409 claimant statement form 2026

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4.9 out of 5

412 votes

The document is an Annuity Claimant Statement from Western National Life Insurance Company, designed for beneficiaries to claim proceeds from a deceased annuitant's policy. It includes sections for personal information of the deceased and claimant, options for payment, tax withholding elections, and instructions for completing the form. The document emphasizes the importance of providing accurate information and includes a fraud warning disclosure. Additionally, it outlines specific requirements based on different beneficiary scenarios.

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Click ‘Get Form’ to open the 409 claimant statement in the editor.
Begin by entering the full name of the deceased annuitant and owner, if applicable. Ensure accuracy as this information is crucial for processing your claim.
In the capacity section, specify your relationship to the deceased and provide your date of birth, Social Security number, and address. This helps verify your identity as a claimant.
Select your desired manner of payment. Options include lump sum or spousal continuation. Make sure to read any additional notes regarding minimum distributions.
Complete the withholding elections section by indicating whether you want federal and state taxes withheld from your distribution.
Finally, sign and date the form. Remember that notarization is required for validation before submission.

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