Death Claims
Remember to complete any applicable Employer's section(s) before distributing forms to beneficiaries.
| Form | Form Number |
|---|---|
48903f (117214) | |
45198k (115813) | |
40302m (115446) | |
Form W-9 (10/07) | |
Form W-9 (SP) (7/08) | |
142020 (05/19/09) |
When you provide the claim form to the beneficiary(ies) to sign, you must also provide settlement options information and an IRS Form W-9 to EACH beneficiary. Each beneficiary must return a signed W-9 form. If a Trust is named as the beneficiary, the Trust Verification form must be completed by the trustee of the trust.
| Settlement Options Information | Form Number |
|---|---|
Settlement Options Brochure for each beneficiary who will receive $5,000 or more unless the group policy was issued in Alaska or if the beneficiary resides in Alaska, Colorado, Kansas, Nevada, North Carolina or North Dakota. | 151973 (7/10) |
Settlement Options Summary for each beneficiary who will receive less than $5,000. Also for all beneficiaries regardless of benefit amount if the group policy was issued in Alaska or if the beneficiary resides in Alaska, Colorado, Kansas, Nevada, North Carolina or North Dakota. | 124886 (rev 3/07) |
Employee Benefits insurance products and services in the U.S. are provided by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the ING family of companies. Product availability and specific provisions may vary by state. Each insurer is solely responsible for the financial obligations under the policies or contracts it issues.
