Get Trustmark A112-2502 2019-2025

Filling out the Trustmark A112-2502 form online can be a straightforward process if you follow the right steps. This guide provides a comprehensive overview of each section, ensuring that you can complete your claim accurately and effectively.

Follow the steps to efficiently fill out your claim form online.

1. Click ‘Get Form’ button to obtain the Trustmark A112-2502 form and open it in your preferred online editor.
2. Begin with the Statement of Beneficiary section. Fill in the policy or certificate number, full name, date of birth, and residence address of the deceased person. Make sure to clearly indicate the beneficiary’s full name, social security number, and their relationship to the deceased.
3. Provide the date and place of death, along with the cause of death. Indicate whether the deceased was confined to a hospital at the time of death and answer any relevant questions regarding the physicians who attended to the deceased in the five years prior to death.
4. Complete the section on any medications prescribed within the last five years. Detail the frequency of tobacco use over the past three years as well.
5. If applicable, indicate the optional settlement type you prefer for the payment of the policy benefits.
6. Proceed to fill out the Disclosure Authorization section by providing the necessary authorizations to obtain medical and insurance information related to the claim.
7. If required, complete the Attending Physician Statement section. This should be filled out by the deceased's primary care physician and includes details about the cause of death and prior conditions.
8. Review all completed sections for clarity and accuracy. Ensure you have included any necessary supporting documentation, such as certified copies of the death certificate and medical records.
9. Once you have filled in all required fields and attached necessary documents, you can save changes, download the form, print it, or share it as needed.

Start your process of filling out the Trustmark A112-2502 online today.