State Pension Claim Form - Department For Work & Pensions Page 19
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26Part 6
About other benefits or entitlement - continued
No
Is anyone getting an increase of their social
security benefit or entitlement for you?
Which benefit or entitlement are they
Yes
getting increased?
What is the reference number of the
benefit or entitlement?
This is on letters about the benefit or entitlement.
No
Have you been in receipt of United Kingdom
Child Benefit at any time since 1978?
Yes
No
Are you, your husband, wife or civil partner
getting any social security benefits from
Yes
Please tell us about the benefits. If you need more space
•
another country
use the space in Part 10 at the end of this form.
•
or
State Social Security Authority
•
or
waiting to hear about a claim for a
benefit?
Name of benefit
We only want to know about benefits
Who is getting this or waiting to
paid by a State Social Security Authority
You
Y ur husband, wife or civil partner
o
hear about this?
Reference number, if known
This is on letters about the benefit.
Name and address of
State Social Security Authority
15
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