Beneficiary Statement for a Death Claim

This Beneficiary Statement form is for the beneficiary to complete and return to MN Life upon the death of the employee.

MN Life Benefit Statement Form

Administrator FormsConversion to Adjustable Life LegendIf any portion of your Minnesota Life group coverage terminates (because your employment or membership in a class eligible for insurance terminates or the master group contract terminates or is amended), you may be able to continue your life insurance protection. Your right to do this is called a conversion privilege, and its features are described here for you.Minnesota Life Notice of DeathNotice of Death Claim Form for Minnesota LifeEmployee Group Insurance Change RequestThis form is used for updating a beneficiary designation, submitting a name change, or recording a change in dependent status.Beneficiary Statement for a Death ClaimThis Beneficiary Statement form is for the beneficiary to complete and return to MN Life upon the death of the employee.

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