Get Claim Form Gl5 S

Filling out the Claim Form Gl5 S online can seem daunting, but it is a straightforward process. This guide offers step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete your Claim Form Gl5 S successfully.

1. Press the ‘Get Form’ button to access the Claim Form Gl5 S and open it in the online editor.
2. Begin by providing the employee's name and employer information in the designated fields.
3. Enter the employee's date of birth and the effective date of their coverage in the appropriate sections.
4. Fill in the employee's address and phone numbers, including both home and work numbers, as well as their email address.
5. Input the name of the deceased and their date of birth in the specified fields.
6. Indicate your relationship to the employee and the deceased's effective date of coverage.
7. State the death benefit amount being claimed and the date of death.
8. Provide the cause of death in the relevant section.
9. Certify the facts by entering the signature of the employee or beneficiary along with the date.
10. List the beneficiaries' names and ages, and indicate their share of the death benefit along with their full street addresses.
11. If there are additional beneficiaries, use a separate sheet to list them.
12. For the employer/policyholder section, enter the premiums paid up to the date of claim and the death benefit available for the claimant.
13. Finalize the form by ensuring all information is accurate and complete, then save your changes.
14. You may choose to download, print, or share the completed form as necessary.

Complete your Claim Form Gl5 S online today and ensure your claim is processed smoothly.