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Get Completed Preference Beneficiarys Affidavit Dearborn National Form

800) 778-2281 Fax: (312) 540-4706 Group Policy Number IF MORE SPACE IS NEEDED ATTACH A SIGNED AND DATED SHEET IN THE SAME FORMAT SHOWN BELOW Name of Deceased Claim Number Note: This affidavit is to be used whenever no beneficiary was designated or no designated beneficiary survived the deceased. It is to be completed only by the person or one of the persons within the first surviving class of the following classes of successive preference beneficiaries of the deceased: 1) widow or widower; 2.

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