Follow the steps to fill out the form accurately.

1. Click the ‘Get Form’ button to access the form online and open it in the document editor.
2. In Part I, complete the Policyholder’s Statement fully. Include all requested information such as policy number, policyholder name, and contact details.
3. In Part II, proceed to the Claimant’s Statement. This should be filled out in its entirety by the individual claiming benefits or their representative.
4. Detail the nature of the claim in the ‘Information About the Claim’ section. Specify benefits claimed and dates relevant to the trip or activity.
5. Attach required documents as outlined in the D section of both the Policyholder’s Statement and Claimant’s Statement. This may include travel itineraries, payment proofs, or incident reports.
6. Review the Important Notice section thoroughly before signing. Ensure you understand the implications related to state laws regarding fraudulent claims.
7. Finally, save any changes made to the form. You can download, print, or share the completed document as needed for submission.

Complete your documents online now for a more efficient claims process.