Report a death

• About the Insured/Annuitant
• About You
• Claim Packet

Insured/Annuitant's Information

First Name*

Last Name*

 

Date of birth*
MMDDYYYY

Date of death*
MMDDYYYY

 

AccidentalNaturalHomicideSuicideUnknownType of death*

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of ColumbiaState of residence at time of death*

 

Where did the death occur?*

Inside of the United States

Outside of the United States

What country did the insured/annuitant pass away?

 

To speed up the claim process, enter any of the optional information below.

Providing this information can help us verify the claim faster.

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SingleMarriedDivorcedMarital status at time of death

Social Security Number

Policy/Contract Number

 

About You

First Name*

Last Name*

Are you the beneficiary?*

Yes

No

I don't know

Relationship to the Insured/Annuitant*

Social Security Number

 

Street Address*

City*

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingWashington DCState*

Zip Code*

Phone Number*

Email Address*

A claim packet, including forms needed to process this claim, will be sent to the person indicated below.

These forms will list the beneficiary of record and summarize requirements necessary to process the claim. All documents should be completed and returned to MassMutual to complete claim processing.

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Do you want the claim packet sent to you as the individual reporting the claim?*

Yes

No

Who would you like the claim packet sent to?

First Name

Last Name

Relationship to the Insured/Annuitant

 

Street Address

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingWashington DCState

ZIP Code

 

EmailMailFaxHow would you like the claim packet sent?

EmailMailFaxHow would you like the claim packet sent

Email Address

Fax

Fax

Next: About You