Annuity Claim Forms and Frequently Asked Questions

The Genworth Financial family of companies services life insurance contracts sold by multiple companies. To ensure that you fill out the correct form, please choose the name listed at the top of the policy/contract from the list below. If the name of the company is not listed, please call the claims department at 888.325.5433.

Annuity Claim Forms

  Annuity claim form for the following companies:

  • American Mayflower Life Insurance Company
  • Federal Home Life Insurance Company
  • First Colony Life Insurance Company
  • Genworth Life and Annuity Insurance
  • Genworth Life Insurance
  • General Electric Capital Assurance
  • The Life Company of Virginia
  • The Harvest Life Company
  • GE Capital Life Assurance Company of New York
  • Genworth Life Insurance Company of New York

Annuity claim form for the following company:

  • Union Fidelity Life Insurance Company

Annuity Frequently Asked Questions

Q. Who is the “Claimant”?
A claimant is the person or entity claiming death proceeds under a contract. Each beneficiary must complete a separate annuity claim form.

Q. After I complete the annuity claim form, can I fax it to you?
Yes, you may fax the completed and signed claim form to 434.948.5783. Please note that an original certified death certificate may be required, which may not be accepted by fax.

Q. May I copy this annuity claim form for other claimants’ use?
Yes. You may copy the blank form to provide to other beneficiaries.

Q. What is “capacity”?
Capacity is the legal authority that entitles you to claim proceeds. If you are claiming on your own behalf, you are an “individual claimant” and should indicate your capacity as Individual. Do not use any other “title” unless you are actually claiming in that capacity. See the Special claimant information and signing in capacity instructions section for details.

Q. If I make a mistake, how do I change information on the Claimant’s Statement?
Put a line through an incorrect answer and insert the correct information. DO NOT use correction fluid. The claimant must initial all corrections.

Q. What makes it a certified death certificate?
Certified death certificates have either a raised seal or a multicolored signature seal from the county, city or state that issued the certificate. In addition, the original death certificate should contain the signature of an appropriate officer of the county, city or state.

Q. Will you accept a certified death certificate with a pending death cause?
No. We must have a certified death certificate with a final cause of death.

Q. Are there any special requirements if the Insured died in a foreign country, i.e., outside the United States or its territories?
We require an original certified death certificate, and, if appropriate, a Death of an American Citizen Abroad document. A Death of an American Citizen Abroad document is not an acceptable substitute for an original certified death certificate. In addition, we may require a cancelled passport, a copy of airline tickets, funeral/cremation bills, remains transport information/bills, or any other information we deem necessary based on the specific circumstances of your claim. To avoid delays, you should contact us immediately for detailed instructions.

Q. If the primary beneficiary is deceased, is a copy of the certified death certificate acceptable for the deceased primary beneficiary?
Yes. We will accept a copy of the certified death certificate for any deceased beneficiary.

Q. Will you accept a copy of the original contract?
No. We require the complete original contract, if available. You may make a copy of the original contract for your records.

Q. What if the original contract is lost or otherwise unavailable?
Simply complete and sign the annuity claim form. By signing the annuity claim form, you are declaring that all original contracts and any duplicates and certificates are lost or otherwise unavailable unless sent in with the annuity claim form.

Q. What claimant information for a trust do I include on the Claimant’s Statement?
You need to indicate the name of the trust under “Claimant’s Name.” The trust name should include the date of the trust. For “Claimant’s Address,” indicate a trustee’s address where the death proceeds should be delivered.

Q. If there are multiple trustees, how many need to sign the Claimant’s Statement?
Each current trustee must sign the Claimant’s Statement in his/her capacity as Co-Trustee, unless the Trust document confers on one trustee the authority to act alone.

Q. Why do we require a trust to provide a Tax Identification Number (TIN)?
A person who is not an individual is required by federal income tax regulations to furnish a TIN to a payor of income. Thus, a trust must submit its TIN. Some trusts are grantor trusts under federal income tax law. The trustee of the grantor trust may provide the social security number of a living grantor (a person treated as the owner of the trust under federal income tax law) instead of the trust’s TIN. In the typical case in which there is a single grantor of the grantor trust and that grantor has died, the trustee must furnish the trust’s TIN, not the social security number of the grantor/trustee.

Q. If the beneficiary’s name has changed since the last beneficiary designation, what do I provide to validate the name change?
If a beneficiary’s name has changed because of marriage or divorce, we require a copy of the marriage certificate or divorce decree. If the beneficiary’s name has changed because of personal preference, we will require a court document indicating the name change from the birth name to the requested name.

Q. If I am signing as the Power of Attorney for the claimant, what do I need to send in as proof?
Submit a copy of the executed Power of Attorney (POA) papers which give you the power to collect proceeds. You must sign the annuity claim form and indicate your capacity as “Attorney-in-fact” for the Beneficiary.” Example of a proper signature: Jane Doe by John W. Doe, Attorney-in-fact under POA dated MM/DD/YYYY.

Q. Can the death claim proceeds from the contract be assigned to a funeral home?
Yes. All designated beneficiaries must complete an appropriate assignment form provided by the funeral home and that form must be submitted to us prior to the payment of the claim along with an annuity claim form for each beneficiary.


206401E2C 08/30/17