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Death Benet Nomination Form
In the event of your death, a lump sum may be paid to a family member, friend, charity, or other
organisation or business. To nominate who the lump sum may be paid to, please complete this form.
Please complete this form in black ink and in BLOCK CAPITALS and return it to: Civil Service Pensions,
PO Box 2017, Liverpool, L69 2BU.
IMPORTANT: We will be unable to process your form if it is incomplete or has not been signed by a
witness. Please read the guidance notes carefully on page two which explain how to complete this form.
Your personal details
Your nomination for death benets
Your name
Your date of birth (DD/MM/YYYY)
Your address and postcode
Your National Insurance (NI)
Nominee Name
Please note: classic members
can only nominate one individual
or one organisation – (refer to
guidance notes on page two for
more information.)
Nominee address and postcode Relationship
to you
% of benets
(Total must add
up to 100%)
In the event of my death, it is my wish that any lump sum payable from Civil Service Pensions is paid
to the nominee(s) noted below, in the proportion(s) shown.
Continue on a separate sheet of paper if required and please ensure this includes your name and
National Insurance number.
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Full name of witness
Witness address and postcode
Your declaration
Guidance notes
I understand that this form replaces any previous Death Benet Nomination form that I have
The Scheme is committed to managing your data in line with the Data Protection Legislation. For
more information about how your data is managed, please visit:
Please read the following guidance carefully before completing your Death Benet Nomination form.
1. If you are a member of classic, you can only nominate one individual or one organisation to receive your
lump sum. The organisation can be incorporated (for example, a bank) or an unincorporated body (for
example, a partnership or rm of solicitors).
2. If you are a member of one of the other schemes (classic plus, nuvos, premium or alpha), you can
a) one or more individuals; or
b) one incorporated organisation or one unincorporated body; or
c) one or more individuals and one incorporated organisation or one unincorporated body.
3. The total percentage of death benets you allocate must add up to 100%. If you do not give a percentage,
we will divide your death benet equally between the people or organisations you have named.
Notes continue on page 3.
Your signature: Date: / /
Important: your witness must sign and date the form on the same date that you sign and
date it. Please note that your witness cannot be a person you have nominated to receive a
Death Benet Lump Sum.
Witness signature: Date: / /
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Important information
1. This nomination will replace any previous lump sum death benet nominations you have made.
We will send you a conrmation letter after your death benet nomination details have been
2. Your nomination is not binding on the pension scheme. If for some reason the scheme does not
pay benets to someone you have named (for example, your nominee has died), we will pay the
benets to your personal representatives (the people who deal with your nancial matters after
your death).
3. You should make sure that you keep your death benet nomination(s) up to date. Your Annual
Benet Statement contains details of your death benet nominee(s).
4. An individual nomination will not be valid, if, at the time of your death:
a nominee was your husband, wife or civil partner at the time you made your nomination and
your marriage or civil partnership has since ended; or
a nominee has died; or
a nominee was convicted of your murder or manslaughter.
5. If you get divorced or your civil partnership is dissolved and your nominee was your spouse or civil
partner, your death benet nomination for them will become invalid. In this instance, if you wish to
nominate a new beneciary, you can do so by submitting a new Death Benet Nomination Form.
Any other existing nominees would remain unaected.
6. In the case of a divorce or a dissolution, in some circumstances the court may order that all or part
of any death benet is to be paid to your former husband, wife or civil partner.
For classic members, should part of your death benet be ordered to be paid to your former
spouse, the remainder of your benet can be paid to another nominee of your choice. You will
need to complete a new form in this circumstance.
For classic plus, nuvos, premium and alpha members, should part of your death benet be ordered
to be paid to your former spouse, the remainder of your benet would be paid to your other
7. The pension scheme must pay death benets within two years of your death. If we are unable to
contact your nominee (s), or if there is no valid nomination, we will pay any death benet to your
personal representatives.
4. You must sign and date the form.
5. Your witness must sign and date the form on the same date that you sign and date it.
Your witness must not be one of your nominees.
Further guidance on how to complete a Death Benet Nomination form can be found
©MyCSP September 2019