Statement of Claimant – Non Spousal
If the Plan Member has died and the beneficiary is a person other than the Member’s spouse, the beneficiary should use the Statement of Claimant – Non Spousal Benefit 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 – Non Spousal Benefit 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 beneficiary’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 the Member’s estate, the Statement of Claimant – Estate 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.
