MONY Annuities Customer Service |
Service Request Forms*
Claim for Death Benefits
Please accept our condolences on your loss. Because this is a difficult time, we want to assist the beneficiary by quickly processing the request. Depending on the specific contract's provisions, the benefits amount payable will be determined as of the date of death, or the date that due proof of death is received in our processing office.
- Beneficiary Guide
- Claim for Insurance Benefits
Form to be used in states of CO, FL, KS, MD, ND, NV, or NY - Claim for Insurance Benefits
Form to be used in all other states - Tax Withholding Elections Statement - Lump Sum
- Periodic Payment Plan Elections Forms:
* 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™ software at the following link: http://www.adobe.com/prodindex/acrobat/readstep.html.
Instructions for installation are also found at that location.
When you have completed and signed the form, please return it to the address indicated, or fax it to 315-477-4357. You may also request these forms be mailed to you by calling our toll-free number, 1-800-659-1058 and speaking to a Customer Service Representative.
If you need additional information, send us your request.
