CLAIMANT’S STATEMENT FOR ANNUITY PROCEEDS

estate, death, or inheritance tax that may be applicable or related to the Annuity Proceeds. Claimant’s Signature Date This Certification must be completed and signed by the listed Beneficiary of the Annuity identified above. If you do not provide your tax identification number, we are required to withhold 31% of the taxable amount distributed. ................
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