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Get Equitable National Opperations Center

Have no reason to believe that you are otherwise disqualified. Are you the sole beneficiary? Yes No Are you a U.S. Person? Yes No (If no, W-8 BEN form is also required). Yes Please indicate if form IRS 712 is needed for the estate tax return: No Your Name as Beneficiary (First, Middle Initial, Last) OR Corporation, Trust or Estate Name, if applicable Street Address (if mailing address is a PO Box also supply a street address). City State Zip Code Your Date of Birth (mm/dd/y.

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