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Insurance and Annuities

Insurance and Annuities (continued) Other Government sources My Family will be eligible for those benefits, which are checked and described below: Railroad Retirement Civil Service Active military of veterans’ service-connected death Veterans’ non-service-connected death Benefits because of my employment by state of local government_________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ My V.A. Claim number is:_________________________________________________ Records and documents needed to apply for benefits are located at__________________ _______________________________________________________________________ Membership organizations Because of my membership in various organizations (union, trade associations, fraternal benefit society, etc.), my survivors may be eligible for certain benefits. The organizations and benefits are as follows: Organization Type of Benefit _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ The papers needed to apply for such benefits are located at _______________________________________________________________________ _______________________________________________________________________ 16

Insurance and Annuities (continued) Health Insurance Our health insurance policies (hospitalization, disability income, accident, long-term care, etc Medicare Supplement) are as follows: Insured Insurance Co. Policy No. Type of Insurance Phone _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Annuities We have the following annuities: Insurance Co. Policy No. Annuitant Beneficiary _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Property/casualty insurance We have the following typed of insurance (homeowners, automobile, personal liability, business coverages, fire, vehicle, and disability etc.): Insurance Co. Policy No. Type of Insurance Phone _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Policies for all insurance converges and annuities are located______________________ 17

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