State Pension Claim Form - Department For Work & Pensions Page 25
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26Part 11 Declaration
I understand that I must promptly tell the Department for Work and
Pensions, by phone or in writing, of anything that may affect my
entitlement to, or the amount of, my State Pension.
I declare that the information I have given on this form is correct and
complete as far as I know and believe.
I understand that if I knowingly give false information, I may be liable to
prosecution or other action.
I understand that if I fail to promptly notify the Department of a change
in circumstances, I may be liable to prosecution or other action.
This is my claim for State Pension
Signature
Date
Please sign the form here after printing
Part 12 What to do now
1. Check that you have answered all the
4. When to claim - If you want to claim your
5. Send this form and any documents to:
International Pension Centre
questions on this form that apply to you.
State Pension now, please send this form
The Pension Service 11
to us without delay.
2. Check that you are sending us all the
Mail Handling Site A
You can get your State Pension paid more
documents we have asked for.
Wolverhampton
These could be your birth certificate, your
quickly if you:
- answer all the questions on the form that
WV98 1LW
marriage certificate, your civil partnership
apply to you, and your husband, wife or
United Kingdom
certificate, your decree absolute or
civil partner if you have one
decree of divorce, your dissolution of civil
- send us all the documents we ask for. If
partnership document, certificate of
annulment or death certificate.
you cannot do this, please get in touch
with us, but your State Pension may be
3. Check that you have signed this form.
delayed or you could see a loss of your
State Pension.
Our phone number is +44 (0)191 218 7777
If you use a textphone the number is
+44 (0)191 218 7280
21
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