Lump sum benefit payable on death form

Lump sum benefit payable on death

This form is for individuals claiming a lump sum payment due to a beneficiary of the estate.

Payment number

Deceased's full name

Please read carefully:

The benefit is payable to a beneficiary of the estate of the above named deceased pensioner.

I hereby undertake to repay you on demand and to indemnify you against any cost, charges, duties or other payments for which you may become liable in consequence of your having made such payment to me without requiring production of Probate or Letters of Administration.

We are asking for this form in place of the normal Grant of Probate to speed up the settlement claim. We may seek full repayment of the benefit, and any associated costs, if we find that the payment was made to the wrong person(s).

Beneficiary's details

Title

Forenames

Surname

Date of birth

Full address

Post code

Contact number

Email address

National Insurance Number

Bank/building society details

Account holder name

Name of bank / building society

Sort code

Account number

Building society roll number

Only required if your bank has issued one to you.

Enclosures

Please upload copies of any supporting documentation as requested in our recent letter i.e. Passport, Marriage Certificate, Death Certificate, Bank Statement.

Drag and drop or choose a file

Add file

Declaration

Beneficiary's confirmation

I confirm that all the details provided above are correct and I am happy for you to proceed accordingly.

Today's date

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If you have any questions about completing this form please contact us on:

0345 0263858

Monday to Friday 9am to 5pm.
Calls may be monitored and recorded.