Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the annuity contract numbers in the provided field. You may use one form for multiple contracts unless different payment options are selected.
3. Fill in the 'Information about the deceased' section. Include the decedent’s full name, date of birth, date of death, and any known aliases. Additionally, provide the country where the death occurred and the decedent’s Social Security number.
4. Attach a certified death certificate that shows the cause and manner of death. If the death occurred outside the United States, include a U.S. Consular’s Report of the Death of an American Citizen.
5. In the 'Beneficiary Information' section, indicate your capacity for claiming the death benefit by marking the appropriate box. Depending on your role, additional forms may be required.
6. Provide beneficiary contact information, including their name, date of birth, Social Security or Tax Identification Number, phone number, and address.
7. Select a payment option in the 'Payment Options' section. Choose between lump sum or various payout options and complete the necessary fields according to the selection.
8. If relevant, complete the 'My Beneficiary(ies)' section by listing all beneficiaries, including their relationships to the deceased and percentage shares. Ensure the total percentages equal 100%.
9. If you are a foreign beneficiary or if applicable, fill out the related sections, providing any required forms, such as IRS Form W-8BEN.
10. Complete the tax withholding section by selecting whether you would like federal and/or state income tax withheld from your payments.
11. Review and sign the 'Certification of Taxpayer Identification Number' section to confirm the accuracy of the information provided.
12. Finally, sign and date the required signatures section. If necessary, have your signature notarized, and include documentation if signing on behalf of another party.
13. Once all sections are completed, save your changes, and prepare to submit the form online.

Complete and submit your DEFERRED ANNUITY CLAIM FORM online now to ensure a smooth processing of your claim.