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	Statement of Claimant – Non Spousal

	Use If the Plan Member has died and the beneficiary is not the Member’s spouse, the beneficiary should use the Statement of Claimant – Non Spousal Benefit to advise the Plan Administrator of the Member’s death and request the lump sum pay–out of the Member’s pension funds.

	Information Needed to Complete the Form The Member's and beneficiary's personal information is needed to complete the form. The original death certificate (or a notarized copy) must be submitted with this form.

	Notes If the beneficiary is the Member’s spouse, the Statement of Claimant – Spousal Benefit form should be use instead of this form. If the beneficiary is the Member’s estate, the Statement of Claimant – Estate form should be use instead of this form. Questions on completing the form should be directed to the Plan Administrator. Completed forms should be forwarded to the Plan Administrator.

	Plan Administrator Heat and Frost Local Union 118 Pension Plan Administrator c/o D.A. Townley & Associates Ltd. 101 – 4190 Lougheed Highway Burnaby, BC V5C 6A8 Phone: 604-299-7482 or 1-800-663-1356 Fax: 604-299-8136 Email: Pension

Form Link

pensionplan