Who is this for? This form is for members of the Final Pay Section and the Money Purchase 2003 (MP03) Section who would like to update or select a nominated dependant. A nominated dependant is someone who is not a spouse or civil partner, but whom is financially dependent on you. If there is a pension payable when you die, the Trustee has the discretion to pay whole or part of the pension to a person who you nominate. If you wish the Trustee to consider someone who is financially dependent on you, please complete this form. While the Trustee will bear your wishes in mind, the Trustee is not legally bound by them. Your details * Denotes required fields Your name Title*MrMrsMissMsDrProfTitle* - This is a required field Forename(s)* - This is a required field Surname* - This is a required field Address Select countryUnited KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaÅland IslandsBhutanBolivia (Plurinational State of)Bonaire, Sint Eustatius & SabaBosnia & HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Democratic Republic of)CongoCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island & McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension & Tristan da CunhaSaint Kitts & NevisSaint LuciaSaint Martin (French part)Saint Pierre & MiquelonSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard & Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan (Province of China)TajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis & FutunaWestern SaharaYemenZambiaZimbabweCountry* - This is a required field Start typing your address Look up address Address line 1* - This is a required field Address line 2 Town County/State/Province/Region Postcode/Zip code Date of birth* Day* of birth - This is a required fieldDD01020304050607080910111213141516171819202122232425262728293031 Month* of birth - This is a required fieldMM010203040506070809101112 Year* of birth - This is a required fieldYYYY20082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920191919181917191619151914 Other information National Insurance number* - This is a required field For example QQ123456C Email address* - This is a required field What would you like to do? Nominee information * Denotes required fields Title*MrMrsMissMsDrProfNominee Title* - This is a required field Nominee Forename* - This is a required field Nominee Surname* - This is a required field Select countryUnited KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaÅland IslandsBhutanBolivia (Plurinational State of)Bonaire, Sint Eustatius & SabaBosnia & HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Democratic Republic of)CongoCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island & McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension & Tristan da CunhaSaint Kitts & NevisSaint LuciaSaint Martin (French part)Saint Pierre & MiquelonSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard & Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan (Province of China)TajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis & FutunaWestern SaharaYemenZambiaZimbabweNominee Country* - This is a required field Start typing the address Look up nominee address Address line 1* - This is a required field Nominee Address line 2 Nominee Town Nominee County/State/Province/Region Nominee Postcode/Zip code Nominee Email address* - This is a required field Nominee Date of birth* Nominee Day* of birth - This is a required fieldDD01020304050607080910111213141516171819202122232425262728293031 Nominee Month* of birth - This is a required fieldMM010203040506070809101112 Nominee Year* of birth - This is a required fieldYYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920191919181917191619151914191319121911191019091908190719061905190419031902190119001899189818971896189518941893189218911890188918881887188618851884 Note: The Trustee has the discretion whether or not to accept this nomination. For guidance, the following conditions must be satisfied for the person you have nominated above to be accepted as a nominated dependant: You must specify a person, not an organisation (i.e. a charity or a club). The nominated person must have been financially dependent on you at the time of your death. Before a pension is paid, the nominated person will be asked to provide evidence of financial dependency (e.g. mortgage statements, utility bills). However, it is ultimately for the Trustee to decide if someone was financially dependent on you. The nomination must be unrevoked by you at the date of death. You may revoke this nomination at any time by contacting the pensions team. This nomination will be revoked automatically on your marriage or remarriage. Although I understand that the recipient(s) of the dependant's pension, in certain circumstances, is at the sole discretion of the Trustee, I would like it to consider the person named above. Your declaration Please tick the boxes below to confirm that you understand and acknowledge the statements. I acknowledge that this notification cancels any previously submitted nominated dependant form. I understand that this nomination will be automatically revoked if I marry or remarry. Data protection The Trustee, as the controller under the applicable data protection legislation in the UK, uses certain personal information about you to (amongst other reasons) communicate with you and administer your benefits in the Plan. Your information is shared with the Plan’s administrators, other providers of services to us, and public bodies such as HM Revenue & Customs. For more detailed information on how we use and disclose your information, the protections we apply, the legal bases we rely on and your data protection rights, please see our privacy notice at www.pearson-pensions.com/privacy-notice/ - This link opens in a new browser window. If you would like a copy of our privacy notice to be sent to you, please contact the pensions helpline. I confirm I understand that the data I provide will be used as outlined in the data protection statement. Today's Date: Date: 19-04-2024 Thank you You will receive a confirmation email shortly. Your form will be processed by the pensions team. Please contact them directly if you have any queries. Back to Home
