Next of Kin Declaration Form Declaration - Our Tesco


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Next of Kin Declaration Form This form should be used for a request by a next of kin of a deceased colleague for payment of outstanding wages up to £5,000 where there is no formal grant of probate or letters of administration.

Declaration I being the next of kin of who was a colleague of Tesco, confirm I am entitled to payment of any outstanding sums representing wages, salary, accrued holiday, bonus, or other forms of remuneration. In acceptance of this payment, I take full responsibility for any future claims to said monies.

I declare that: 1. They did not leave a will.* 2. They did leave a will in my favour, but there will be a delay in processing the probate application.* *delete 1 or 2, whichever does not apply 3. To the best of my information, knowledge and belief, the above statements are true.

Signature of the next of kin:

________________________________

Date:

________________________________

Signature of witness (not a relative):

________________________________

Date:

________________________________

Printed Name of witness*:

________________________________

Address of witness:

________________________________ ________________________________ ________________________________ ________________________________

* The witness must have known the next of kin for at least two years but cannot be a close relative or live at the same address.

Bank account details Name of bank: Name of account: Sort Code: Account Code: