Form SF200 Adult
About you
Q1. First name
About you
Q2. Last name
About you
Q3. Date of birth DD / MM / YYYY
About you
Q4. Your National Insurance number
Guidance: You can find the National Insurance number on a National Insurance number card, letters about benefit, or payslips
More information about you
Q5. Please tell us which benefit(s) you or your partner are getting or are waiting to hear about
Options: Universal Credit; Income Support; income-based Jobseeker’s Allowance; income-related Employment and Support Allowance; Pension Credit; Housing Benefit; Support for Mortgage Interest; None of the above
More information about you
Q6. Your address Postcode
More information about you
Q7. Your email, if you have one
More information about you
Q8. A phone number we can contact you on
Guidance: We may need to contact you by phone to get more information or to let you know when we have made a decision on your claim. Our number may show as 0800, unknown or withheld.
About your partner
Q9. Do you have a partner?
Options: No; Yes
About your partner
Q10. Your partner’s National Insurance number
Guidance: You can find the National Insurance number on a National Insurance number card, letters about benefit, or payslips.
About your partner
Q11. If you do not know your partner’s National Insurance number, has your partner ever had one or used one at any time?
Options: No; Yes
About your partner
Q12. Your partner’s surname or family name
About your partner
Q13. All your partner’s other names, in full
About your partner
Q14. Your partner’s date of birth DD/MM/YYYY
About your partner
Q15. Your partner’s email, if they have one
About your partner
Q16. A phone number we can contact your partner on, if they have one
Guidance: We may need to contact your partner by phone to get more information or to let them know when we have made a decision on your claim. Please note that our number may show as 0800, unknown or withheld.
About your partner
Q17. Your partner’s address Postcode
About the person who has died
Q18. Their surname or family name
About the person who has died
Q19. Their other names, in full
About the person who has died
Q20. Their date of birth DD/MM/YYYY
About the person who has died
Q21. Their address Postcode
Guidance: Please see the notes booklet.
About the person who has died
Q22. Their National Insurance number
About the person who has died
Q23. The date they died DD/MM/YYYY
About the person who has died
Q24. The date of funeral if known DD/MM/YYYY
About the person who has died
Q25. Will the funeral take place in the United Kingdom (UK)?
Options: No; Yes
Guidance: The UK is England, Scotland, Wales and Northern Ireland.
About the person who has died
Q26. If the funeral is not in the UK, in which country will it take place?
About the person who has died
Q27. Did the person who has died have their main home in the UK?
Options: No; Yes
About paying for the funeral
Q28. Have you or your partner taken responsibility for the funeral expenses?
Options: No; Yes
Guidance: You will not be able to get Funeral Expenses Payment.
About paying for the funeral
Q29. Is the signed contract or the final bill for the funeral in either your name or your partner’s name?
Options: No; Yes
Guidance: The contract is the signed agreement between you and the funeral director.
About paying for the funeral
Q30. Has anyone else claimed a Funeral Expenses Payment for this person?
Options: No; Yes
About paying for the funeral
Q31. Has a Funeral Support Payment from the Scottish Government been paid to either you or someone else for this funeral?
Options: No; Yes
About taking responsibility for the funeral
Q32. Was the person who died your partner and living with you at the time of their death? Or had you been living together immediately before one or both of you moved into a care home?
Options: No; Yes
Guidance: By partner we mean: • a person you live with who is your husband, wife or civil partner, or • a person you live with as if you are a married couple.
About taking responsibility for the funeral
Q33. Please tell us their relationship to you
Guidance: For example, they were your son, daughter, sister, brother, daughter-in-law, father-in-law, step-parent, step-son, step-daughter-in-law, close friend.
About taking responsibility for the funeral
Q34. Is there a surviving partner of the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q35. Did the person who has died have any other surviving parents or children?
Options: No; Yes
Guidance: Do not include yourself or any children of the person who has died if Child Benefit is still in payment for them.
About taking responsibility for the funeral
Q36. Had the relationship between the person who has died and any of the surviving parents or children broken down?
Options: No; Yes
About taking responsibility for the funeral
Q37. Please tell us how the family relationship had broken down and for how long.
About taking responsibility for the funeral
Q38. Their full name
About taking responsibility for the funeral
Q39. Their address Postcode
About taking responsibility for the funeral
Q40. Their relationship to the person who has died
About taking responsibility for the funeral
Q41. Their date of birth DD/MM/YYYY
About taking responsibility for the funeral
Q42. Their National Insurance number, if you know it
About taking responsibility for the funeral
Q43. Do they get a qualifying benefit?
Options: Yes; No; Do not know
Guidance: Please see the notes booklet.
About taking responsibility for the funeral
Q44. Did they keep in touch with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q45. Did they give domestic or caring help to the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q46. Did they go on social outings or holidays with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q47. Was the contact they had with the person who has died limited because of work or domestic responsibilities?
Options: No; Yes
About taking responsibility for the funeral
Q48. Tell us anything else about their relationship with the person who has died that might be relevant
About taking responsibility for the funeral
Q49. Their full name
About taking responsibility for the funeral
Q50. Their address Postcode
About taking responsibility for the funeral
Q51. Their relationship to the person who has died
About taking responsibility for the funeral
Q52. Their date of birth DD/MM/YYYY
About taking responsibility for the funeral
Q53. Their National Insurance number, if you know it
About taking responsibility for the funeral
Q54. Do they get a qualifying benefit?
Options: Yes; No; Do not know
Guidance: Please see the notes booklet.
About taking responsibility for the funeral
Q55. Did they keep in touch with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q56. Did they give domestic or caring help to the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q57. Did they go on social outings or holidays with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q58. Was the contact they had with the person who has died limited because of work or domestic responsibilities?
Options: No; Yes
About taking responsibility for the funeral
Q59. Tell us anything else about their relationship with the person who has died that might be relevant
About taking responsibility for the funeral
Q60. Their full name
About taking responsibility for the funeral
Q61. Their address Postcode
About taking responsibility for the funeral
Q62. Their relationship to the person who has died
About taking responsibility for the funeral
Q63. Their date of birth DD/MM/YYYY
About taking responsibility for the funeral
Q64. Their National Insurance number, if you know it
About taking responsibility for the funeral
Q65. Do they get a qualifying benefit?
Options: Yes; No; Do not know
Guidance: Please see the notes booklet.
About taking responsibility for the funeral
Q66. Did they keep in touch with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q67. Did they give domestic or caring help to the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q68. Did they go on social outings or holidays with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q69. Was the contact they had with the person who has died limited because of work or domestic responsibilities?
Options: No; Yes
About taking responsibility for the funeral
Q70. Tell us anything else about their relationship with the person who has died that might be relevant
About taking responsibility for the funeral
Q71. Their full name
About taking responsibility for the funeral
Q72. Their address Postcode
About taking responsibility for the funeral
Q73. Their relationship to the person who has died
About taking responsibility for the funeral
Q74. Their date of birth DD/MM/YYYY
About taking responsibility for the funeral
Q75. Their National Insurance number, if you know it
About taking responsibility for the funeral
Q76. Do they get a qualifying benefit?
Options: Yes; No; Do not know
Guidance: Please see the notes booklet.
About taking responsibility for the funeral
Q77. Did they keep in touch with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q78. Did they give domestic or caring help to the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q79. Did they go on social outings or holidays with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q80. Was the contact they had with the person who has died limited because of work or domestic responsibilities?
Options: No; Yes
About taking responsibility for the funeral
Q81. Tell us anything else about their relationship with the person who has died that might be relevant
About taking responsibility for the funeral
Q82. Did the person who has died have any other surviving close relatives?
Options: No; Yes
Guidance: Do not include yourself even if you are a close relative. Include your partner if you have one.
By other close relative we mean a: • father-in-law, mother-in-law if you or step-parent • son-in-law, step-son, or step-son-in-law • daughter-in-law, step-daughter or step-daughter-in-law • brother or brother-in-law • sister or sister-in-law.
About taking responsibility for the funeral
Q83. Their full name
About taking responsibility for the funeral
Q84. Their address Postcode
About taking responsibility for the funeral
Q85. Their relationship to the person who has died
About taking responsibility for the funeral
Q86. Their date of birth DD/MM/YYYY
About taking responsibility for the funeral
Q87. Their National Insurance number, if you know it
About taking responsibility for the funeral
Q88. Do they get a qualifying benefit?
Options: Yes; No; Do not know
Guidance: Please see the notes booklet.
About taking responsibility for the funeral
Q89. Did they keep in touch with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q90. Did they give domestic or caring help to the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q91. Did they go on social outings or holidays with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q92. Was the contact they had with the person who has died limited because of work or domestic responsibilities?
Options: No; Yes
About taking responsibility for the funeral
Q93. Tell us anything else about their relationship with the person who has died that might be relevant
About taking responsibility for the funeral
Q94. Their full name
About taking responsibility for the funeral
Q95. Their address Postcode
About taking responsibility for the funeral
Q96. Their relationship to the person who has died
About taking responsibility for the funeral
Q97. Their date of birth DD/MM/YYYY
About taking responsibility for the funeral
Q98. Their National Insurance number, if you know it
About taking responsibility for the funeral
Q99. Do they get a qualifying benefit?
Options: Yes; No; Do not know
Guidance: Please see the notes booklet.
About taking responsibility for the funeral
Q100. Did they keep in touch with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q101. Did they give domestic or caring help to the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q102. Did they go on social outings or holidays with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q103. Was the contact they had with the person who has died limited because of work or domestic responsibilities?
Options: No; Yes
About taking responsibility for the funeral
Q104. Tell us anything else about their relationship with the person who has died that might be relevant
About taking responsibility for the funeral
Q105. Their full name
About taking responsibility for the funeral
Q106. Their address Postcode
About taking responsibility for the funeral
Q107. Their relationship to the person who has died
About taking responsibility for the funeral
Q108. Their date of birth DD/MM/YYYY
About taking responsibility for the funeral
Q109. Their National Insurance number, if you know it
About taking responsibility for the funeral
Q110. Do they get a qualifying benefit?
Options: Yes; No; Do not know
Guidance: Please see the notes booklet.
About taking responsibility for the funeral
Q111. Did they keep in touch with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q112. Did they give domestic or caring help to the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q113. Did they go on social outings or holidays with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q114. Was the contact they had with the person who has died limited because of work or domestic responsibilities?
Options: No; Yes
About taking responsibility for the funeral
Q115. Tell us anything else about their relationship with the person who has died that might be relevant
About taking responsibility for the funeral
Q116. Their full name
About taking responsibility for the funeral
Q117. Their address Postcode
About taking responsibility for the funeral
Q118. Their relationship to the person who has died
About taking responsibility for the funeral
Q119. Their date of birth DD/MM/YYYY
About taking responsibility for the funeral
Q120. Their National Insurance number, if you know it
About taking responsibility for the funeral
Q121. Do they get a qualifying benefit?
Options: Yes; No; Do not know
Guidance: Please see the notes booklet.
About taking responsibility for the funeral
Q122. Did they keep in touch with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q123. Did they give domestic or caring help to the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q124. Did they go on social outings or holidays with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q125. Was the contact they had with the person who has died limited because of work or domestic responsibilities?
Options: No; Yes
About taking responsibility for the funeral
Q126. Tell us anything else about their relationship with the person who has died that might be relevant
About taking responsibility for the funeral
Q127. Did you or your partner keep in touch with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q128. Did you or your partner give domestic or caring help to the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q129. Did you or your partner go on social outings or holidays with the person who has died?
Options: No; Yes
About taking responsibility for the funeral
Q130. Was the contact you or your partner had with the person who has died limited because of work or domestic responsibilities?
Options: No; Yes
About taking responsibility for the funeral
Q131. Please tell us anything else about your relationship with the person who has died that might be relevant
About the funeral
Q132. Have you used a funeral director to arrange the funeral?
Options: No; Yes
About the funeral
Q133. What type of funeral has been arranged? Please specify
About the funeral
Q134. Where is the funeral taking place? Postcode
About the funeral
Q135. Can we get in touch with the funeral director for more information?
Options: No; Yes
About the funeral
Q136. Do you have any other bills for things not included on the funeral estimate or bill?
Options: No; Yes
Guidance: For example, flowers or a wreath.
About the funeral
Q137. Did you have any travel expenses to arrange or to attend the funeral?
Options: No; Yes
About the funeral
Q138. Why are you claiming travel expenses? Please tick one box. To arrange the funeral / To go to the funeral
Options: To arrange the funeral; To go to the funeral
About money available or due to pay for the funeral
Q139. Is there any money available or due to you or a member of your family to pay for the funeral?
Options: No; Yes
About money available or due to pay for the funeral
Q140. Is someone else sorting out the financial affairs of the person who has died?
Options: No; Yes
About money available or due to pay for the funeral
Q141. Is there any cash belonging to the person who has died?
Options: No; Yes
About money available or due to pay for the funeral
Q142. Is there any money in accounts at date of death?
Options: No; Yes
About money available or due to pay for the funeral
Q143. Is there any money in an ISA?
Options: No; Yes
About money available or due to pay for the funeral
Q144. Is there any money from date insurance policies?
Options: No; Yes
About money available or due to pay for the funeral
Q145. Is there any money from an occupational pension scheme?
Options: No; Yes
About money available or due to pay for the funeral
Q146. Is there any money from a burial club?
Options: No; Yes
About money available or due to pay for the funeral
Q147. Is there any money from a prepaid funeral plan?
Options: No; Yes
About money available or due to pay for the funeral
Q148. Is there any money from a prepaid funeral plan?
Options: No; Yes
About money available or due to pay for the funeral
Q149. Is there any money from a prepaid funeral plan?
Options: No; Yes
About money available or due to pay for the funeral
Q150. Is there any other money available to pay for the funeral?
Options: No; Yes
About money available or due to pay for the funeral
Q151. Has anyone claimed a War Pension Funeral Grant for the person who has died?
Options: No; Yes
Making payment
Q152. Have you already paid the funeral bill? What date was it paid?
Options: No; Yes
Making payment
Q153. How much was paid? Did you pay the full funeral bill?
Options: No; Yes
Making payment
Q154. If you paid the funeral bill in part, who else paid part of the bill?
Making payment
Q155. How was the bill paid?
How we pay you
Q156. What to do now • Tell us about the account you want to use By giving us your account details you: - agree that we will pay you into an account, and - understand what we have told you above • If you are going to open an account, please tell us your account details as soon as you get them. • If you do not have an account, and do not intend to open one, please tick the box and we will contact you.
About the account you want to use
Q157. Name of the account holder Please tell us the name of the account holder exactly as it is shown on the chequebook or statement.
Other information
Q158. Please use this space to tell us anything else you think we might need to know. If there is not enough space, please use a separate sheet of paper. Make sure that you put your full name and NI number on each separate sheet of paper you use.
For people filling in and signing this form for someone else
Q159. Please tell us why you are filling in and signing this form for someone else I am sending a letter signed by the claimant with this form. The letter tells you that they agree to me making the claim for them. / I am their appointee / I have power of attorney
For people filling in and signing this form for someone else
Q160. Your address Postcode A phone number we can contact you on, if you have one Your full name Your date of birth DD/MM/YYYY
For people filling in and signing this form for someone else
Q161. Declaration I agree that the information I have given is complete and correct. If I give wrong or incomplete information, or I do not report changes straight away, I may: • be prosecuted • need to pay a financial penalty • be paid too much Funeral Expenses Payment and have to pay back any money that I am not entitled to
For people filling in and signing this form for someone else
Q162. If you pay me less than you should, you may pay me the money that you owe me. I understand that if I have provided a signed contract or funeral bill, I must let the department know straight away if any later changes are made to this contract. The contract is the signed agreement between you and the funeral director.
For people filling in and signing this form for someone else
Q163. Your signature Date DD/MM/YYYY
What to do now
Q164. What to do now Please check that you have done everything you need to and are sending all the documents we have asked for. Use the checklist below.
What to do now
Q165. • Have you answered all the questions that apply to you? • Have you signed and dated this form? • If you have the funeral director’s bill or the signed contract, have you sent it to us?
What to do now
Q166. We cannot accept estimated bills. If you do not have the final bill or signed contract yet, please send it to us as soon as possible. Make sure that the final bill or signed contract has your name, address and NI number written on it.
What to do now
Q167. • If the bill has already been paid, have you told us about the money you have used to pay the bill in question 141 of this form?
What to do now
Q168. • Have you sent any other bills or receipts you may have in connection with this claim? For example, for things like flowers.
What to do now
Q169. • If the person who has died had a prepaid funeral plan, have you sent the documents we have asked for in question 149 of this form?
What to do now
Q170. • If you have had to pay for any documents to release money of the person who has died, have you sent us the bill or receipt?
What to do now
Q171. What to do with this form and any documents we have asked for Send it by post to: Freepost DWP Funeral Payments Take it to: your local Jobcentre Plus.