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

Download Application 

  • 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.

  • 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.

    Central States, Southeast and Southwest Areas Pension Fund
    PO Box 5109
    Des Plaines, IL 60017-5109


Need Help?

Contact one of our Benefits Specialists for more information on Survivor Benefits.

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