See the D.A. Townley COVID-19 Update

Pension Plan Forms —

Statement of Claimant – Estate

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.

Since Statement of Claimant – Estate form is specific to each Pension Plan, please contact the Plan Administrator for a copy of your form.

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.

Completed forms should be forwarded to the Plan Administrator.

Questions on completing the form should be directed to the Plan Administrator.

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