pension
plan


	Statement of Claimant – Estate

	Use If the Plan Member has died and the beneficiary is the Member's estate, the executor of the estate should use the Statement of Claimant – Estate form to advise the Plan Administrator of the Member's death and request the lump sum pay–out of the Member's pension funds.

	Information Needed to Complete the Form The Member's and executor's personal information is needed to complete the form. The original death certificate (or a notarized copy) must be submitted with this form.

	Notes If the beneficiary is the Member's spouse, the Statement of Claimant – Spousal Benefit form should be use instead of this form. If the beneficiary is a person other than the Member's spouse, the Statement of Claimant – Non Spousal form should be use instead of this form. Questions on completing the form should be directed to the Plan Administrator. Completed forms should be forwarded to the Plan Administrator.

	Plan Administrator D.A. Townley & Associates Ltd. 101 – 4190 Lougheed Highway Burnaby, BC V5C 6A8 Phone: 604-299-7482 or 1-800-663-1356 Fax: 604-299-8136 Email: Pension

Form Link

pensionplan