Get Claimant Statement Death Claim Important: Please Read Carefully The Instructions At The Back Of

Completing the claimant statement for a death claim can be challenging during a difficult time. This guide provides clear, step-by-step instructions to help users fill out the form accurately and efficiently.

Follow the steps to successfully complete your claimant statement.

1. Locate the form by clicking the ‘Get Form’ button to open it in your preferred online editor.
2. Fill out the claimant's full name, including first name, middle name, and last name. If applicable, provide the maiden name of a married female claimant.
3. Complete the claimant's address with necessary details, such as house number, street, subdivision, town, city, and province.
4. Input a cellphone number where updates about your claim can be sent, and then enter your date of birth.
5. Indicate your relationship to the deceased, and list the policy numbers of the deceased for which you are a beneficiary.
6. Determine if the agent on record is authorized to pick up the check by selecting 'YES' or 'NO'.
7. Answer whether you are a US citizen; if 'YES', be prepared to submit a W-9 form.
8. Sign the form as the claimant, including the date and place of signing.
9. Have two witnesses sign the form, providing their printed names and signatures.
10. If applicable, fill out the certificate of authorization for the attending physician and provide the necessary information.
11. Ensure all parts of the form are completed and verify all information is accurate before submission.
12. Once the form is completed, save your changes, download, print, or share it as needed.

Complete your forms online today to ensure a smooth submission process.