Central States Pension Fund
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Death Notification

Use this form to report the passing of a member, spouse, or beneficiary. Please provide the following details about the deceased individual.


Once you have completed all the fields, click "Submit" at the bottom of the form.

Decedent’s Information

Please enter the full name, date of death, and additional details about the deceased person below if available. Fields marked with * are required.

Reporter’s Information

Please provide your name and contact information so we can follow up if needed. Select your relationship to the deceased individual, such as a spouse, child, parent, sibling, etc. If none of the options apply, you can select "Other."