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