start-claim

First, tell us about you.

SECURE ONLINE CLAIMS

Which choice best describes you?*

* Required

Beneficiary's relationship to the deceased*

First Name*

Last Name*

Email Address*

Confirm Email Address*

Primary Phone Number

Date you were notified*

Social Security Number*

Address*

City*

State*

Zip*

Would you like to receive beneficiary claim form(s)?

Claims kit delivery method?

Yes, please email
Yes, please send by U.S. Postal

No, not needed

Address*

City*

State*

Zip*

Now tell us about the deceased.

First Name*

Last Name*

Date of Death*

Social Security Number*

Policy/Contract Number

Cause of Death

Funeral Home Name

City

State

— Now tell us about beneficiary
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Beneficiary's relationship to the deceased*

First Name*

Last Name*

Email Address*

Confirm Email Address*

Primary Phone Number

Social Security Number*

Address*

City*

State*

Zip*

First, tell us about you.

Now tell us about the deceased.

— Now tell us about beneficiary
#1

Would you like to add beneficiary information?

Would you like to add information about an additional beneficiary?

First, tell us about you.

Now tell us about the deceased.

— Now tell us about beneficiary #1

Would you like to add beneficiary information?

Would you like to add information about an additional beneficiary?

Questions?

Call us

— Now tell us about beneficiary
#1