Follow the steps to complete your Fortis Life Insurance form effectively.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering the employer's name and full address in the designated section. Ensure that this information is printed clearly for proper identification.
3. Next, provide the group policy number, the name of the administrator, their telephone number, email address, and fax number to establish communication.
4. An authorized signature from the policyholder with no financial interest in the claim is required. This individual must sign and date the form to certify the truthfulness of the information provided.
5. Move on to the employee eligibility section. Fill in the insured's full name, certificate number, date of birth, date of death, and social security number.
6. Document the legal residence of the insured at the time of death, including street address, city, state, and zip code.
7. Complete the employee information section by providing the hire date, date insurance became effective, job title, hours worked per week, and the last day worked.
8. Indicate the reason for the last day worked such as illness, layoff, retired, disabled, or leave of absence.
9. Record the base salary as of the last working day, date of last increase, and due date of the last premium paid.
10. In the type and amount of claim section, specify the amount for employee life, accidental death, dependent life, and accidental dismemberment, distinguishing between basic and contributory amounts.
11. Review the completed form thoroughly to ensure all information is accurate and complete. Missing details may delay processing of the claim.
12. Once all sections are filled out, save changes, and choose to download, print, or share the form as necessary.

Complete your Fortis Life Insurance claim form online now to ensure a timely processing.