Az claim benefits 2025

1. Click ‘Get Form’ to open the az claim benefits document in the editor.
2. Begin by checking the appropriate box for your relationship to the deceased, such as spouse, parents, or dependent children.
3. Fill in the information regarding the deceased, including their name, date of birth, and address. Ensure you provide accurate details about their employer and cause of death.
4. For spousal benefits, enter your full name, address, and marriage details. If applicable, include certified copies of your marriage certificate and any divorce decrees.
5. List all dependent children along with their birth dates and relationships to the deceased. Indicate which children are currently in your care.
6. Complete any additional sections for other dependents if necessary, detailing their relationship and extent of dependency.
7. Finally, sign the form on behalf of the dependent and provide a contact telephone number before submitting it to the Industrial Commission offices.

Start filling out your az claim benefits form online for free today!