Comprehensive General Structures Checklist
To ensure a smooth application process and secure your annuity policy or contract, please review the checklist below. This list outlines the information and documents that may be required as part of your structured settlement planning.
Traditional Settlement Structures
Full Name of Claimant(s) (the person who will receive the annuity payments)
Proof of Date of Birth of Claimant(s)
Social Security Number of Claimant(s)
Current Mailing Address of Claimant’s Parent or Court Appointed Guardian
Current Phone Number of Claimant’s Parent or Court Appointed Guardian
Current Email Address of Claimant’s Parent or Court Appointed Guardian
Name of Claimant(s) Parent(s) or Court Appointed Guardian/Representative
Brief Description of Claimant(s) Injury (Ex. Broken leg, spinal fractures from automobile accident)
Name of Attorney Handling Personal Injury Claim
Name of the Personal Representative of the Estate (if applicable)
Name of the Defendant and or Insurer
Copy of the Demand or Complaint
Copy of the Draft Release
Copy of the Draft Petition and Order Approving Settlement
Copy of Mediation Agreement
Copy of Trust (if applicable)
Copy of the Release with Terms of Settlement or Settlement Agreement
Copy of the Qualified Assignment
Copy of the Beneficiary Designation
Medicare Set-Aside Allocation Report (if applicable)
Centers for Medicare and Medicaid Services (CMS) Decision (if applicable)
Attorney Fee Structure
Completed W9
Completed W4-P
Hold Harmless Agreement