Fillable Application For Award Of Dependant's Allowance (AW9

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Application For Award Of Dependant's Allowance (AW9

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NHS AW9 27/04/2020
NHS Superannuation Scheme (Scotland)
Application for award of dependents allowance
This form should be completed by the surviving parent or guardian of the child/children or child if over 16
Important: Changes to our application process
The SPPA is focused on making our processes as simple as possible for our members, their
representatives and employers. Given the challenges presented by the Covid-19 pandemic, we
are asking applicants to email all application forms and supporting documents to the SPPA rather
than post physical copies.
The following changes to the application process have been made to ensure that applicants can
continue to access pension benefits as quickly as possible:
A form you can fill in electronically
This form has been changed into a form that you can update and fill in. This means that you do not
need to print out this document. Just fill it in electronically and return it to us by email. Please send
it to sppacontactus@gov.scot
Signatures
We have amended our signature process to make it easier to assist those of you who don’t have
access to a printer or scanner. We are now temporarily accepting forms with digital signatures.
Please type your name into the relevant signature box for the form to be accepted.
By doing this, you must provide consent in your email for the SPPA to process your application.
Supporting Documents
Supporting documentation should still be scanned and emailed, where possible. We appreciate
that there will be cases where a scanned document cannot be provided, so we are now accepting
electronic photographs of documents (providing that they are clear and complete images of the
entire document).
If you cannot send us any supporting documents, in some cases we may be able to make a partial
payment of benefits provisionally before the supporting certificates have been received. We will
still require copies of these certificates to be sent and verified before a full award of benefits can be
made. If you do not supply the supporting documents then the provisional payments will stop and
any benefits that have been paid will be recovered.
Where to get further help
If you need help with your application please contact our Customer Engagement team on 01896
893000 for advice, or email SPPAcontactus@gov.scot.
NHS AW9 27/04/2020
Section 1 - deceased member’s personal details
Scheme reference number
Surname
Forename(s)
Title
Dr
Mr
Mrs
Ms
Other
National Insurance number
Date of birth
(DD/MM/YYYY)
/
/
Date of death
(DD/MM/YYYY)
/
/
Section 2 – details of parent or guardian
Surname
Forename(s)
Title
Dr
Mr
Mrs
Miss
Ms
Other
National Insurance number
Date of birth
/
/
Contact address
Post code
Telephone number
Mobile number
Email address
NHS AW9 27/04/2020
Section 3 – details of dependant child
Child 1
Surname
Forenames (in full)
Date of birth
National Insurance number
/
/
Contact address
Post code
Bank Details
Bank Details of:
Parent
Guardian
Dependant
Name of account holder
Name of Bank/Building
Society
Branch
Branch address
Post code
Bank Sort code
Account number
Building Society Roll
Number
Bank Account type
Current Account
Deposit Account
NHS AW9 27/04/2020
Section 4 – declaration (Should be signed by the dependant if aged over 16)
I declare that I am the dependant/parent/guardian of the child overleaf and apply for
benefits under the NHS Superannuation Scheme (Scotland) Regulations. Any child’s
allowance paid to me shall be applied to the benefit of said child.
Please tick:
I am the dependant
I am the parent
I am the Guardian of the child
I declare that the child named
overleaf suffers from permanent
ill health and is permanently
incapable of earning a living.
I declare that the statements made by me on this form are true to the best of my
knowledge and belief and confirm that any dependants allowance should be paid into the
bank account overleaf.
Signed
Date
/
/
NHS AW9 27/04/2020
Section 3 – details of dependant child
Child 2
Surname
Forenames (in full)
Date of birth
National Insurance Number
/
/
Contact address
Post code
Bank Details
Bank Details of:
Parent
Guardian
Dependant
Name of account holder
Name of Bank/Building
Society
Branch
Branch address
Post code
Bank Sort Code
Account number
Building Society Roll
Number
Bank Account type
Current Account
Deposit Account
NHS AW9 27/04/2020
Section 4 – declaration (Should be signed by the dependant if aged over 16)
I declare that I am the dependant/parent/guardian of the child overleaf and apply for
benefits under the NHS Superannuation Scheme (Scotland) Regulations. Any child’s
allowance paid to me shall be applied to the benefit of said child.
Please tick:
I am the dependant
I am the parent
I am the Guardian of the child
I declare that the child named
overleaf suffers from permanent
ill health and is permanently
incapable of earning a living.
I declare that the statements made by me on this form are true to the best of my
knowledge and belief and confirm that any dependants allowance should be paid into the
bank account overleaf.
Signed
Date
/
/
NHS AW9 27/04/2020
Section 3 – details of dependant child
Child 2
Surname
Forenames (in full)
Date of birth
National Insurance Number
/
/
Contact address
Post code
Bank Details
Bank Details of:
Parent
Guardian
Dependant
Name of account holder
Name of Bank/Building
Society
Branch
Branch address
Post code
Bank Sort Code
Account number
Building Society Roll
Number
Bank Account type
Current Account
Deposit Account
NHS AW9 27/04/2020
Section 4 – declaration (Should be signed by the dependant if aged over 16)
I declare that I am the dependant/parent/guardian of the child overleaf and apply for
benefits under the NHS Superannuation Scheme (Scotland) Regulations. Any child’s
allowance paid to me shall be applied to the benefit of said child.
Please tick:
I am the dependant
I am the parent
I am the Guardian of the child
I declare that the child named
overleaf suffers from permanent
ill health and is permanently
incapable of earning a living.
I declare that the statements made by me on this form are true to the best of my
knowledge and belief and confirm that any dependants allowance should be paid into the
bank account overleaf.
Signed
Date
/
/
NHS AW9 27/04/2020
Section 3 – details of dependant child
Child 2
Surname
Forenames (in full)
Date of birth
National Insurance Number
/
/
Contact address
Post code
Bank Details
Bank Details of:
Parent
Guardian
Dependant
Name of account holder
Name of Bank/Building
Society
Branch
Branch address
Post code
Bank Sort Code
Account number
Building Society Roll
Number
Bank Account type
Current Account
Deposit Account
NHS AW9 27/04/2020
Section 4 – declaration (Should be signed by the dependant if aged over 16)
I declare that I am the dependant/parent/guardian of the child overleaf and apply for
benefits under the NHS Superannuation Scheme (Scotland) Regulations. Any child’s
allowance paid to me shall be applied to the benefit of said child.
Please tick:
I am the dependant
I am the parent
I am the Guardian of the child
I declare that the child named
overleaf suffers from permanent
ill health and is permanently
incapable of earning a living.
I declare that the statements made by me on this form are true to the best of my
knowledge and belief and confirm that any dependants allowance should be paid into the
bank account overleaf.
Signed
Date
/
/
Please include any further dependents details on a separate sheet and attach to this
application
On completion of this form please forward together with all photocopies of the members
Death Certificate and the child/children’s Birth Certificate(s) to sppacontactus@gov.scot
or by post to, Scottish Public Pensions Agency, 7 Tweedside Park, Tweedbank,
Galashiels, TD1 3TE
SPPA Privacy Policy
The Scottish Public Pensions Agency (SPPA) is an executive Agency of the Scottish Government. On the behalf of the
Scottish Ministers, we undertake our role as a pension scheme administrator in accordance to the Pensions Act
1995, The Public Services Pension Act 2013 and The Occupational and Personal Pension Schemes
(Disclosure of Information) Regulations 2013.
This privacy statement relates to the personal information we collect, why we collect it and what we do with it. Full
information on our Privacy Policy can be found on the SPPA website at www.pensions.gov.scot
NHS AW9 27/04/2020
Notes for guidance
A child’s allowance is payable to any DEPENDANT child of a deceased member who at the date of
death was in receipt of a pension or was entitled to benefits under the NHS Superannuation
Scheme (Scotland) Regulations.
A child must have been dependent on the member at the date of death, and born before or not
more than one year after the member left pensionable employment or died, and if the member dies
after leaving pensionable employment was dependent when the member left pensionable
employment.
Members whose pensionable service ended before 1 April 2008
A child is dependent if under age 17 or over age 17 but has not reached the age of 23 and in full
time education; or is in full time training for a trade, profession or vocation, for which they are not
receiving remuneration in excess of the allowable maximum.
A child is dependent if over age 17 but has not reached the age of 23 and taking a break in full
time education, or full time training for a trade, profession or vocation, where the Scottish Ministers’
are satisfied that the child intends to return to some such education or training. The allowance will
cease to be payable after 12 months if the child has not returned to full-time education or training,
but may be reinstated if the child later returns to such education or training if Scottish Ministers’ are
satisfied that the child intended to do so at the start of the break.
A child who has ceased to be a dependant child will be treated as a dependent child if they return
to full-time education or training for a trade, profession or vocation, for which they are not receiving
remuneration in excess of the allowable maximum before reaching age 21 and within 12 months
after ceasing to be a dependent child.
A child who is incapable of earning a living because of permanent physical or mental infirmity from
which he was suffering at the time the member died will be treated as a dependant child for so long
as he remains incapable of earning a living.
Members whose pensionable service ended on or after 1 April 2008
A child is a dependant child for so long as they
(a) are under age 23 or
(b) age 23 or over and incapable of earning a living because of permanent physical or mental
infirmity from which they were suffering at the time the member died
No allowance shall be payable to, or for the benefit of, a child who is incapable of earning a living
because of permanent physical or mental infirmity for any period exceeding one month during
which the child is maintained out of money provided by Parliament in a hospital or other institution.
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Application For Award Of Dependant's Allowance (AW9

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Completed 15 July 2020

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