State Pension Claim Form - Department For Work & Pensions Page 18
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26Part 6
About other benefits or entitlements
We need to know if you, your husband, wife or civil partner are getting any benefits or entitlements from the Department for Work and Pensions
or any other United Kingdom government department, as they will normally affect your basic State Pension. It will usually be reduced by the
amount of the other benefit.
No
Are you, your husband, wife or civil partner
getting any of these benefits or entitlements
Yes
Please tell us about the benefits or entitlements.
from the United Kingdom or the Isle of Man?
Benefit 1
Or have you received any of these benefits or
Name of benefit or entitlement
entitlements since you reached State Pension
age?
Who is getting this or waiting to hear
You
Your husband, wife or civil partner
Tick Yes if you, your husband, wife or
about this?
civil partner are waiting to hear about
a benefit.
Reference number, if known
•
Attendance Allowance
This is on letters about the benefit
•
or entitlement.
Bereavement Benefit
•
Carer’s Allowance
•
Child Benefit
Benefit 2
•
Disability Living Allowance
Name of benefit or entitlement
•
Employment and Support Allowance
•
Who is getting this or waiting to hear
Graduated Retirement Benefit
You
Your husband, wife or civil partner
•
about this?
Guardian’s Allowance
•
Incapacity Benefit
Reference number, if known
•
Income Support
This is on letters about the benefit
•
Industrial Death Benefit
or entitlement.
•
Jobseeker’s Allowance
•
Pension Credit
Benefit 3
•
Reduced Earnings Allowance
•
Name of benefit
Severe Disablement Allowance
•
State Pension
Who is getting this or waiting to hear
•
Temporary Allowance for Widows
You
Your husband, wife or civil partner
about this?
•
Unemployability Supplement
paid because of
Reference number, if known
- a war disability due to service with
This is on letters about the benefit
HM forces
or entitlement.
or - an industrial accident or disease.
•
War Widow’s or Widower’s Pension
If you, your husband, wife or civil partner
•
Widow’s Benefit
get more than 3 benefits or entitlements,
•
Working Tax Credit
tell us about them in Part 10.
14
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