Fillable NHS Application For Lump Sum On Death AW6

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NHS Application For Lump Sum On Death AW6

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NHS AW6 04/05/2020
NHS Superannuation Scheme (Scotland)
Application for lump sum on death and widow(er)’s/partners pension
Death with deferred benefit/death in receipt of pension
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 PDF form you can fill in electronically
This form has been changed into a PDF 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 AW6 04/05/2020
Section 1 - deceased member’s personal details
Scheme reference number
Surname
Forename(s)
Title
Dr
Mr
Mrs
Miss
Ms
Other
National Insurance number
Date of birth (DD/MM/YYYY)
/
/
Date of death
(DD/MM/YYYY)
/
/
Section 2 - applicants details
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 AW6 04/05/2020
Section 4 – please state in which capacity you are completing this application
Spouse
Proceed to section 8
Civil partner
Proceed to section 8
Date of marriage/civil registration
/
/
Surviving partner
Nominee
Legal personal representative
Sections 5–7 should not be completed if the member and applicant were married or in a civil
partnership.
Section 3 - bank details
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 AW6 04/05/2020
Section 5 – about you and your partner
1. Were you living together at the time of your
partners death?
Yes
No
2. How long you and your partner lived together?
Years
Months
(see personal checklist part 3)
3. If not, please explain why you were living apart:
If not at the same address, where were you living at the time of your partners death?
Did you spend any long periods (over six months) apart (other than, for example, stays
in hospital)? If yes, please give details of the circumstances and dates
Have you or your partner ever been married previously?
Yes
No
If Yes, please provide copies of all relevant decree
absolute(s), or previous partners death certificate(s).
Have you or your partner ever been in a civil partnership with
Yes
No
a previous partner?
If Yes, please provide copies of all relevant final dissolution
order(s), or previous partners death certificate(s).
NHS AW6 04/05/2020
Section 6 – about you and your partner’s financial circumstances
Please indicate whether you and your partner had any of the joint financial
arrangements. If you indicate ‘Yes’ you must provide a copy of a document to confirm
this:
Joint mortgage or tenancy
Yes
No
Joint bank account
Yes
No
Joint savings account or investments
Yes
No
A joint credit card statement
Yes
No
Were you the beneficiary of your partners will?
Yes
No
Was your partner the beneficiary of your will?
Yes
No
Were you the beneficiary of your partners life assurance,
or was your partner the beneficiary of your life
assurance?
Yes
No
Did you and your partner share any other joint financial
commitments not shown in the above list? If so, please
provide details and copies of any relevant documents
Yes
No
Please give any other information about you and your partner’s financial arrangements
that would support your claim. For example, whether you shared day-to-day living
expenses and whether you are experiencing additional expense following your
partners death (continue on a separate document if necessary)
NHS AW6 04/05/2020
Section 7 – confirmation
I confirm that the following applied at the time of my partners death:
My partner and I had lived together for the length of time stated in Section 5 of
this form, during which time our financial affairs were interdependent (or I was
financially dependent on my partner).
We had an exclusive relationship with each other and we intended to continue
this indefinitely.
We were not married to each other and had not formed a civil partnership with
each other.
We were not related in a way that would have prevented marriage or civil
partnership.
Neither of us was married to anyone else.
Neither of us had formed a civil partnership with anyone else.
Neither of us was nominated as the non-legal partner of anyone else.
Section 8 – enclosed documents
Documents included with application (if you are posting, please do not send the
original copy). Please tick:
Marriage/civil partnership certificate
Spouse/surviving partners/applicants birth certificate
Members full death certificate
Divorce decree or dissolution or nullity of civil partnership for both parties
Previous partners death certificate
Documents proving financial interdependence
Section 9 – dependent children
Did the deceased member have any dependent children?
Yes
No
If the answer is ‘Yes’, form AW9 – Application for Award of Child Allowance
should also be completed
Information on qualification for entitlement as a dependent child can be found
in Annex A at the back of this application form
NHS AW6 04/05/2020
Section 10 – declaration
I declare that the statements made by me on this form are true to the best of my
knowledge and belief. I have included the relevant certificates (where applicable)
Signed
Date
/
/
Section 11 – witness declaration
This must not be completed by a spouse, civil partner or nominee.
I declare that I am the person named below.
I certify that the above declaration was signed and dated in my presence by
the applicant, whom I believe to be the person named.
I understand that if I provide false or misleading information, I may be liable to
criminal/civil proceedings.
Witness full name
Signed
Date
/
/
Address
Post code
Occupation
Please send this completed form with all supporting documents 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 AW6 04/05/2020
Annex A - dependents: notes for guidance
A child's allowance is payable to any dependent 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
Born before or not more than one year after the member left pensionable employment or
died.
Dependent when the member left pensionable employment (if the member died after
leaving pensionable employment).
When pensionable service ended before 1 April 2008
A child is dependent if they are:
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 dependent 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.
When pensionable service ended on or after 1 April 2008
A child is dependent if they are
Under 23 years of age.
Over 23 years of age and incapable of earning a living because of permanent physical or
mental disability from that they were suffering at the time the member died.
Note: No allowance shall be payable to, or for the benefit of, a child who is unable to earn
money because of permanent physical or mental disability for any period exceeding one month
during which the child is maintained out of money provided by Parliament in a hospital or other
institution.
NHS AW6 04/05/2020
Personal checklist
You should complete and keep this part of the form for future reference
Application for award of pension
Superannuation number
1.
Date the application was sent to SPPA
(DD/MM/YYYY)
/
/
2.
Documents enclosed (you may wish to tick the documents you have sent as a reminder)
Only photocopies scans or clear, full photographs should be included.
Marriage/civil partnership certificate
Applicants birth certificate
Spouse/partners full death certificate
Divorce decree or dissolution or nullity of
civil partnership certificate
Previous partners full death certificate
Documents proving financial
interdependence
3.
Under the NHS Scheme regulations, benefits may be payable to a surviving partner upon their
death. The member must have accrued service after 1 April 2008. The benefits will be
paid to the surviving partner, provided that at the date of death the member and partner were:
Living together in an exclusive, long-term relationship of at least two years
Free to marry or enter a civil partnership during the above period
Financially interdependent
To ensure that the above criteria continued to be met at the time of the
members death, the surviving partner will be asked to provide supporting evidence.
Examples of supporting evidence include:
Confirmation that you lived in a shared household
Confirmation of shared household spending
Children of the member and/or partner are being jointly brought up
Shared bank accounts or investments
A loan or mortgage in joint names
Wills, naming each other as the main beneficiary
A mutual power of attorney
The partner being nominated as the main beneficiary of life insurance
The death of the member leading to substantive living costs for the partner
If the member did not have service after 1 April 2008, the surviving partner may still be entitled to
benefits. Please contact us for further information prior to completing the application
4.
Please let us know if you change your address. You can do this by email at
sppacontactus@gov.scot Alternatively, you can do this by post by writing to:
Scottish Public Pensions Agency, 7 Tweedside Park, Tweedbank, Galashiels, TD1 3TE
5.
SPPA Payroll will be responsible for the payment of your pension
NHS AW6 04/05/2020
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NHS Application For Lump Sum On Death AW6

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Completed 15 July 2020

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