Survivor Benefits Application
when there is a loss
Download the Form
To receive Survivor Benefits, fill out the application and either print and mail it back, or upload the form and all related documents using our secure Message Center. Everything you need to get started is included in the application, and you must fully complete each section to avoid a delay. It is very important that you provide us with timely notice of the member's death along with the completed Survivor Benefits application. Any retroactive benefit payments that you would otherwise be eligible to receive are limited to the 12-month period prior to the date the Fund receives written notification.
Download the Survivor Benefits Application
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1
Survivor Benefits Application
You must attach/include copies (not originals) of all appropriate documents including:
- Copy of the member's death certificate
- Copy of your birth certificate
- Copy of your marriage certificate
Be sure to sign and date the application to avoid any delay with your benefit.
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2
Send Us the Form
Be sure to return the entire completed application.
Message Center
The fastest way to send in your application is through the secure Message Center. Registered users can log in to upload forms and attach all required documentation. If your form requires a signature, you must print, sign, and then upload the signed page.Mail:
Central States, Southeast and Southwest Areas Pension Fund
PO Box 5109
Des Plaines, IL 60017-5109Fax:
847-518-9752
Need Help?
Contact one of our Benefits Specialists for more information on Survivor Benefits.
Contact Us