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Protective Life Insurance Company1 Life and Annuity Division West Coast Life Insurance Company1 VARIABLE Annuity Claimant s Statement Post Office Box 1928 / Birmingham AL 35201-1928 Toll Free 800-456-6330 / Fax 205-268-6479 ANNUITY CLAIMANT S STATEMENT MUST BE SUBMITTED WITH ORIGINAL CERTIFIED DEATH CERTIFICATE 1. Please select one SecurePay SecurePay R72 may not be available in all states Continue to page 4 for signature. IRS W-9 form instructions can be used for clarification in completing...
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