Claiming UK State Pension - Questionnaire

1. Title:

2. Surname:

3. Forenames:

4. Maiden Name 5. (if applicable)

6. Date of Birth:

7. UK National Insurance number (if know):

8. Address (Australia): 9. Home Tel: 10. Mobile: 11. Email:

12. Previous UK Address (1): 13. Previous UK Address (2):

Date from: To: Date from: To:

14. Martial status: 19. Date first entered Australia:

14. Date of marriage: 20. Did you return to work in the

UK after this date? Yes No

15. Did you marry in the UK? Yes No 21. Date you returned to the UK:

*If yes, please send your marriage certificate to us 22. Date you re-entered Australia:

16. Partner’s National Insurance number:

23. Have you lived and worked in

any other Country? Yes No

17. Partner’s date of birth: 24. If yes, which Country?

18. Have you ever been in HM forces? 25. Date entered Country:

No Army Navy RAF 26. Date departed Country:

27. Previous UK Employer Name and Address (1): 28. Previous UK Employer Name and Address (2):

29. Date work commenced: 30. Date work commenced:

31. Date finished: 32. Date finished:

33. Have you ever been self employed in the UK since 1978? Yes No

34. Since you reached state pension age have you been admitted into a UK hospital? Yes No

If yes, please confirm the hospital name:

Date you entered: Date discharged:

35. Are you or your partner in receipt of any UK state payments or benefits including Child Benefit?

Yes No

36. If yes, please confirm the benefit you are receiving:

Please send your certified birth and marriage certificates to us with your completed forms

Version: 10/2015

AGREEMENT TO STATE PENSION SERVICE

I acknowledge that I have requested assistance with obtaining my present entitlement to the UK State Pension, and ways on how I can improve this entitlement, thus enhancing my income in retirement. I am aware that there is a fee for this service and I acknowledge that I will settle my account with PTS personally.

Due to the complexity and certain eligibility conditions for the UK State Pension we have a

range of State Pension Services we are able to assist you with. Please select the service you

wish to proceed by ticking the service/s you wish use:

The Top up Service Full Top-Up Service: $550 (INC GST)

Full Top-Up Service for Couple: $950 (INC GST) Upon receipt of your signed agreement we will contact the UK to request your State Pension Statement. We

will also issue you with an employment pack to enable us to collate the information required for the appeal

process. At this stage we will issue you with an invoice which is payable within 30 days.

Claiming your UK State Pension Please select either Option A or B Option A

Claiming UK Pension (If you have not claimed your UK Pension and are within 3 months of

reaching UK State Pension age or within one year of state pension age): $350 (INC GST) Option B Claiming UK Pension (If you have reached your State Pension Age and deferred taking this for more

than 1 year we are able to claim an additional lump sum payment with interest):

$550 (INC GST) AND (Optional Additional Service)

Increasing UK State Pension whilst over State Pension Age (If you are currently working and you would like to increase your pension income in retirement by topping up your National Insurance Contributions) $550 (INC GST) Signed

…………………………………………………………………………………

NAME: Date ……………… Please ensure you tick for the appropriate service you authorise Pension Transfer Specialists to complete *Your invoice is payable within the terms indicated and failure to comply may necessitate in legal action being taken against you resulting in additional

legal and court costs which you will be liable for. Any expenses incurred relating to any debt collection costs, dishonoured cheque(s) fees, legal costs,

whether charged on scale or on any other basis incurred shall be paid by you on demand.

International Pension Centre The Pension Service 11 Mail Handling Site A Wolverhampton WV98 1LW United Kingdom Dear Sirs Please take this letter as formal confirmation that I wish to authorise Pension Transfer Specialists (PTS) and any member of its staff to obtain and receive information directly relating to my UK State Pension benefits. I have instructed PTS to handle my affairs relating to this matter and therefore please ensure that any correspondence is issued directly to PTS in the first instance. I trust you find this to be satisfactory but should you have any questions please do not hesitate to contact me. Yours faithfully

Name:

Address:

Date of Birth:

National Insurance Number (if known):

___________________________________ _________________________ Signature Date