NOTIFICATION OF COHABITING PARTNER FOR SURVIVOR'S PENSION Benefits payable on the death of a member of the Local Government Pension Scheme (LGPS) include pensions for children, for a surviving spouse or registered civil partner * and, provided the scheme member paid into the LGPS on or after 1 April 2009, for an eligible co-habiting partner. You can nominate a cohabiting partner, of either the opposite or the same sex, by completing this nomination form and returning it to the Pension Fund. Failure to notify us of an eligible cohabiting partner may delay payment of a survivor’s pension. For a cohabiting partner to be eligible for a survivor’s pension, you must be free to marry or enter into a civil partnership with your cohabiting partner and the following conditions must be met for a continuous period of at least 2 years on the date you both sign the nomination form:    you have been living together as if you were husband and wife, or civil partners, and neither you or your partner have been living with someone else as if you/they were husband and wife or civil partners, and either your partner is financially dependent on you or you are financially interdependent on each other. Your partner is financially dependent on you if you have the higher income. Financially interdependent means that you rely on your joint finances to support your standard of living. It doesn’t mean that you need to be contributing equally. For example, if your partner’s income is a lot more than yours, he or she may pay the mortgage and most of the bills, and you may pay for other household expenses such as shopping and clothing. On your death, a survivor’s pension would be paid to your nominated co-habiting partner if:  the nomination was still in effect at the date of your death**, and  your nominated cohabiting partner satisfies us that the above conditions had also been met for a continuous period of at least 2 years immediately prior to your death. You and your co-habiting partner should be aware that on your death we will have to verify that the eligibility conditions have been satisfied. We may do this by, for example, asking for confirmation that you lived in a shared household with shared household spending, or your partner may be asked to demonstrate that you had a bank account or mortgage in joint names. There would be a right of appeal if we decide not to pay a pension and your partner believes that he/she has entitlement. If you are married or are in a registered civil partnership you do not need to complete a survivor’s pension nomination form for your husband, wife or registered civil partner – they are automatically covered for a survivor benefit in the event of your death. Remember to let us know of a change in your circumstances which could affect the nomination, or if you wish to cancel it. * A civil partnership is a relationship between two people of the same sex (“civil partners”) which is formed when they legally register as civil partners of each other. ** A nomination ceases to have effect if(a) either you or your nominated partner gives us written notice to cancel the nomination, or (b) you make a subsequent valid nomination in favour of a new co-habiting partner, or (c) either you or your nominated partner marries, forms a civil partnership or lives with a third person as if they were husband and wife or as if they were civil partners, or (d) your nominated partner dies before you. NOTIFICATION OF COHABITING PARTNER FOR SURVIVOR’S PENSION YOUR DETAILS Full Name: Home Address: Date of Birth: Contact Number: Employer: National Insurance Number: NOMINATED PARTNER’S DETAILS Full Name: Home Address: Date of Birth: Contact Number: DECLARATION We confirm that for a continuous period of at least 2 years prior to the date of this declaration all of the following have applied –  we have been free to marry each other or enter into a civil partnership with each other, and  we have lived together as if we were husband and wife or registered civil partners, and  neither of us have been living with someone else as if we were husband and wife or civil partners, and  our financial affairs have been interdependent (or the nominated partner has been financially dependent upon the Scheme member). Signature: Name: Date: Nominated Partners Signature: Name: Date: Please note: on your death, we will need to be satisfied that your relationship met the qualifying conditions for the payment of a co-habiting partner’s p

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