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Untitled - Semantic Scholar

Untitled - Semantic Scholar 2026

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The document is a Statement of Claim for Death Benefits from Foresters Financial, providing instructions and a checklist for claimants to submit necessary information and documentation following the death of a loved one. It emphasizes the importance of completing all sections accurately to ensure prompt processing of claims, outlines required documents such as death certificates, and includes legal warnings regarding fraudulent claims.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out SECTION 1: DECEDENT INFORMATION. Enter the decedent's full name, any other names used, address, date of birth, date of death, place of birth, cause of death, and state of residence prior to death. If applicable, provide details if the death was due to an accident, suicide, or homicide.
Proceed to SECTION 2: CLAIMANT’S STATEMENT AND CERTIFICATE NUMBER(S) BEING CLAIMED. List the certificate numbers for which you are making a claim and provide your personal information including name, relationship to the deceased, date of birth, Social Security/Tax I.D. number, address, telephone number, and email address.
Review all entries for accuracy and completeness. Ensure that you sign and date the form where required. If there are multiple claimants, make sure each completes a separate statement.

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