
				Have you been misled? Fill in our short questionnaire and we can advise you.

SERPS Claim Questionnaire

Please complete our short questionnaire to see if you are entitled to claim.
If you would prefer to fax or post the questionnaire, please click here to open a version for print (PDF file)

* indicates required field.

Your Name *
Address *
Your Age *
Spouses Age
Contact Number *
Contact E-Mail

Have you ever received information about SERPS inheritance?
	No
	Yes
If yes, when did you receive the information? If you do not know the exact date, give an approximate date:


Who gave you the information?
	The Benefits Agency or Department of Social Security
	Another Government Department or Agency
	A Voluntary Organisation
	A Pensions Advisor or Financial Advisor
	Previous Employer
	Other - Please state below:


How did you get this information?
	A Benefits Agency or Department of Social Security
	Letter from a Government official
	Telephone call from a Government official
	Telephone call to a Government official
	In person at a visit to a Government office
	In person at a visit to your home by a Government official
	Other - Please state below:


What was the information about?
	The amount of SERPS pension I might inherit
	The amount of SERPS pension my spouse might inherit
	The amount of SERPS pension my spouse and I might inherit
	Other - Please state below:


What were you told?

Did you make any financial decisions based on the incorrect information you received?

If you had known the true facts, might you have done something different?
	No
	Yes
	Don't know

Please provide any further information you feel may support your claim: