Claim For Funeral Payment And Or Arrears Of Benefit (Page 5 of 6) in pdf

Claim For Funeral Payment And Or Arrears Of Benefit Page 5

Part 4

About the funeral expenses

22. Have the funeral expenses been paid?

Yes

23. Did you pay them, or will you be paying them?

Yes

Please enclose the funeral director’s receipted account or written estimate. Now go to Part 5

Please complete question 24

24. Please state the name, address and relationship to the deceased or the person who paid, or will be paying for, the

funeral expenses.

Name

Address

Postcode

Relationship to the deceased

Part 5

Documents enclosed with this form

The following documents should be sent with this claim. But if any documents are not readily available, do not delay

sending us this form. If you do not send it to us within 12 months of the date death, you will not be entitled to a

Funeral Payment. Please tick the appropriate boxes to indicate which documents you have enclosed.

Grant of Probate

Letters of Administration

Death Certificate (Form D8A)

Funeral Director’s account or estimate

Payment orders or benefit cheques issued by the Treasury or the UK DWP relating to the deceased

Child Benefit payment orders or benefit cheques relating to the parent, if the deceased was a child

Part 6

About you and your claim

Your full name

Your full address

Postcode

Your relationship to the deceased

Please answer the following by ticking the appropriate boxes

I claim a Funeral Payment in respect of the deceased named in Part 1 of this form on the grounds that:

I am the executor

I am the administrator

I am the next of kin

I have paid the funeral expenses

I shall be paying the funeral expenses

I claim any arrears of Social Security benefit which may have been due to the deceased

I declare that to the best of my knowledge and belief the information I have given on this form is true and

complete. I am over 16 years of age.

Your signature

Date

WARNING: To give false information may result in legal action being taken against you

Claim For Funeral Payment And Or Arrears Of Benefit Page 5

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