Death claim application 2026

1. Click ‘Get Form’ to open the death claim application in the editor.
2. Begin by filling out the MEMBER'S INFORMATION section. Enter the member's name, Social Security number, date of birth, and date of death. Ensure all information is printed in capital letters using black ink.
3. Indicate the TYPE OF CLAIM by selecting either 'Social Security' or 'Employees’ Compensation'.
4. Complete the EMPLOYMENT HISTORY section. List the name of the employer, period of employment, and address. If necessary, use a separate sheet for additional details.
5. In the DEPENDENT CHILDREN section, provide names and dates of birth for any eligible children. Check whether they are legitimate or illegitimate.
6. Fill out the CLAIMANT'S INFORMATION with your details including name, SS number (if applicable), address, date of birth, gender, relationship to member, and contact information.
7. Select your preferred mode of payment from options like Cash Card or ATM/Passbook.
8. Review all entries for accuracy before saving your completed form. Attach any required documents as specified in the instructions.

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