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While we have tried to make our Claims Form as simple as possible, here are some tips that might avoid confusion and delay when completing the form:


Complete one claim form per beneficiary. The one form may be used for multiple policies.   Only one certified death certificate per deceased is required.
Pages 1 to 5
  

        Must all be completed.

Page 1
  • Note the Mailing & Courier addresses for you to mail your completed form and other claim requirements.  These addresses are also available on Claims Overview
  • Complete all of Section D, especially Trustees and Companies
Page 3 - Section H
  • If an individual is the beneficiary, provide the individual Social Security Number
  • If an estate, trust, corporation etc is the beneficiary, provide the Tax Identification Number
Page 5
  • Read the general fraud warning statement or the state-specific one if it applies to you and sign on Page 5. 
  • Have a third-party sign as a witness. 
Page 6

 

  •  Must be completed only if:
     1) the insured died within the contestable period (within the first two years of
         the policy issue date) OR
     2) the insured's death was accidental and the policy contains an accidental
        death rider.   
Signatures

 

Provide your signature on pages 3, 5 (and 6 if it is a contestable claim).

   If you have questions or require further information, call our Customer Service Center at
   1-800-387-2747 and ask to speak with a Claims Analyst.
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