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Click ‘Get Form’ to open the cl06540 form in the editor.
Begin by entering the Policy Number at the top of the form. This is essential for identifying your claim.
Fill in the Deceased’s Information section, including their name, address, date of birth, and Social Security number. Ensure accuracy as this information is crucial for processing.
In the Claimant Information section, provide your details such as name, address, and relationship to the deceased. This helps establish your eligibility as a claimant.
Select your preferred Payment Option from the choices provided. Each option has specific requirements; read them carefully to ensure you select correctly.
Complete the Automatic Withdrawal Service Information if applicable. Specify how much you wish to withdraw and when payments should begin.
Finally, review all sections for completeness and accuracy before signing at the end of the form. Your signature certifies that all information is correct.
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