Check your answers before sending your application

• Bereavement benefits: Change
• National Insurance (NI) number: Change
• If you do not know your NI number, have you ever had one or used one at any time?: Change
• Surname or family name: Change
• All other names, in full: Change
• All other surnames or family names you have been known by or are using now.: Change
• Address: Change
• Home phone number: Change
• Mobile phone number: Change
• Email address: Change
• Please confirm if this email address is: Change
• Date of birth: Change
• Please send us your original birth certificate, if you have it. Do not send us a photocopy. But if you do not have your birth certificate, do not delay sending in this claim form. If you prefer, you can take your birth certificate to your Jobcentre Plus office. Take this form as well. They will sign this form to show that they have seen your certificate.: Change
• Are you sending your birth certificate with this form?: Change
• We will send your birth certificate back to you as soon as we can.: Change
• What was the date of your marriage or civil partnership? If you converted or changed your civil partnership into a marriage or married your civil partner, enter the date your marriage is treated as starting on.: Change
• Are you sending your marriage or civil partnership certificate with this form?: Change
• Under what law/religion was the ceremony conducted?: Change
• Please tell us the country where your marriage or civil partnership took place.: Change
• Did your marriage end in divorce or has your civil partnership been dissolved?: Change
• Are you legally separated?: Change
• Are you, or have you been living with someone else as if you were married to them, or as if you are civil partners?: Change
• Your spouse or civil partner's National Insurance (NI) number: Change
• Your spouse or civil partner's surname: Change
• Your spouse or civil partner's other names: Change
• Address: Change
• Your spouse or civil partner's date of birth: Change
• What date did your spouse or civil partner die?: Change
• Did your spouse or civil partner die more than 3 months ago?: Change
• Were they getting a State Pension or any other benefits?: Change
• Did they pay NI contributions during the 2 years up to 5 April before they died?: Change
• Did they pay these contributions through an employer?: Change
• Employer's name and address: Change
• Clock or payroll number: Change
• Date they started work for this employer: Change
• Date they stopped work for this employer: Change
• Were they self-employed?: Change
• Were they a member of HM Forces when they died?: Change
• Were they getting a War Pension when they died?: Change
• Do you think your spouse or civil partner died because of an accident at work, or because of a disease or illness connected with their work?: Change
• We need to know about any time that your spouse or civil partner lived or worked outside the United Kingdom (UK). This is because if they paid into the social security scheme in another country, it may count towards your bereavement benefits. The United Kingdom is England, Scotland, Wales and Northern Ireland. Please tell us about any time that they lived in a country outside the UK, or the Channel Islands, or the Republic of Ireland.: Change
• Did your spouse or civil partner ever live outside the UK? If they only ever lived in England, Scotland, Wales or Northern Ireland, tick No.: Change
• Which country or crown dependency did they live in? If they lived in the Isle of Man, tell us here.: Change
• When did they live there?: Change
• Did they pay into the social security scheme of the country they lived in?: Change
• Are you expecting a child with your late spouse or civil partner? If you are, you may be able to get extra benefit when the baby is born.: Change
• What date is the baby expected?: Change
• Are you entitled to any Child Benefit?: Change
• Tell us the Child Benefit reference number. This is on any letters sent to you about Child Benefit, or on a bank statement.: Change
• How much do you get each week?: Change
• Are you waiting to hear if you can get Child Benefit?: Change
• When your spouse or civil partner died, were they getting any Child Benefit for any children?: Change
• Tell us the Child Benefit reference number. This is on any letters sent to them about Child Benefit, or on a bank statement.: Change
• How much did they get each week?: Change
• Do you have any children or qualifying young persons living permanently in your household who are dependent on you? We use child to mean a person aged under 16 and qualifying young person to mean a person aged 16, 17, 18 or 19.: Change
• Child's surname: Change
• Child's other names: Change
• Child's date of birth: Change
• What relation, if any, are you to the child?: Change
• What relation, if any, was your spouse or civil partner to the child?: Change
• Child's surname: Change
• Child's other names: Change
• Child's date of birth: Change
• What relation, if any, are you to the child?: Change
• What relation, if any, was your spouse or civil partner to the child?: Change
• Child's surname: Change
• Child's other names: Change
• Child's date of birth: Change
• What relation, if any, are you to the child?: Change
• What relation, if any, was your spouse or civil partner to the child?: Change
• Child's surname: Change
• Child's other names: Change
• Child's date of birth: Change
• What relation, if any, are you to the child?: Change
• What relation, if any, was your spouse or civil partner to the child?: Change
• Which child is living with another person?: Change
• What relation, if any, is this other person to the child?: Change
• How much do you send each week for the child?: Change
• Which child is in care?: Change
• What is the name and address of the local authority caring for the child?: Change
• How much do you send each week for the child?: Change
• Have you told us about any children who you are not a parent of?: Change
• Name of the child.: Change
• Does one of their parents live at the same address as you?: Change
• What is their name?: Change
• Are you, or anyone else, entitled to any benefit or allowance for any of the children you have told us about?: Change
• Name of the benefit or allowance: Change
• Address of the office it comes from: Change
• Name of the child it is for: Change
• Who gets the benefit or allowance?: Change
• Benefit reference number: Change
• Are any of the children you have told us about getting any benefit or allowance?: Change
• Name of the benefit or allowance: Change
• Address of the office it comes from: Change
• Name of the child it is for: Change
• Benefit reference number: Change
• Have you claimed bereavement benefits or Widow's Benefit before?: Change
• Did you get bereavement benefits or Widow's Benefit?: Change
• Are you getting any of these benefits or entitlements?: Change
• Name of benefit: Change
• Reference number: Change

Now send your application

By submitting this application you are confirming that, to the best of your knowledge, the details you are providing are correct.