Nationwide Form If21 – Fill Out and Use This PDF

Under Deceased investor's details, mark the Title (Mr, Mrs, Miss, Ms or Other), enter ALL forenames, the Surname, and the Sort code and Account number (including sort code if there is one).

Under Personal Representative's details, mark X in the box that applies to you or state your title (Mr, Mrs, Miss, Ms or Other), enter ALL forenames and the Surname.

Enter your permanent residential address (Property number and/or Property name, Street, Town, Postcode) and your contact telephone number, with the Extension if applicable.

Under Payment details, enter the Amount in £, then mark X in one box only to indicate to whom the cheque should be made payable: HM Revenue & Customs (for the purpose of paying inheritance tax), HM Court Service (for the purpose of paying probate application fees) or Funeral director.

If the cheque is for funeral expenses, please complete the company's name and attach the original invoice.

Nationwide Building Society cannot send payment directly to HM Revenue & Customs, HM Court Service or funeral directors.

Under Solicitors details, if you require the cheque to be sent to your solicitor, please enter the solicitor's details: the Solicitor's name and the Company address (Property number and/or Property name, Street, Town, Postcode).

As the personal representative of the named deceased, you agree to indemnify the Society in respect of any costs, claims proceedings or disputes which may arise as a result of payment being made without/prior to a grant of representation for the deceased's estate, and, if grant of representation is being applied for, to produce the grant of representation to the Society as soon as practicable after it has been received.

Write the Date INSIDE the boxes, and sign as Personal Representative WITHIN THE SIGNATURE BOX.