1. Information about the person who died
Personal information
First name *
Middle name
Last name *
Date of birth *
Please use the format DD/MM/YYYY
Date of death*
The date of death stated on the death certificate. Please use the format DD/MM/YYYY. Date of Death can only have current or past dates.
Usual or last known address
Address line 1 *
Address line 2
Address line 3
Town/city/region *
Postcode *
Policy number(s)
Multiple policy numbers should be separated by commas. If you do not know your policy number, please put UNKNOWN.
2. Who's getting in touch?
Personal information collected on this form will be used so we can assess your claim. To understand the detail of how we use your information you can read the privacy policy (opens in new window) or listen on 0800 085 8352 .
Your details
If 'other', please specify the relationship *
If 'other' please specify *
Company name (if applicable)
If 'other', please specify the title*
First name *
Middle name
Last name *
Date of birth *
Please use the format DD/MM/YYYY
Email address *
Please make sure to double check your email address so we can get in touch with you
Please re-enter your email address to make sure it has been correctly entered *
Telephone number *
Your address / Company address
Address line 1 *
Address line 2
Address line 3
Town/city/region *
Postcode *
3. Additional information
Full name of spouse *
Full names of children *
Please separate multiple names with commas
Full names of grandchildren *
Please separate multiple names with commas
Full names of parents *
Please separate with commas
Full names of siblings *
Please separate multiple names with commas
Full names of niece/nephew *
Please separate multiple names with commas
If 'other', please specify the relationship *
If 'other', please give their full name *
Please separate multiple names with commas
Please provide the name of the Executor/s or Applicant *
Trustee First Name *
Where the policy has been left in trust, please provide all the trustee’s name and address. Please note, the trustees for this plan may need to register the trust with HMRC’s Trust Registration Service. For more information see https://www.gov.uk/guidance/register-a-trust-as-a-trustee or speak to a financial adviser.
Trustee Last name *
Trustee Address 1 *
Trustee Address 2
Trustee Address 3
Town *
Postcode *
4. Claimant’s details and payment information
If 'other', please specify the title*
Claimant's First name *
Middle name
Last name *
Date of birth *
Please use the format DD/MM/YYYY
Relationship to the person who died if you're a relative *
-- Select an option --
Spouse/Civil partner
Child
Grandson/granddaughter
Parent
Sibling
Niece/nephew
Other
If 'other', please specify *
If 'other', please specify *
Email address *
Please re-enter your email address to make sure it has been correctly entered *
Telephone number *
Address line 1 *
Address line 2
Address line 3
Town/city/region *
Postcode *
Payment information
Please note that the account must be in the name of the claimant and must NOT be a:
Business account;
Post office account; or
Building Society account with a Roll Number*
*We can accept Building Society if it has a Sort Code and Account Number.
Claimant's name as it appears on their Bank / Building Society account *
Sort code *
Must be 6 digits long
Account number *
Must be 8 digits long, if it's less add 0 to the start of your account number
5. Document upload
To process your claim, we’ll need to see this:
Death certificate
Will - only if one has been left
Grant of Probate or Letters of Administration - only if they have been issued
Original policy documents - if available
Proof of name changes (Marriage certificate/ Deed poll/ Decree Absolute). We only need to see this if you are the executor, and your name is different now to how it is in the will.
If certain documents are not supplied, this will delay the completion and payment of the claim.
You can upload your documents in the following formats:
PDF – 1 or more pages
PNG – 1 page only
JPEG/JPG – 1 page only
To make this easier, you can upload scanned images, showing all four corners of the specified document you have taken using your mobile phone or tablet.
All uploaded documents must have a combined file size of less than 28MB
6. Declaration
I confirm that:
I am the claimant entitled to the death benefit of the policy number(s) noted in section 1 of this form; or
If I am not the claimant named in section 4, I have their consent to fill out this form on their behalf.
I confirm/the claimant confirms that the information and every answer provided on this form is correct and complete to the best of my/their knowledge and belief.
I am/the claimant is legally entitled to the death benefit.
I am/the claimant is 18 years of age or over.
I accept/the claimant accepts that you will check my/their identity prior to proceeding with any claim for death benefits.
I/the claimant will sign a receipt for the death benefit if asked.
I/the claimant will pay any share of the death benefit due to anyone else entitled to it.
The death certificate I have uploaded represents an image of an original certified copy (or extract in Scotland) of the death certificate / document issued from a registry office and is not from a reproduced copy.
By ticking on the following box I confirm the above/I confirm the above on behalf of the claimant.
* Indicates a required field
Submit
