2 countries, tell us about this below.

6

BB1 05/16

Part 3: About children

Are you expecting a child with your late spouse or civil partner?

If you are, you may be able to get extra benefit when the baby is born.

No

Yes What date is the baby expected?

/ /

Are you entitled to any

Child Benefit?

If you fall into the High Income Child Benefit charge group and you:

lare entitled to Child Benefit but do not receive it, please tick Yes and tell us the Child Benefit reference number

lhave not claimed Child Benefit, you must do so for your claim for a Widowed Parent's Allowance to be considered. If you fall into this group please provide details of your dependant children or qualifying young person in the rest of Part 3.

No

Yes Tell us the Child Benefit reference number. This is on any letters sent to you about Child Benefit, or on a bank statement.

How much do you get each week?

£each week

Are you waiting to hear if you can

No

get Child Benefit?

Yes

 

When your spouse or civil partner died, were they getting any Child Benefit for any children?

If your late spouse or civil partner was claiming Child Benefit and you have not yet made a claim to transfer it to your name, you must do so, but please complete the rest of Part 3 and complete your claim for bereavement benefits.

No

Yes Tell us the Child Benefit reference number. This is on any letters sent to them about Child Benefit, or on a bank statement.

How much did they get each week?

£each week

What to do next

If you have answered Yes to one or more of these questions, please fill in the rest of Part 3.

More information

For more information about claiming Child Benefit please contact HMRC.

Go to www.gov.uk/child-benefit/how-to-claim child benefit or telephone the HMRC Helpline on 0300 200 3100. Lines are open Monday to Friday 8am to 8pm, Saturday 8am to 4pm. If you have speech or hearing difficulties and use a textphone, the number to use is 0300 200 3103.

BB1 05/16

7

Part 3: About children continued

Do you have any children or qualifying young persons living permanently in your household who are dependent on you?

We use child to mean a person aged under 16 and qualifying young person to mean a person aged 16, 17, 18 or 19.

Child’s surname

Child’s other names

Child’s date of birth

What relation, if any, are you to the child?

What relation, if any, was your spouse or civil partner to the child?

Child’s surname

Child’s other names

Child’s date of birth

What relation, if any, are you to the child?

What relation, if any, was your spouse or civil partner to the child?

No Please go to Part 4.

Yes Tell us about these children or qualifying young persons below.

1st child

/ /

2nd child

/ /

Child’s surname

Child’s other names

Child’s date of birth

What relation, if any, are you to the child?

What relation, if any, was your spouse or civil partner to the child?

3rd child

/ /

8

BB1 05/16

Part 3: About children continued

Child’s surname

Child’s other names

Child’s date of birth

What relation, if any, are you to the child?

What relation, if any, was your spouse or civil partner to the child?

4th child

/ /

If you want to tell us about more than 4 children, please tell us about them in Part 6.

If a child is living with another person

Which child is living with another person?

What relation, if any, is this other person to the child?

How much do you send each week for the child?

£each week

If a child is in care

Which child is in care?

What is the name and address of the local authority caring for the child?

How much do you send each week for the child?

Postcode

£each week

Have you told us about any children who you are not a parent of? We use parent to include step- parents, parents by legal adoption and fathers and mothers of illegitimate children. If you need to tell us about more than one child, use the space in Part 6.

No

 

 

 

 

 

 

 

 

 

Yes

 

Name of the child.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Does one of their parents live at

 

 

 

 

 

 

 

 

 

the same address as you?

No

 

 

 

 

 

 

 

 

 

Yes

 

What is their name?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BB1 05/16

9

Part 3: About children

Are you, or anyone else, entitled to any benefit or allowance for any of the children you have told us about?

For example Guardian’s Allowance. But tick No if you are just entitled to Child Benefit.

continued

No

Yes Please tell us about this.

Benefit or allowance 1

Benefit or allowance 2

Name of the benefit or allowance

Address of the office it comes from

Name of the child it is for

 

 

 

 

 

 

 

 

Who gets the benefit or allowance?

You

 

 

 

You

 

 

 

 

 

 

 

 

 

 

Someone else

 

Please say who. Someone else

 

Please say who.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Benefit reference number

 

 

 

 

 

 

 

 

This is on any letters about

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the benefit.

 

 

 

 

 

 

 

 

Are any of the children you have told us about getting any benefit or allowance?

Name of the benefit or allowance

Address of the office it comes from

Name of the child it is for

Benefit reference number This is on any letters about the benefit.

No

Yes Please tell us about this.

Benefit or allowance 1

Benefit or allowance 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For more information about money for children see Part 10 About Child Tax Credit.

10

BB1 05/16

Part 4: About other benefits

Have you claimed bereavement benefits or Widow’s Benefit before? Tick Yes if you claimed but were turned down.

No

 

 

 

 

Yes

 

Did you get bereavement

No

 

 

 

 

 

benefits or Widow’s Benefit?

Yes

 

 

 

 

 

 

 

 

Are you getting any of these benefits or entitlements?

Tick Yes if you are waiting to hear about a benefit.

Even if the benefit or entitlement is not listed here, tell us about it anyway. We will contact you if we need more information.

lState Pension

lJobseeker’s Allowance

lJob Release Allowance

lIncome Support

lPension Credit

lWar Widow’s Pension

lTemporary Allowance for Widows, Widowers and Surviving Civil Partners

lEmployment and Support Allowance

lIncapacity Benefit

lSevere Disablement Allowance

lCarer’s Allowance

lReduced Earnings Allowance

lTraining Allowance

lUnemployability Supplement paid because of

a war disability due to service with HM Forces, or

an industrial accident or disease

lGuardian’s Allowance

lArmed Forces Compensation Scheme Guaranteed Income Payment

lUniversal Credit.

No

Yes Please tell us about the benefits.

Name of benefit

Reference number

 

This is on any letters we have

 

sent you about the benefit.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BB1 05/16

11

Part 5: How we pay you

You can choose how often you want us to pay your benefit.

How often do you want us to

Every 2 weeks

 

 

 

 

pay your benefit?

Every 4 weeks

 

 

 

 

 

 

 

 

 

 

Every 13 weeks

 

 

 

 

 

 

We normally pay your money into an account.

Many banks and building societies will let you collect your money at the post office.

We will tell you when we will make the first payment and how much it will be for. We will tell you if the amount we pay into the account is going to change.

Finding out how much we have paid into the account

You can check your payments on account statements. The statements may show your National Insurance (NI) number next to any payments we have made. If you think a payment is wrong, get in touch with the office that pays you straight away.

If we pay you too much money

If we pay you too much money we have the right to take back any money we pay that you are not entitled to. This may be because of the way the payment system works.

For example, you may give us some information which means you are entitled to less money. Sometimes we may not be able to change the amount we have already paid you. This means we will have paid you money that you are not entitled to.

We will contact you before we take back any money.

What to do now

lTell us about the account you want to use on the next page. By giving us your account details you

agree that we will pay you into an account, and

understand what we have told you above in the section If we pay you too much money.

lIf you are going to open an account, please tell us your account details as soon as you get them.

lIf you do not have an account, please contact us and we will give you more information.

Fill in the rest of this form. You do not have to wait until you have opened an account or contacted us.

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Part 5: How we pay you continued

About the account you want to use

lYou can use an account in your name, or a joint account.

lYou can use someone else’s account if

the terms and conditions of their account allow this, and

they agree to let you use their account, and

you are sure they will use your money in the way you tell them.

lYou can use a credit union account. You must tell us the credit union’s account details. Your credit union will be able to help you with this.

lIf you are an appointee or a legal representative acting on behalf of the claimant, the account should be in your name only.

Please tell us your account details below.

It is very important you fill in all the boxes correctly, including the building society roll or reference number, if you have one. If you tell us the wrong account details your payment may be delayed or you may lose money.

You can find the account details on your chequebook or bank statements. If you do not know the account details, ask the bank or building society.

Name of the account holder

Please write the name of the account holder exactly as it is shown on the chequebook or statement.

Full name of bank or building society

Sort code

Please tell us all 6 numbers, for example 12-34-56.

Account number

Most account numbers are 8 numbers long. If your account number has fewer than 10 numbers, please fill in the numbers from the left.

Building society roll or reference number

If you are using a building society account you may need to tell us a roll or reference number. This may be made up of letters and numbers, and may be up to 18 characters long.

If you are not sure if the account has a roll or reference number, ask the building society.

You may get other benefits and entitlements we do not pay into an account. If you want us to pay them into the account above, please tick the box.

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Part 6: Other information

Please read carefully the notes that came with this form. Use this space to tell us anything else you think we might need to know.

If there is not enough space, please use a separate sheet of paper. Make sure you put your full name and National Insurance (NI) number on each sheet of paper, and sign and date each sheet that you use.

Part 7: Declaration

I declare that I am a widow, widower or surviving civil partner of the person named in Part 2 of this form.

I understand that if I give false or incomplete information or fail to report all changes in my circumstances which may affect my entitlement promptly, I may be liable to prosecution or face a financial penalty.

I declare that I have read and understand the notes which came with this form and that I must telephone or write to the office that pays my benefit to report any change in my circumstances.

I declare that the information in my claim is complete and correct.

Signature

Date

/ /

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Part 8: What to do now

1 Check that you have answered all the questions that apply to you and your spouse or civil partner.

2Check that you have shown us all the documents we have asked for, or are sending them with this form.

Use the checklist below:

the Certificate of Registration of Death

your birth certificate and marriage or civil partnership certificate

a birth certificate for each child.

3 Check that you have signed this form.

4Send us your claim form as soon as possible.

You must send us your claim form within 3 months of the death of your spouse or civil partner. Failure to do so may affect your entitlement to benefit.

You can claim a Bereavement Payment for up 12 months after the death of your spouse or civil partner.

Return this claim form to Dover Benefit Centre, Post Handling Site B, Wolverhampton WV99 1LA or your nearest Jobcentre Plus office.

You can contact the Dover Bereavement Benefits office on 0345 608 8601. If you have speech or hearing difficulties you can contact them using a textphone on 0345 608 8551. Lines are open 9am to 5pm Monday to Friday. On the first Wednesday of every month the lines are open from 10am to 5pm.

Part 9: What happens next

lIf you are entitled to a Bereavement Payment, we will make payment into your account as soon as we can. If you are not entitled to this benefit, we will write to tell you why.

lIt will take a little longer to work out if you are entitled to any other benefit. But we will write to tell you about this as soon as we can.

lBenefit you can get because of this claim can be paid more quickly if you answer all the questions on this form that apply to you and your spouse or civil partner.

If you cannot do this, get in touch with us. But benefit you can get because of this claim may be delayed.

Part 10: About Child Tax Credit

Child Tax Credit is a payment to support families with children. It can be claimed by those responsible for one or more child or young person.

Child Tax Credit

lis claimed from HM Revenue & Customs

lis paid in addition to Child Benefit

lcan provide income for families with children, whether in or out of work

lis normally paid to the main carer.

To find out more about Child Tax Credit visit www.gov.uk/child-tax-credits

You can claim Child Tax Credit online too.

You can also phone HM Revenue & Customs about Child Tax Credit on 0345 300 3900. If you have speech or hearing difficulties you can contact them using a textphone on 0345 300 3909.

Lines are open 8am to 8pm Monday to Friday, and 8am to 4pm on Saturday. Lines are closed Sundays, Christmas Day, Boxing Day, New Year’s Day and Easter Sunday.

If you need help or a form in Welsh, please phone 0345 302 1489. Lines are open 8.30am to 5pm, Monday to Friday.

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