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”
PLEASE NOTE:
Please check your annuity contract number before choosing a claim form from this page.Claim Forms
- 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)
