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  • Claimant's Statement For Death Benefit - Cuna Mutual ...

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CLAIMANT?S STATEMENT FOR DEATH BENEFIT (Life Insurance Contract) Administrative Office PO Box 61 ? Waverly, IA 50677-0061 Phone: 800.779.5433 All Sections Must Be Completed ? Please Print or Type.

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How to fill out the claimant's statement for death benefit - CUNA Mutual online

Filling out the claimant's statement for a death benefit can seem overwhelming, but this guide will provide you with a clear and supportive approach. By following these steps, you can complete the form accurately and submit it with confidence.

Follow the steps to conveniently complete your form online

  1. Press the ‘Get Form’ button to access the claimant's statement for death benefit form.
  2. In Section 1, provide the required information about the deceased. This includes their full name, any other names they may have used (e.g., maiden name or nickname), their resident address, policy number(s), date of death, city, state, zip code, social security number, and date of birth.
  3. Proceed to Section 2 to fill in details about the beneficiary. Enter the beneficiary's name, indicate if they are not a U.S. citizen, and provide their mailing address along with the resident address if it differs. Include the beneficiary's phone number, date of birth, and social security number. If applicable, specify their relation to the insured or indicate if the beneficiary is a trust or estate by listing the taxpayer ID number.
  4. Complete the certification statement, ensuring that you check the appropriate boxes regarding backup withholding requirements. Note that if notified by the IRS about backup withholding, you must cross out the second item.
  5. In Section 3, select your preferred settlement option. You can choose between lump sum, periodic installments, or the interest option. Depending on your selection, complete any additional information required, such as the contract number.
  6. If you opt for electronic funds transfer (EFT), complete Section 4 by providing your financial institution's information, account owner's name, checking account number, city/state, and routing/transit number. Remember to attach a void check to validate the account information.
  7. After reviewing all sections for accuracy, save your changes, then download, print, or share the filled form as needed.

Complete your documents online today to ensure a smooth submission process.

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The term “claimant” means any individual applying for, or submitting a claim for, any benefit under the laws administered by the Secretary.

claimant. noun. claim·​ant ˈklā-mənt. : a person who claims to have a right to something.

A claimant is someone who requests payment from an insurer for covered losses. An insurance claimant could be the named insured – in other words, the person or business that is listed on an insurance policy's declarations page.

For example, when one of your employees gets hurt on the job, that employee becomes a claimant under your workers' compensation policy. Additionally, if one of your employees rear-ends another vehicle while driving your company car, the owner of that vehicle might seek payment for the damage your employee caused.

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