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    Contract Continuation Acknowledgment: SECTION 1: Current Information

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    brocodebyminds
    This document outlines the process and requirements for a beneficiary to continue receiving annuity payments after the death of the original contract owner. The beneficiary must acknowledge that the contract ownership remains with the deceased, payments will be based on the beneficiary's life expectancy, and a beneficiary designation form must be completed. The beneficiary also provides identification information and certifies their tax status.

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    © All Rights Reserved
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    Contract Continuation Acknowledgment: SECTION 1: Current Information

    Uploaded by

    brocodebyminds
    142 views2 pages
    This document outlines the process and requirements for a beneficiary to continue receiving annuity payments after the death of the original contract owner. The beneficiary must acknowledge that the contract ownership remains with the deceased, payments will be based on the beneficiary's life expectancy, and a beneficiary designation form must be completed. The beneficiary also provides identification information and certifies their tax status.

    Original Title

    L-25479-B

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    This document outlines the process and requirements for a beneficiary to continue receiving annuity payments after the death of the original contract owner. The beneficiary must acknowledge that the contract ownership remains with the deceased, payments will be based on the beneficiary's life expectancy, and a beneficiary designation form must be completed. The beneficiary also provides identification information and certifies their tax status.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    142 views2 pages

    Contract Continuation Acknowledgment: SECTION 1: Current Information

    Uploaded by

    brocodebyminds
    This document outlines the process and requirements for a beneficiary to continue receiving annuity payments after the death of the original contract owner. The beneficiary must acknowledge that the contract ownership remains with the deceased, payments will be based on the beneficiary's life expectancy, and a beneficiary designation form must be completed. The beneficiary also provides identification information and certifies their tax status.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Annuities

    Contract Continuation Acknowledgment

    Brighthouse Life Insurance Company


    (“Brighthouse Financial”)

    SECTION 1: Current Information


    Owner/Deceased Name
    First Name Middle Name Last Name

    Contract Number

    Beneficiary
    First Name Middle Name Last Name

    Address City State ZIP

    Social Security Number Date of Birth

    SECTION 2: Acknowledgments and Signature


    I wish to continue the above contract as an option receiving death claim proceeds. I acknowledge the
    following:

    • The ownership of this contract must remain in the name of the deceased (prior contract owner) for
    the benefit of myself. Account statements and other correspondence will reflect this designation.
    This form of ownership is required to enable continuation of the contract under the IRS rules and
    regulations.
    • Payment amounts are required to be based on my life expectancy and must be taken no less than
    annually. Brighthouse Financial can make these payments as directed. I understand, however,
    that it remains my responsibility as the beneficiary to assure payments continue to be accurate.
    Payments can be accelerated at any time. No withdrawal or surrender charges will apply.
    • For variable products, I have received and read the most current prospectus and understand that
    there are fees and charges associated with this account. I understand that my account value may
    increase or decrease as with all variable investments.
    • I cannot not make additional payments into this account nor will loans be allowed.
    • I will need to complete a beneficiary designation form to assure payment of proceeds upon my
    death.

    FOR CALIFORNIA RESIDENTS ONLY: For your protection, California law requires the following to
    appear on this form: Any person who knowingly presents false or fraudulent information to obtain or
    amend insurance coverage or to make a claim for the payment of a loss is guilty of a crime and may be
    subject to fines and confinement in state prison.

    L-25479-B (03/23) Page 1 of 2


    U.S. Tax Certification
    Under penalties of perjury, I certify that:
    1. The number shown on this form is my correct taxpayer identification number; and
    2. I am not subject to backup withholding because: (a) I am exempt from backup withholding,
    or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to
    backup withholding as a result of a failure to report all interest and dividends, or (c) the IRS
    has notified me that I am no longer subject to backup withholding; and
    3. I am a U.S. citizen or other U.S. person; and
    4. The FATCA Code(s) entered on this form (if any) indicating that I am exempt from FATCA
    reporting is correct.
    Certification Instructions: You must cross out item 2 above if you have been notified by the IRS
    that you are currently subject to backup withholding because you have failed to report all interest or
    dividends on your tax return. “U.S. citizen” and “U.S. person” are as defined in IRS Form W-9. If
    you are not a U.S. citizen or a U.S. person for tax purposes, please cross out item 3 above and
    complete appropriate IRS documentation such as IRS Form W-8BEN. Item number 4, FATCA
    Code: N/A (No FATCA Code Applicable).
    The Internal Revenue Service does not require your consent to any provision of this document
    other than the certifications required to avoid backup withholding.

    I direct you to keep my death claim proceeds in the same funds as the original contract was invested in.
    My signature indicates I agree with all the statements listed above.

    Beneficiary Signature Date (mm/dd/yyyy)

    SECTION 3: Please submit this entire form.


    Fixed Annuities: Variable Annuities: Overnight Mail:
    Brighthouse Financial Brighthouse Financial Brighthouse Financial
    PO Box 4259 PO Box 4258 MSC: 049006-MR-1
    Clinton, IA 37230-4259 Clinton, IA 37230-4258 1315 19th Ave NW
    Clinton, IA 52732

    Fax: (877) 319-2495 Customer Service Center: (833) 208-3018

    L-25479-B (03/23) Page 2 of 2

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