Dec-08 10:02 AM Prudential 973-548-5633 ‘he Prudential Insurance Company of G Prudential ee a PO Box 8517, Philadelphia, PA 19176 Tel (800) 524-0542 Fax (888) 227- 6764 December 08, 2011 Diane Hunter Insured: Thomas O, Prescott 402 Prescott Ave #9 Control Number: G-16000 Endicott, NY 13760-2168 : 11155459 Dear Diane Hunter: We were recently notified of the passing of Thomas O. Prescott, Our sincere condolences go out to the family and friends. According to our records, Thomas O. Prescott did not name a beneficiary for this insurance policy. Therefore, in accordance with the group contract, Prudential i obligated to pay the insurance proceeds to the fist of the following surviving heirs in this, order of preference: (1) surviving spouse; (2) surviving child(ren) in equal shares; (3) surviving parents in equal shares; (4) the estate, ‘We would like to make the processing of this claim as prompt and convenient for you as possible. In order to do s0, please provide us with the following information: * Original or certified copy (with a raised seal) of the Death Certificate for Thomes 0. Prescott Completed Preferential Beneficiary’s Statement (enclosed) Completed Beneficiary Statement (enclosed) When completing the enclosed Preferential Beneficiary's Statement, the individual completing it should include all persons within the highest surviving class of heirs, including him/herself, if applicable. If the estate (represented by an executor or administrator) is the highest surviving class, please provide us with a certified copy of the ‘court appointment and the estate’s Tax Identification Number. Bach person listed on the Preferential Beneficiary’s Statement must also complete a Beneficiary Statement. Each beneficiary is responsible for completing his/her own Beneficiary Statement and submitting it to Prudential. Enclosed is a self-addressed return envelope for your convenience, If another form is. required, it can be obtained from our website at www.prudential.com/giemployeeforms, or copies of the enclosed form can be made, We will give this claim our immediate attention upon receipt of all necessary documents.Please note that the Preferential Beneficiary’s Statement is not valid unless the last page is signed and returned to us. We appreciate the opportunity to serve you. If you have any questions or would like more information, please contact Customer Service at (800) 524-0542. If you are calling from outside the United States, you can dial us directly at (215) 784-2823. We are available Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern Time. Sincerely, Claims Coordinatorc-08 10:02 AM Prudential 973-548-5633 a S Prudential Group Insurance Please send the completed orm ta The Prudential Insurance Company ofA Group Life Claim Division re. oe tst? Preferential Beneficiary’s Statement Pistons PA 10178 Decoosed'a tine oie: Information fea a Sec utr ai jen Dal otro Preferential Boneficiary’s Statement What isa Preferential Beneficiary? ‘Atte tne ofthe decease passing, there was no ving. named beneficiary forte Group Life surance coverage issued though The Puiental Insurance Company of Americ. Therefore, beefs are payable tothe highest suing lass of hes ofthe decaased Insured based onthe following ada of preferance: 1. Banafs ae payable tothe spouse, it iving, 2. to gpuse was ving atthe tne of tha insureds passing, benef aro payable to all surviving children in cual shares, ttre is any ane suing hl, the entre benefits payable othe suring ci Legally adopted ciren re ype efile to receive benefits; however, stepcitren are typical not ei. Pease eer tothe plan documants for data 5.1 heres no surviving spouse er cilce, benefits ere payable in aque shares lo the insures suviving parents. only one parents surviving, the entre benef is payable othe suing paren, 41 her sno sunivng spouse cir, or parents the benoit wil be payable to the Estate of the insured Th ighast soning class fs, n accordance with he shove ode of preference, must follow the below nsrtons 1 receive ben efit proceeds tht may be payable under he Group Life Insurance poi, {Instructions for completing the referential Bonefciary’ Statement: ‘Stop 1: Complete and sign the attached Preferential Beneficiary Statement. ll orsoein tho highstsunivng cass of hs must be listed on this statement. Example I her was no suring Spouse, ut the insured was sunived by ‘roe cilren, ll three cidren must be liste onthe attached statement] ‘Step 2 Each parson sod on he Preferential Benefcian’ Statement mus iso complete @ Beneficiary Statement, ‘This frm can be obtained onine at ww prudential.com/giemployeeforms. Each bent is responsible {or completing ser own Benefiay Statment and submiting ito Prudential Step 3 Onca completed the following documentation should be submited direct to Prudential: |-A completed Preferential enefears Statement fisting all heirs in he highest sunving cass 2A completed Benatar Statement foreach her inthe highest surviving cass. 8A certified copy af the deat cart eee for the insored, (Prudential ony needs to receive one copy, isnot necessary fer each bonofciry ta submit copy) 4. the benefits payable to the insureds Estat, Estate papers must be submited cluding acetic copy af the eur order appointing te lgal epresotaie, 5. the hein the highest sunving cassis amino letters of quardian over the minors esata must be subnitad. Step 4 Retun el documents to Prudential at: ‘The Prodenti! insurance Company of America Group Life Ciim Dvsion PO, Box8517 Prileeloia,P& 19176, eee N00 itil 8 ST eRe .