Bereavement Form

Tell us about you
If you need to tell us about the death of a Wesleyan policyholder, please fill out the short form below.

We’ll then be in touch by phone or email to offer support and let you know of any next steps. Please give us a little information about yourself.
Your name*

First nameLast name
What is your relationship to the deceased?*
Are you the main contact?*
Please supply the contact details of the primary contact:
Primary contact name

First NameLast Name
Primary contact postal address

Street Address

Street Address Line 2

CityCounty

Postcode
Primary contact email address
Primary contact phone number
Your postal address

Street Address

Street Address Line 2

CityCounty

Postcode
Your email address
Your phone number
If there are any payments due, would you be the primary recipient?*
Your date of birth*

DayMonthYear
Your National Insurance number
Please supply your bank details:
Sort code
Account number

Tell us about the person who's passed away
If you need to tell us about the death of a Wesleyan policyholder, please fill out the short form below. We’ll then be in touch by phone or email to offer support and let you know of any next steps.

Please let us know the details of the policyholder who has died.
Their name*

First nameLast name
Wesleyan reference number
You can find this on correspondence from us, such as letters or emails.
Their financial product(s), if known

Allied Steel Wired Scheme (Group Pensions)Investment (All non-pension investment products, e.g. ISAs, Capital Investment Bonds etc.)Pension (All uncrystallised Personal Pensions)Protection (Individual or Group)Retirement (Inc. Flexi Access Drawdown or Annuity)Wesleyan Staff Pension (Group Pensions)
Date of birth*

DayMonthYear
Date of death*

DayMonthYear
Their address

Street Address

Street Address Line 2

CityCounty

Postcode
Has the death been registered and a death certificate obtained?*
Death certificate number
You can find this in the top right hand corner of the certificate
Did they leave a will?*
Has probate been granted?
Were they married or in a civil partnership?*
Please give name of spouse or civil partner, their date of birth, and home and email address (if known):
Did they have any children?*
Please give child's or children's name(s), date(s) of birth, and home and email address(es) (if known):
Should be Empty:

Tell us about you