Application for Survivor`s Pension - Pensionskasse für die Deutsche

Page 1 / 4 of Application for “Survivor’s Pension”
Pensionskasse für die
Deutsche Wirtschaft VVaG
Sender:
Pensionskasse
für die Deutsche Wirtschaft
VVaG Postfach 10 10 54
47010 Duisburg
Membership number
Surname, First name
Street, Number
Postcode, Town/City
Tel. no. for queries
Email for queries
Application for Survivor’s Pension
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Pension for widows, widowers and registered civil partners,
as well as surviving under-age children
I hereby apply for my survivor’s pension from PKDW
Please transfer my pension to the following account
IBAN
Swift-BIC
Bank
My health insurance provider is
Name of Health Insurance Provider
Postcode, Town/City
Insurance Number
My Tax ID Number is
My Pension Insurance Number is
11 Digit Tax ID Number
See Notice of Pension Entitlement / Social Security ID
Pensionskasse für die Deutsche Wirtschaft VVaG, Am Burgacker 37, 47051 Duisburg, Tel 0203 99219-0, Fax 0203 99219-38, www.pkdw.de
Page 2 / 4 of Application for “Survivor’s Pension”
Membership number
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I have enclosed the death certificate
The death certificate has been submitted by the mortician
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I have enclosed a certificate of marriage or civil partnership
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I hereby confirm that I do not have any children
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I have enclosed a copy of one full form birth certificate for my child
(Because persons without children have to pay higher nursing care insurance premiums, the pension fund requires proof of
parenthood, e.g. child’s birth certificate. It does not matter whether the child is already of adult age or still lives under parental
care. Please mark X to confirm that you have no children or enclose proof of parenthood. Persons with private health insurance
arrange nursing care insurance with their health insurance fund, and may skip this point.)
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I have enclosed the original insurance certificate
PKDW already has the original insurance certificate
The original insurance certificate has been lost
My spouse had already submitted the original insurance certificate upon retirement
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The deceased person is survived by under-age children
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I have enclosed the birth certificates of all under-age children
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I have enclosed the pension insurance number of (request from health insurer if necessary) and Tax ID Number
(request from Tax Office if necessary) of each under-age child
Note: If no information is provided, the pension fund will assume that under-age children are insured by the same health
insurance fund as the surviving spouse or civil partner. The pension for surviving under-age children will also be transferred to
the same account as the surviving widow/widower/civil partner’s pension if no information is provided.
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The deceased person is survived by adult children who are over 18 but not yet 25
Note: Please submit a separate application for a pension for surviving children for each child (see overleaf).
I understand that my personal data relevant to the insurance relationship, as defined by the Federal Data Protection Act (BDSG)
will be stored.
Date, Signature
Pensionskasse für die Deutsche Wirtschaft VVaG, Am Burgacker 37, 47051 Duisburg, Tel 0203 99219-0, Fax 0203 99219-38, www.pkdw.de
Page 3 / 4 of Application for “Survivor’s Pension”
Pensionskasse für die
Deutsche Wirtschaft VVaG
Sender::
Pensionskasse
für die Deutsche Wirtschaft
VVaG Postfach 10 10 54
47010 Duisburg
Membership number
Surname, First name
Street, Number
Postcode, Town/City
Tel. no. for queries
Email for queries

Pension for surviving children under the age of 25
I hereby apply for my pension for surviving children from PKDW
Please transfer my pension to the following account
IBAN
Swift-BIC
Bank
My health insurance provider is
Name of Health Insurance Provider
Postcode, Town/City
Insurance Number
My Tax ID Number is
My Pension Insurance Number is
11 Digit Tax ID Number
See Notice of Pension Entitlement / Social Security ID
Pensionskasse für die Deutsche Wirtschaft VVaG, Am Burgacker 37, 47051 Duisburg, Tel 0203 99219-0, Fax 0203 99219-38, www.pkdw.de
Page 4 / 4 of Application for “Survivor’s Pension”
Membership number
 I have enclosed a copy of my full form birth certificate
 I have enclosed a copy of the Notice of Pension Entitlements for the “Pension for Surviving Children”
under statutory pension insurance
For insurance taken out after 01/01/2007 (= Membership No. > 100,000), additionally:
 I have enclosed a certificate of enrolment in school/training or education
I understand that my personal data relevant to the insurance relationship, as defined by the Federal Data Protection Act (BDSG)
will be stored.
Date, Signature
Pensionskasse für die Deutsche Wirtschaft VVaG, Am Burgacker 37, 47051 Duisburg, Tel 0203 99219-0, Fax 0203 99219-38, www.pkdw.de