Job Offer Document

This form should only be completed by members of the Local Government Pension Scheme who wish to nominate a beneficiary (or beneficiaries) to receive any Death Grant that may become payable in the event of their death.

The form should be witnessed at the time of signing by someone other than a beneficiary.

A member may nominate any individual or an incorporated or unincorporated body. The London Borough of Lewisham may, but without being in any way bound to do so, have regard to any nomination made by the member when determining the payment of the death grant.

A nomination will be treated as not being in force at the time of the member's death in the following circumstances:

A subsequent nomination has been made.
The beneficiary has died.
The beneficiary was the member’s spouse/registered civil partner when the nomination was made (or later became the spouse/registered civil partner) but has since been divorced from the member (or the partnership has been dissolved.)
The London Borough of Lewisham are of the opinion that payment of the death grant to the nominated beneficiary is not reasonable in all the circumstances.

If no valid nomination is in force at the date of death the Council will try to determine how the death grant should be distributed by putting itself in the place of the member at the time of their death. If this is not possible or practical, the death grant will be paid to the member’s estate.

Where the death grant has not been paid within two years of the date of the death then – irrespective of whether a valid nomination was in force – the death grant will be paid to the member’s estate.

This nomination will be cancelled by the completion of another nomination form (forms are available from the Pensions Team, 5th Floor, Laurence House, Catford, SE6 4RU).

Do you wish to nominate someone under the Death Grant Expression of Wishes guidelines:*

Yes - Witness Information is required belowNo

Employee Surname*

Employee Forename*

Date of Birth*

Date

Employee Address*

Street Address

Street Address Line 2

CityCounty

Postal Code

Employee Email*

example@example.com

Employee NI Number*

Having read the notes mentioned above, I wish to nominate the following person(s) - or organisation(s) - to receive payment of any Death Grant that may become payable in the event of my death.

Note: Where there is more than one potential beneficiary, please indicate how the Death Grant should be split - for example, 50% to my husband/wife and 25% to each of my two children. If you are nominating children who are under age 18, you will need to appoint a guardian to receive the payment on their behalf.)

Details of Beneficiary / Beneficiaries (press + button to add more)*

Employee Signature*

Date*

Date

Employee Name*

Witness and Witness’ Details:

This section must be witnessed at the time of completion by someone other than a named beneficiary.

Please check the details on this form are correct and clearly written and that:

the percentage shares add up to 100%
you have signed and dated the form
it has been signed and dated by a witness who is not a nominated beneficiary

I declare that this form has been signed in my presence by the member who I know to be the person whose details are given above:

Is witness other person than named beneficiary mentioned above?*

YesNo

ERROR

Unfortunatley a witness must be someone other than a named beneficiary (mentioned in the expression wishes form). Please find another witness to sign this section.

Witness Name*

Witness Address*

Witness Signature*

Date*

Date

Death Grant - Expression of Wishes Pension Form