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Claiming UK State Pension - Questionnaire
1. Title:
2. Surname:
3.
4.
5.
6.
Forenames:
Maiden Name
(if applicable)
Date of Birth:
7. UK National Insurance number (if know):
8. Address (Australia):
9. Home Tel:
10. Mobile:
11. Email:
12. Previous UK Address (1):
13. Previous UK Address (2):
Date from:
To:
Date from:
14. Martial status:
14. Date of marriage:
15. Did you marry in the UK?
Yes
No
To:
19. Date first entered Australia:
20. Did you return to work in the
UK after this date?
21. Date you returned to the UK:
*If yes, please send your marriage certificate to us
16. Partner’s National
Insurance number:
17. Partner’s date of birth:
22. Date you re-entered Australia:
23. Have you lived and worked in
any other Country?
24. If yes, which Country?
18. Have you ever been in HM forces?
No
Army
Navy
25. Date entered Country:
RAF
Yes
No
Yes
No
26. Date departed Country:
27. Previous UK Employer Name and Address (1):
28. Previous UK Employer Name and Address (2):
29. Date work commenced:
30. Date work commenced:
31. Date finished:
32. Date finished:
33. Have you ever been self employed in the UK since 1978?
Yes
No
34. Since you reached state pension age have you been admitted into a UK hospital?
Yes
No
Yes
No
If yes, please confirm the hospital name:
Date you entered:
Date discharged:
35. Are you or your partner in receipt of any UK state payments or benefits including
Child Benefit?
36. If yes, please confirm the benefit you are receiving:
Please send your certified birth and marriage certificates to us with your completed forms
AGREEMENT TO STATE PENSION SERVICE
I acknowledge that I have requested assistance with obtaining my present entitlement to the
UK State Pension, and ways on how I can improve this entitlement, thus enhancing my
income in retirement. I am aware that there is a fee for this service and I acknowledge that I
will settle my account with PTS personally.
Due to the complexity and certain eligibility conditions for the UK State Pension we have a
range of State Pension Services we are able to assist you with. Please select the service
you wish to proceed by ticking the service/s you wish use:
The Top up Service
Full Top-Up Service:
$500 (INC GST)
Full Top-Up Service for Couple:
$900 (INC GST)
The top up service includes a full report containing details of your entitlement and how you can top
up. The invoice for our services will be issued report. The report will contain an information pack
which needs to be completed and returned to enter the appeal process. Upon receipt of the
appropriate Class 2/3 acceptance from HMRC we will contact you to confirm the National Insurance
Contributions payable and confirm the different ways to pay.
Claiming your UK State Pension
Please select either Option A or B
Option A
Claiming UK Pension (If you have not claimed your UK Pension and are within 3 months of
reaching UK State Pension age or within one year of state pension age):
$300 (INC GST)
Option B
Claiming UK Pension (If you have reached your State Pension Age and deferred taking this for
more than 1 year we are able to claim an additional lump sum payment with interest):
$500 (INC GST)
AND (Optional Additional Service)
Increasing UK State Pension whilst over State Pension Age (If you are currently working and
you would like to increase your pension income in retirement by topping up your National Insurance
Contributions)
$500 (INC GST)
Signed
…………………………………………………………………………………………………..
NAME:
Date ………………
Please ensure you tick for the appropriate service you authorise Pension Transfer Specialists to
complete
International Pension Centre
The Pension Service 11
Mail Handling Site A
Wolverhampton
WV98 1LW
United Kingdom
Dear Sirs
Please take this letter as formal confirmation that I wish to authorise Pension Transfer
Specialists (PTS) and any member of its staff to obtain and receive information directly relating
to my UK State Pension benefits.
I have instructed PTS to handle my affairs relating to this matter and therefore please ensure
that any correspondence is issued directly to PTS in the first instance.
I trust you find this to be satisfactory but should you have any questions please do not hesitate
to contact me.
Yours faithfully
Name:
Address:
Date of Birth:
National Insurance Number (if known):
___________________________________
Signature
_________________________
Date
Part 9
How we pay you
Your benefit will be paid direct to your account.
It is very important that you give us all the information we ask for and that you check with your bank that the details you give us are correct.
If you tell us the wrong account details your payment may be delayed or you may lose money.
Please tell us:
your bank or financial institution’s full name
your bank or financial institution’s full address
Postcode
name of the account holder fill in from the left
account number fill in from the left
account type should be: 0 for checking account
1 for savings account
3 for other account
Please continue on the next page
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Part 9
How we pay you - continued
Please tell us:
bank/branch code
International Bank Account Number (IBAN) fill in from the left
Bank Identification Code (BIC) fill in from the left
If your code has only 8 characters, enter 3 “X” for last 3 characters
If you have a cheque book for your account please attach a paying-in slip to this form. This will help us to confirm your details.
I would like to be paid
at the end of every
4 weeks
13 weeks
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Part 11
Declaration
I understand that I must promptly tell The Pension Service, by phone or
in writing, of anything that may affect my entitlement to, or the amount
of, my State Pension.
I declare that the information I have given on this form is correct and
complete as far as I know and believe.
I understand that if I knowingly give false information, I may be liable to
prosecution or other action.
I understand that if I fail to promptly notify the Department of a change
in circumstances, I may be liable to prosecution or other action.
This is my claim for State Pension
Signature
Date
Day
Month
/
Year
/
When you return your claim form
We will make enquiries for you so that we can consider your
claim for pension or benefit. This can take around 8 weeks
from the date we get your claim.
About your claim
It would help if you did not phone us to check on the progress
we are making unless you want to report a change that would
affect your claim - for example, bank details etc.
We will only acknowledge your claim if you are sending a
birth certificate
marriage certificate
civil partnership certificate
certificate of annulment
certificate of civil partnership dissolution
decree absolute
decree of divorce
death certificate
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Part 12 What to do now
1. Check that you have answered all the
questions on this form that apply to you.
4. When to claim - If you want to claim your
State Pension now, please send this form
to us without delay.
2. Check that you are sending us all the
You can get your State Pension paid more
documents we have asked for.
quickly if you:These could be your birth certificate, your
- answer all the questions on the form that
marriage certificate, your civil partnership
apply to you, and your husband, wife or
certificate, your decree absolute or
civil partner if you have one
decree of divorce, your
send us all the documents we ask for.
dissolution of civil partnership document,
If you cannot do this, please get in touch
certificate of annulment or death certificate.
with us, but your State Pension may be
3. Check that you have signed this form.
delayed or you could see a loss of your
State Pension.
5. Send this form and any documents to:
The Pension Service
International Pension Centre
Tyneview Park
Newcastle upon Tyne
England NE98 1BA
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