Follow the steps to fill out the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the policyholder's name and policy number in the designated fields.
3. Provide the policyholder's address, including street, city, state, and zip code.
4. Fill in the phone number and social security number of the policyholder, followed by their date of birth.
5. If applicable, check the box indicating a new address.
6. Select whether the claim is for the insured, their spouse, or their child. If applicable, complete the additional fields for the spouse or child.
7. Enter the patient's name, their date of birth, their relationship to the policyholder, and the social security number.
8. Detail the condition being claimed and include the date the doctor was first consulted regarding this condition.
9. List the names, addresses, and phone numbers of the first and second doctors consulted.
10. If the patient was hospitalized, fill in the date admitted and date discharged, along with the name and phone number of the hospital.
11. Review the 'Authorization to Release Information' section, ensuring to sign and date where required.
12. Prepare additional documents, including a pathologist’s report and itemized statements of any hospital expenses.
13. Submit the completed form and all necessary documents to the Life Insurance Company of Alabama at the address provided.
14. Finally, save changes, download, print, or share the completed form as needed.

Complete your documents online today to ensure a smooth claim process.