ePA for [client name]

Your Details

• Full Name
• Relationship to the Member
• Telephone Number
• Email Address
• Confirm Email Address
• Address
• Communication Preference
  click to select Email Post

Details of the person who has passed away

To help us identify the person that has passed away, please always provide the name of the pension scheme they belonged to, their full name, address and postcode together with their Date of Birth or National Insurance Number / PPS Number.

• Full Name
• Date of Birth
• Identifier
  click to select National Insurance Number PPS Number
• National Insurance Number
• PPS Number
• Does the member that passed away have benefits in more than one scheme administered by WTW?
  click to select Yes No Don't Know
• How many?
  click to select 2 3 4 5
• Pension Scheme Name
• Name of Company relating to the Pension Scheme
• Pension Scheme Reference
• Pension Scheme Name
• Name of Company relating to the Pension Scheme
• Pension Scheme Reference
• Pension Scheme Name
• Name of Company relating to the Pension Scheme
• Pension Scheme Reference
• Pension Scheme Name
• Name of Company relating to the Pension Scheme
• Pension Scheme Reference
• Pension Scheme Name
• Name of Company relating to the Pension Scheme
• Pension Scheme Reference
• Date of Death
• Address
• Marital Status
  click to select Married Civil Partnership Widowed Separated Divorced Single Unknown
• Were they co-habitating at the time they died?
  click to select Yes No Don't Know
• Do they leave any dependent children?
  click to select Yes No Don't Know
• Were they a member of the pension scheme or the spouse or dependent of the member?
  click to select Member Spouse Dependent Don't Know
• Is probate being applied for?
  click to select Yes No Don't Know

Next of Kin Information

• Are you the Next of Kin?
  click to select Yes No
• Full Name of Next of Kin
• Relationship to member
• Telephone Number
• Email Address
• Address
• Communication Preference
  click to select Email Post
• Who should we write to about the bereavement?
  click to select You Next of Kin Person dealing with estate Other

If Other, please provide details below

• Full Name
• Relationship to member
• Telephone Number
• Email Address
• Address
• Communication Preference
  click to select Email Post

Details of the person dealing with the Estate

Please provide details of the person/company dealing with the Estate (complete this where a person/company has been appointed to act on behalf of the next of kin).

• Are you the person dealing with the Estate?
  click to select Yes No
• Is the Next of Kin dealing with the Estate?
  click to select Yes No
• Is the Other person dealing with the Estate?
  click to select Yes No
• Full Name of person or company dealing with the Estate
• Relationship / Company
• Telephone Number
• Email Address
• Address
• Communication Preference
  click to select Email Post

• Is there any other information you would like to share with us?
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