Filing a Claim with PFSA

1. Contact the PFSA Office.
2. Office must confirm beneficiary/ies’s information.
3. Request a Claimant’s Statement.
4. Claimant’s Statement: This statement must be completed and signed by the beneficiary or at least one of the beneficiaries. If there are multiple beneficiaries, claimant must provide the information required for all beneficiaries.
5. Death Certificate: PFSA requires a Certified Death Certificate. A certified copy has a raised seal, will show the signature of the State Registrar, and will be printed on security paper. 
6. Policy: The original or duplicate policy issued by PFSA must be surrendered, or the appropriate box must be checked as to a lost or destroyed policy on the front side of form. Partial contracts will not be accepted.
7. Name Change: If any of the beneficiary/ies have a name change (other than as listed on the contract), a copy of the court document must be submitted, or a copy of a marriage certificate.
8. Minor Beneficiary (under the age of 15 years old): The Claimant Statement must be completed and signed by the parent or the legally appointed guardian of the minor. A Birth Certificate or an official certificate of guardian’s appointment must be submitted.

 ADDITIONAL INSTRUCTIONS & INFORMATION

 Predeceased Beneficiary: If the beneficiary (ies) has predeceased the insured the following documents must be submitted:

1. A copy of their death certificate.
2. A copy of will/trust

Trust/Estate Beneficiary: A copy of the certification of the trust must be submitted.

Legal Heir/s:  A notarized affidavit/statement noting the legal heir/s must be submitted.

Incomplete forms will not be accepted. Upon reviewing the documents submitted, the claim will be processed within 30 days of receiving all required documents. PFSA may request additional information or documents.

Completed and signed documents must be mailed to:

PFSA at 1100 14^th Street, Suite E, Modesto, CA 95354

If you have any questions, please contact our office at 1.866-.687.7372 Monday-Friday from 8:30-5:00 P.M.  Our office is closed during lunch from 12:30-1:30 P.M.

1. Contact the PFSA Office.
2. Office must confirm Insured/Owner’s information.
3. Request a Cash Surrender form.
4. Cash Surrender: This statement must be completed and signed by the insured.
5. Policy: The original or duplicate policy issued by PFSA must be surrendered, or the appropriate box must be checked as to a lost or destroyed policy on the front side of form.
6. Name Change: A copy of the court document must be submitted, or a marriage certificate.
7. Minor Insured under the age of 15 years old: The Claim must be completed and singed by the legally appointed guardian of the minor and an official certificate of guardian’s appointment must be submitted.

Incomplete forms will not be accepted. The claim will be processed within 30 days of receiving all required documents. PFSA may request additional information or forms.

 Completed and signed documents must be mailed to:

PFSA at 1100 14^th Street, Suite E, Modesto, CA 95354

If you have any questions, please contact our office at 866-687-7372 Monday-Friday from 8:30-5:00 P.M.  Our office is closed during lunch from 12:30-1:30 P.M.

1. Contact the PFSA Office.
2. Office must confirm policy owner’s information.
3. Sign Annuity Withdrawal Request form.
4. Submit a signed and completed IRS Form W-4P form.
5. Submit a copy of your current Photo ID.

Incomplete forms will not be accepted.  The claim will be processed within 30 days of receiving all required documents. PFSA may request additional information or forms.

Completed and signed documents must be mailed to:

PFSA at 1100 14^th Street, Suite E, Modesto, CA 95354

If you have any questions, please contact our office at 866-687-7372 Monday-Friday from 8:30-5:00 P.M.  Our office is closed during lunch from 12:30-1:30 P.M.