Application for a State Pension statement

Part 1 - About you

National Insurance (NI) number
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Date of birth
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Title
  • - Please choose -
  • Mr
  • Mrs
  • Miss
  • Ms
  • Other
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First Name
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Surname
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Other Surnames
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Full address including postcode or zipcode
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Correspondence address
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Have you ever worked or paid National Insurance in the Isle of Man?
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Part 2 - Marital status

Please tick the description that applies to you and give exact dates as DD/MM/YYYY.
Marital Status
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Date of marriage
If you converted or changed your civil partnership into a marriage, or married your civil partner, enter the date your marriage is treated as starting on.
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Date of formation of civil partnership
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Date of marriage
If you converted or changed your civil partnership into a marriage, or married your civil partner, enter the date your marriage is treated as starting on.
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Date of divorce
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Date of formation of civil partnership
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Date of dissolution
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Date you were married
If you converted or changed your civil partnership into a marriage, or married your civil partner, enter the date your marriage was treated as starting on.
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Date you were widowed
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Date of formation of civil partnership
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Date your civil partner died
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Part 3 - Contact details

If we need to contact you before we send you your State Pension statement, how would you prefer us to get in touch with you?
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Home phone number
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Daytime phone number, if different
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What is this number?
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If you live in Wales, we can send you your State Pension statement in English or Welsh. Which language do you prefer?
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We can send you your State Pension statement in braille or large print.
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Part 4 - Living outside the United Kingdom

We use United Kingdom (UK) to mean England, Scotland, Wales and Northern Ireland. If you are currently living in the UK please go to Part 5. If you are currently living outside the UK, please tell us:
Do you currently live outside the UK?
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Your last two UK addresses, including postcodes

The date you left the UK
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Address 1
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Address 2
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Part 5 - What to do now

Please tick the box that applies to you. If you tick both boxes, we will only send the State Pension statement to you.
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Please note that:

  • This authorisation relates only to enquiries made to the Newcastle Pension Centre, Futures Group and

  • l we can only provide information to your representative for the period that your State Pension statement is held on our computer records If you request another State Pension statement in the future, you would need to provide further authorisation for us to provide or discuss that statement with your representative.


I am a Personal Acting Body.
A Personal Acting Body is a named person appointed to look after all or some aspects of a customer’s affairs.
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Part 6 - Your representative

Please give details of your representative. If you are a Personal Acting Body, please give your name and address.
Title
  • - please choose -
  • Mr
  • Mrs
  • Miss
  • Ms
  • Other
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Surname or family name
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Organisation’s name
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Full address including postcode or zip code
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Daytime phone number
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Fax number
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Reference number
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Submit