ANNUITY CLAIM FORMS

The claim forms listed on this page can only be used with the following annuity contracts:

• All Western United Life Assurance Company annuity contracts, and
• Manhattan Life Insurance Company annuity contract numbers beginning with “ML”

• Annuity Claimant’s Statement

  Beneficiary request to elect a payment option upon the inheritance of an annuity contract. Also print State Tax Withholding Instructions to determine if state taxes are required to be withheld.

• Annuity Claimant’s Statement for Established Periodic Payments

  Beneficiary request to continue established periodic payments. Also print State Tax Withholding Instructions to determine if state taxes are required to be withheld.

• Beneficiary Annuity Contract Change Request

  To be used only by Spouse Beneficiary to endorse a contract. Also print Beneficiary Substitute IRS W-4P and W9 form.

• Beneficiary Substitute IRS W-4P and W9

  To be used by Spouse Beneficiary to endorse a contract, or other Beneficiary to change existing withholding instructions. Also print State Tax Withholding Instructions to determine if state taxes are required to be withheld.

• State Tax Withholding Instructions

  Guide for determining state tax withholding.

• Trust Information; Trustee Certification Indemnification Agreement

  To be completed when a trust applies for an annuity, changes trustees/ownership, or makes a claim for a death benefit as a beneficiary.

• IRS W-8BEN

  Complete, sign and return as applicable. Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals)