Notice Regarding Hardship Request - Standard Life Of Indiana printable pdf download

NOTICE REGARDING HARDSHIP REQUEST

FOR EXEMPTION FROM MORATORIUM

We understand that certain policy owners may face financial hardships as a result of the

moratorium that the receivership order placed upon cash surrenders and partial withdrawals,

under Standard Life Insurance Company of Indiana (“Standard Life”) policies or contracts. The

Court has granted the Special Deputy Rehabilitator (the “Rehabilitator”) authority to consider

hardship payment requests. To request a hardship payment, you must complete and return the

“Hardship Request Form.” For the purpose of hardship requests, this form will replace the

customary forms that Standard Life previously used for cash disbursement requests.

To qualify for hardship payment consideration, you must include the following:

Notarized or Sworn Statement of Facts that the Annuitant, Owner, or someone with a

Power of Attorney acting for the Owner or Annuitant has completed, made under the

penalties of perjury. This Statement of Facts should outline the circumstances that

support your claim of hardship and should accompany the information sent to our office.

The hardship request will not be processed unless the Statement of Facts is notarized.

If you deliver the enclosed information by facsimile, then the Company must receive an

identical, signed, and notarized original before final approval may be granted. Please be

as specific as possible, as the more information you give to the Rehabilitator, the easier

it will be to process your request;

Proof or Evidence Supporting the Statement of Facts – This would include, as

applicable, bills, notices, doctor’s statements, or Power of Attorney, Guardianship or

Conservator paperwork;

Authorization for Hardship Withdrawal Form; and/or

Annuitization Form.

By providing you with this information and these forms, we are not indicating whether the

Rehabilitator will approve your hardship request. The Rehabilitator will review each request on

its own merits.

Upon receipt of your completed hardship documents, the Rehabilitator will review them and

reserves the right to request such additional information and documentation, as he deems

appropriate.

You must cooperate with the Rehabilitator by providing all such requested

documentation and information or your request will be denied.

If you have any questions, please contact Standard Life Insurance Company of Indiana by

writing or calling us, as noted on this letter. Thank you in advance for your attention to these

matters.

Sincerely yours,

Randolph Lamberjack

Special Deputy Rehabilitator

10689 N Pennsylvania Indianapolis, IN 46280 (800) 222-3216

Notice Regarding Hardship Request - Standard Life Of Indiana