Get 18002639120

Completing the 18002639120 form is an essential step in the claims process with CUMIS Life Insurance Company. This guide will provide you with clear instructions and support to ensure a smooth online completion of the form.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to download the form and open it in the editor.
2. Begin by filling in the name of the deceased in full in the specified field.
3. Next, provide the residence address of the deceased, including the street, city, province, and postal code.
4. Enter the date of death in the designated area and specify the immediate cause of death.
5. Indicate when the deceased first consulted a physician regarding their last illness.
6. Fill in the CUMIS policy or certificate number(s) under which you are claiming.
7. Provide the date of birth of the deceased and their occupation in the relevant sections.
8. List the name and address of the current family doctor, along with previous family doctor details if applicable.
9. Enter the name of any specialist involved in the deceased's care, including their address.
10. In this section, indicate your capacity or title in making the claim, your date of birth, and your Social Insurance Number.
11. Certify the form by signing and dating it at the bottom, ensuring that all information is accurate and complete.
12. Complete the authorization for the release of medical and employment information by stating the relevant details and signing as a witness.
13. Finally, review all entered information for accuracy, then choose to save changes, download, print, or share the completed form.

Complete your documents online now for a smoother claims process.