About the form

This form is for the Estate of a deceased person who was a member of the Scottish Infected Blood Support Scheme (SIBSS) and passed away after 1st April 2017.

This form allows the Estate of the deceased beneficiary to apply for the Bereavement Lump Sum payment that is available via the scheme. Where the beneficiary died after 1st April 2019 (but before backdated payments were paid in summer 2021), if this form is accepted SIBSS will also confirm if the estate is due additional backdated regular annual payments due to the increases in annual payments agreed (if the estate applies for this by 31 March 2022, you may be eligible for additional top-up annual payments to cover the period from April 2019 until the beneficiary died so please contact us as soon as possible if you think you may be eligible).

Please note that if you are a widow, widower, civil partner or long-term cohabiting partner who was living with the deceased person when the deceased person when they died then you should not need to submit an application. If you are already registered with SIBSS, they will automatically arrange this payment for you. However, please contact SIBSS if you have any queries.

If your circumstances differ to the above, please contact the Scottish Infected Blood Support Scheme for guidance.

How to apply

This form must be completed by a person who is an Executor of the Estate of a deceased person, on behalf of all the Executors where there is more than one. You should complete all sections of this form. You should then return the completed form, along with all requested supporting documents direct to:

Supporting documents required

Please provide the following documents to support your application:

• A copy of photographic identification for yourself, for example: Driving Licence; Passport; National Entitlement Card for concessionary travel
• A copy of the Death Certificate for the deceased beneficiary
• Evidence to show you are the Executor, or acting on behalf of the Executor(s)
• A copy of a recent bank statement for the account you would like the payment made to

If you are sending us a printed internet bank statement or bill, please ensure it contains your address and the print must also include the HTTP address on the page.

What happens next

The Scottish Infected Blood Support Scheme will review the application and the supporting documents you have provided. If any additional details are required, the scheme will contact you to ask for these. Provided that the information supplied confirms you are eligible to receive payment, you will receive a letter from the scheme to confirm this.

Help with this form

If you require any assistance in completing this form, please contact the Scottish Infected Blood Support Scheme on 0131 275 6754.

Documents

£10,000 bereavement lump sum claim form