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Click ‘Get Form’ to open it in the editor.
Begin by entering the policy numbers in Section 1. If multiple policies are involved, complete a separate claim form for each.
In Section 2, provide detailed information about the deceased, including their name, date of birth, and date of death. Ensure accuracy as this information is crucial for processing.
Fill out Section 3 with your beneficiary information. Include your relationship to the deceased and contact details such as phone number and email address.
Choose your claim option in Section 4. Depending on your preference, select from options like Lump Sum Payment or Spousal Continuance and complete any additional required sections.
Complete the Income Tax Certification in Section 5 to indicate your tax withholding preferences.
Review all entered information for accuracy before signing in Section 9. Your signature confirms that all details are correct.
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