Fort dearborn life insurance company death claim form 2026

1. Click ‘Get Form’ to open the Fort Dearborn Life Insurance Company Death Claim Form in the editor.
2. Begin with Part 1, which must be completed by the Employer/Administrator. Fill in the Group Name, Group Number, and address details accurately.
3. Provide information about the deceased employee, including their name, Social Security number, date of birth, and date of death. Ensure all fields are filled out completely.
4. In Part 2, beneficiaries should enter their personal details such as name, date of birth, and relationship to the deceased. If there are multiple beneficiaries, each must complete a separate form.
5. Review all sections for accuracy before submitting. Attach required documents like the death certificate and payroll records as specified in the instructions.

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