Claim Form Life Insurance Plan Yes No - Fidelity Life 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Statement of Claimant' section. Enter the policy number and complete the decedent information, including their name, residence at the time of death, date of birth, place of death, date of death, cause of death, and manner of death.
3. Next, provide your information as the beneficiary or claimant. Fill in your name, Social Security Number/Tax ID Number, residence details, date of birth, daytime telephone number, and your relationship to the deceased.
4. Indicate if you are subject to back-up withholding by checking 'Yes' or 'No'. Then select your capacity or title for claiming this insurance by checking one of the options provided.
5. If applicable, complete the 'Statement of Lost Policy' section. Confirm that you are unable to locate the original policy and agree to return it if found.
6. Choose your payment preference under 'Payment of Fund'. Select either a single sum payment or installment payments and specify the frequency.
7. Finally, sign and date the form. Ensure that all information is accurate before submitting.

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