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Death benefit nomination form template

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If you provide a life insurance/death in service benefit you can issue a Death Benefit Nomination form for your employee to confirm who they want to be considered to receive any lump sum benefit. This could be a family member, a friend, a charity, a business or any other organisation.

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What is a Death benefit nomination form?

An Employee Death Benefit Nomination Form is a legal document used by an employee to specify who should receive any death benefits payable from their employer's life insurance policy or pension plan in the event of their death.

Many employers offer life insurance and/or pension plans as part of their employee benefits package. These plans typically provide death benefits in the event of the employee's death. When an employee enrolls in these plans, they are usually required to designate one or more beneficiaries who will receive the death benefits in the event of their death.

The Employee Death Benefit Nomination Form allows the employee to specify or update their beneficiary designation as needed. This can be important if the employee's circumstances change, such as if they get married, have children, or get divorced.

Death benefit nomination form template
death benefit nomination form template

Death benefit nomination

In the event of my death, I would like my lump sum benefit to be paid to the following named beneficiaries, in the proportions shown:

Full name of beneficiary: Relationship: Percentage of benefit:

To the Trustees and Scheme Administrators

I understand that this request will be used as a guide for the Trustees when they exercise their discretion in line with the governing documents of the scheme. This form supersedes any other form completed before the date shown below.

Nominee name:  


Most employees nominate their spouse or partner as the main beneficiary. If you would like to detail how you wish the lump sum to be paid in the event of your joint deaths e.g. to your children or other family members, please provide details on a separate sheet.

You should always keep your Nominated Beneficiaries form up to date and it is your responsibility to notify the Trustees of any change to your circumstances by completing a new form.

On completion, please return this form in a sealed envelope (with your name printed on it) to the HR department, who will retain it with your HR file.

Version: [1.0]

Issue date: [date]


The Death benefit nomination form template is issued by an employee
Issue path
The Death benefit nomination form template is issued to an employer

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