Fillable Va Form 29-4125a - Claim For Monthly Payments National Service Life Insurance (Page 2 of 2) in pdf

INSTRUCTIONS FOR SELECTION OF OPTIONAL SETTLEMENT

1. OPTION 1- LUMP SUM SETTLEMENT is not available when the insured selected a monthly installment option. HOWEVER, if

the insured left a will or there is other evidence, in writing, that the insured desired that the beneficiary receive a lump sum, the

beneficiary may submit a copy of such consideration. When submitting also sign Item 16 of this form and return it along with

the additional evidence. It is not necessary to complete the entire form.

2. If insured selected an option, the beneficiary may abide by the insured's selection or may request settlement in installments.

A. If insured selected Option 1 (Lump Sum Settlement), beneficiary may select Option 1, 2, 3 or 4 or may request part

payment under Option 1 and remainder under one of the other options.

B. If insured selected Option 2, beneficiary may request settlement split between two variations of Option 2.

C. If insured selected Option 2, with monthly installments in excess of 120, beneficiary may select to receive payment in a

greater number of installments under Option 2, or may elect to receive payment under Option 3 or 4 or may request

settlement split between Option 2, as herein limited, and Option 3 or 4.

D. If insured selected Option 2, with monthly installments not in excess of 120, beneficiary may select a greater number of

installments under Option 2 or may select Option 4, provided number of installments guaranteed under Option 4 is greater

than number of installments selected by insured under Option 2 or may request settlement split between Option 2 and 4,

as herein limited.

E. If insured has selected Option 3, beneficiary may select Option 4.

F. If insured has selected Option 4, and named no contingent beneficiary, beneficiary may select Option 3.

G. If beneficiary selects two methods of payment the amount payable under at least one of them must be in multiples of

$1000 and all monthly installments under such selection must be at least $10. (See instruction 5)

3. Settlement under Option 4 is not authorized when payments would be made in a shorter period than 120 months.

4. Option 3 and 4 shall not be available if the beneficiary is a firm, corporation, legal entity or trustee. Settlement to an estate is

authorized only in one sum.

5. If option selected requires payment of installments of less than $10, the amount payable shall be paid under Option 2 in such

maximum number of installments as are a multiple of 12 as will provide a monthly installment of not less than $10. If present

value at time any person initially becomes entitled to payment thereof is not sufficient to pay at least twelve monthly

installments of not less than $10 each, such amount shall be payable in one sum.

6. If the insured selected Option 1 and the beneficiary has elected payment under Option 2, 3 or 4 and dies before receiving all

installments due, the commuted (cash) value of the remaining unpaid installments guaranteed will be paid to the ESTATE OF

THE BENEFICIARY. If the insured designated Option 2, 3 or 4 and all beneficiaries die before receiving all installments due, the

commuted value of the remaining installments guaranteed will be paid to the ESTATE OF THE INSURED.

SUBMIT THE COMPLETED FORM TO:

DEPARTMENT OF VETERANS AFFAIRS

REGIONAL OFFICE AND INSURANCE CENTER

P.O. BOX 7208

PHILADELPHIA, PA 19101

PRIVACY ACT NOTICE: No proceeds may be paid unless a completed claim form has been received (38 U.S.C. 1917). The information

provided on a voluntary basis will be used by VA employees and your authorized representatives in the maintenance of Government

Insurance programs. Responses may be disclosed outside the VA only if the disclosure is authorized under the Privacy Act, including the

routine uses identified in the VA system of records, 36VA00, Veterans and Armed Forces Personnel U.S. Government Life Insurance

Records - VA, published in the Federal Register.

RESPONDENT BURDEN: VA may not conduct or sponsor, and respondent is not required to respond to this collection of information

unless it displays a valid OMB Control Number. Public reporting burden for this collection of information is estimated to average 6

minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data

needed, and completing and reviewing the collection of information. If you have comments regarding this burden estimate or any other

aspect of this collection of information, call 1-800-827-1000 for mailing information on where to send your comments.

VA FORM 29-4125a, NOV 2010

Va Form 29-4125a - Claim For Monthly Payments National Service Life Insurance Page 2

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