Qualified Claimant's Statement 2025

1. Click ‘Get Form’ to open the Qualified Claimant's Statement in our editor.
2. Begin by entering the Deceased’s Information, including the Claim Number, Contract Number(s), and personal details such as First Name, Last Name, and Date of Death.
3. Next, fill in your Claimant Information. Provide your name, relationship to the decedent, and contact details. Ensure you select your gender and citizenship status accurately.
4. Select your preferred Payment Method from the options provided. Make sure to read each option carefully to understand any additional requirements.
5. Complete the Tax Withholding section by choosing whether to apply federal and state income tax withholding based on your preferences.
6. In the Election of Beneficiary Section, designate primary and contingent beneficiaries with their respective details and percentages.
7. Authorize transactions if desired by checking the appropriate box. Review all information for accuracy before proceeding.
8. Finally, certify and sign the statement at the end of the form. Ensure that all required fields are completed before submission.

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