Pension Credit Application Form

November 30, 2009

in Application Forms

When sending out your pension credit application form, be aware that you will be asked to attach original copies of your documents. It is important that you attach all the documents requested in order to have your application processed smoothly. These documents are usually returned within five working days.

ABOUT YOU

Full names: ___________________________________________________________

Telephone: ________________________ __________________________________

Home                                          Office

Postal address: ________________________________________________________

_____________________________________________________________________

ABOUT YOUR PARTNER (someone you are married to)

Full name: ____________________________________________________________

Telephone: ____________________________________________________________

Address: ______________________________________________________________

WHERE YOU LIVE

Street address of where you live: ____________________________________________

_______________________________________________________________________

Do you have any dependents?  ? Yes   ? No

If yes, how many of them are children under 16 years old? _____________________

Do you have any foster or adopted children? ________________________________

Are any of your relatives staying with you? _________________________________

How many other boarders, lodgers or friends are living with you? __________________

________________________________________________________________________

INVESTMENTS

How much in savings do you have? $_________________________________________

How much total investment do you have? _____________________________________

________________________________________________________________________

Your partner’s savings in total: $ ____________________________________________

Your partners’ investments: $ ________________________________________________

________________________________________________________________________

Do you hold any joint accounts or property with someone else in the country or abroad? ________________________________________________________________________________________________________________________________________________

PENSION

Do you have any other pension scheme? ? Yes ? No

If yes, give details: ______________________________________________________________________

_______________________________________________________________________

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