Annuities in the accumulation phase pay beneficiaries the total amount contributed to the account. 10/19 Page 1 of 8 Use this form to request claim payment for an individual beneficiary (natural person) on an Athene deferred annuity contract. Note: For an individual beneficiary (natural person), use the Deferred Annuity Claim Form for Individual Beneficiaries 4 Elected Income and Guaranteed Life Income do not have cash or loan values and no withdrawals are permitted. ANN-DC-MPCG (11/13) Page 1 of 10 Fs • Please print all information in black or blue ink, and then sign and date on the signature page of this form. Nonqualified options Naming a beneficiary on an annuity can help lower probate expenses Annuities are contracts between an individual and an insurance company. John L. Olsen | October 25, 2013 | Annuity Beneficiaries, Annuity Taxes, Deferred Annuities, John L. Olsen, Member Posts. Please note that this flier does not apply to nonnatural ownership annuity claims and not all options are guaranteed with the underlying contract. Beneficiaries of a deferred annuity must have payments commence within one year of the date of death. • Please note: We reserve the right to request additional information we may deem necessary to settle the claim. Because this is Once the annuity is in the payout phase, the beneficiary subtracts payments already … • Election of Income Option for Beneficiaries Form Spouse • Beneficiary Claim Form How to claim your benefit 3 To claim your annuity benefit, you need to send us a death certificate that’s certified by the state department of health or a bureau of vital statistics. Athene deferred annuity contract. When filing a claim, these documents are necessary: Annuity contract, if available; Certified copy of death certificate; SPDA Claim to Annuity Benefits (Required for all beneficiaries listed on the contract) Any additional claim form that is required for the payment option you have selected (see additional documents below) Additional documents Annuity beneficiary claim This form is used to request death benefit proceeds when a contract Owner or Annuitant passes away. Athene deferred annuity contract. Complete pages 1-7 of this form in their entirety, including appropriate signatures and dates on page 7, and submit with a copy of the certified death certificate showing cause and manner of death. Download and print Nationwide forms for commercial agribusiness policies, personal property and auto policies, life insurance policies, mutual funds and more REQUIRED DOCUMENTS • Deferred Annuity Claim Form for Individual Beneficiaries (10034) • Complete and return pages 1-6. Sign and date page 6, using today’s date. Annuity claims Options-At-A-Glance 1829256 Page 1 of 2 Comparing annuity-claim qualified and nonqualified options will help you plan and prepare for your income needs.

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