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ANNUITY DEATH NOTIFICATION FORM

We know that losing a loved one can be one of the most difficult times you'll ever face. That's why we've made it simple for you to file a claim.

Take these first steps

  • Complete the Online Notification of Death for an Annuity Claim below and click submit.

If you have any questions regarding your claim

  • Call us toll-free at 800-454-6265. Select option 4. Then select option 2.
  • We're here for you Monday through Thursday, 8:00 a.m. to 6:00 p.m. ET, and Friday, 8:00 a.m. to 5:30 p.m. ET.
Claim Form
(* Required Information)

Without the following information, we can only respond to the address of record for the policy number provided below.

Name*
Relationship to Insured
Street Address*
City*
State*
ZIP Code* (Must be 5 or 9 digits)
Daytime Phone Number*
Evening Phone Number
Email Address
How would you like for us to respond to you?*
Email Telephone U.S. Mail

Deceased's Personal Information

Name*
Street Address*
City*
State*
ZIP Code* (Must be 5 or 9 digits)
Policy Number(s)* (separated by commas)
Date of Birth
(mm/dd/yyyy)
Date of Death*
(mm/dd/yyyy)
Place of Death* (city/state)
Cause of Death

Additional Policies

Are you aware of any other policies or annuities that include the deceased — as owner, insured, annuitant or payer — that were issued by any of the following companies?

  • The Lincoln National Life Insurance Company
  • Lincoln Life & Annuity Company of New York
  • First Penn-Pacific Life Insurance Company
Yes    No

If YES, please provide details including policy, contract and account numbers.

Hello future.
Lincoln Financial Group is the marketing name for Lincoln National Corporation and insurance
company affiliates, including The Lincoln National Life Insurance Company, Fort Wayne, IN,
and in New York, Lincoln Life & Annuity Company of New York, Syracuse, NY. Variable products
distributed by broker/dealer-affiliate Lincoln Financial Distributors, Inc., Radnor, PA. Securities
and investment advisory services offered through other affiliates. Explore Lincoln.



LCN-876666-031114