State Pension Claim Form - Department For Work & Pensions Page 6

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Part 1
About you - continued
For official use only
Nature of evidence
Date of birth
Verified by
Please send us your birth certificate
We need the original certificate. If you do not wish to send your original certificate a photocopy may be
Checked by
acceptable but only if the photocopy has been stamped and signed by any of the following
a civil servant
or
a doctor or surgeon registered under the laws of the country where the declaration is made
Certificate returned by
or
a minister of religion
or
a barrister, solicitor or advocate authorised to practice in the country where the declaration is made
on
or
a notary public or any person allowed to administer oaths in the country where the declaration is made
/
/
or
an officer of a bank authorised to sign documents on the customer’s behalf
or
a magistrate
If you do not have your birth certificate, and are unable to send it quickly, do not delay sending in this claim
form.
You must remember to send us all the documents we ask for. If you do not, benefit you can get because
of this claim may be delayed.
Other documents on which your date of birth is recorded may be acceptable.
Are you sending your birth certificate with this form?
No
Yes
We will send the certificate back to you
as soon as we can.
2

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