Equitable Life Insurance forms

Life insurance claims are paid after the Company ensures:

• You are the true beneficiary
• The policy is current and in force
• That all conditions of the policy have been met

Important Notice: Your plan may qualify for Express Processing with no additional forms required if filing a claim for $10,000 or less.

Required Documents

When filing a claim, these documents are necessary:

• Completed Death Claim Form 
  (Required for all beneficiaries listed on the policy) 
• Original life insurance policy, if available
• Certified copy of death certificate

• Any additional claim form that is required for the payment option you have selected
  (see additional documents below)

Additional Documents

Not all options are available to all beneficiaries.  Depending on your personal situation, these additional documents may be necessary:

• Special Payment Plan Form
  Available when requesting an Interest, Installment Payments or Life Income Options settlement
• Family Status Statement Form
  Available if the policy covers more than the deceased person (i.e. children’s term rider, additional insured rider)
• Release of Interest in Claims Proceeds by Beneficiary Form
  Available if disclaiming proceeds. (Please Note: Proceeds will then be payable according to policy provisions)
• Statement of Surviving Children Form 
  Available if beneficiaries of the policy are the children of the insured, but are not named in the beneficiary provision
• Certification of Foreign Status of Beneficial Owner for United States Form (W8-BEN)
  Available if you are a foreign national. This form is non-applicable for permanent residents
• Affidavit for Payment w/o Administration Form
  Available when the deceased's estate is not being probated
• Certificate of appointments (copy)
  If you are filing as the executor, administrator or guardian
• Copy of Trust excerpts
  title, appointment and signature pages and any amendment naming the successor trustee
• Beneficiary Guide 
  To assist with important decisions after the loss of a loved one
• Authorization to Release Information
  Available if the death occurs within two years of policy issue 

Return all documents to:

Regular Mail

Equitable 
PO Box 1047
Charlotte, NC 28201-1047

Express Mail

Equitable
National Operations Center
8501 IBM Drive, Suite 150
Charlotte, NC 28262

FAX - Forms Only

(855) 268-6373

You may also request these forms be mailed to you by calling:

• Our toll-free number (800) 777-6510, Monday through Thursday 8:30 AM - 7:00 PM, Friday 8:30 AM - 5:30 PM
• The policyholder’s financial professional 

These forms are Portable Document Format (PDF) files. If your browser is not yet capable of reading PDF files, you can download the free Adobe^® Acrobat Reader^tm software at the following link: http://www.adobe.com/prodindex/acrobat/readstep.html. Instructions for installation are also found at that location.