Beneficiary Resource Center |
Forms: MONY/MLOA Annuity
Annuity claims are paid after the Company ensures:
- You are the true beneficiary
- The contract is current and in force
- That all conditions of the contract have been met
Required Documents
When filing a claim, these documents are necessary:
- Claim to MONY Life Insurance or Annuity Benefits Form
For CO, FL, KS, MD, ND, NV, or NY states (Required for all beneficiaries listed on the contract) - Claim to MONY Life Insurance or Annuity Benefits Form
For all other states (Required for all beneficiaries listed on the contract) - Original annuity contract, 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:
- Specified Income Options Form
To request claim proceeds as an income for a specified period or specified amount - Life/Income Options Form
To request claim proceeds as a life income - Interest Options
To request claim proceeds in an interest bearing contract - IRA Spousal Election Form
When a spouse is continuing the existing contract or receives the proceeds of an IRA contract - Assignment of Benefits Form
To assign all or part of claim proceeds to another party - Statement as to Children Form
To be completed if the beneficiaries are the children of the insured, but not named in the beneficiary provision and/or if the policy covers more than the deceased person (i.e. children’s term rider, additional insured rider, etc.) - Tax Withholding Elections Statement - Lump Sum Form
Completed if a specified income option or life income option is elected - Tax Withholding Elections Statement- Special Payment Form (W-4P)
Completed if a specified income option or life income option is elected - Certificate of appointments: if you are filing as executor, administrator or guardian
- Copy of Trust Excerpts: title, appointment and signature pages and any amendment naming the successor trustee(s)
- Beneficiary Guide
To assist with important decisions after the loss of a loved one
Return all documents to:
Regular Mail:
MONY, an AXA Financial Company
PO Box 4830
Syracuse, NY 13221
Express Mail:
MONY, an AXA Financial Company
100 Madison Street
Syracuse, NY 13202
FAX:
(315) 477-4357
You may also request these forms be mailed to you by calling:
- Our toll-free number, (800) 659-1058, Monday through Friday, 8:00 AM to 5:00 PM (Eastern)
- The contractholder’s Financial Professional
If you need assistance at any time, we recommend that you check with your Financial Professional, Talk To An AXA Advisors, LLC Financial Professional or contact the customer service area applicable to your situation.
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.
