Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to acquire the form and open it for completion.
2. Begin by filling in the certificate/claim/policy number at the top of the form. Ensure this number is accurate as it is crucial for processing your claim.
3. In the section labeled Payment of Claims Authorization, declare your status by selecting whether you are a US Citizen, Resident Alien, or Non-Resident Alien. Print your name and provide your signature.
4. Complete the Claimant's Statement (Part 1) by entering the name of the deceased insured and provide their date of birth and date of death. Include your relationship to the deceased and details of their surviving spouse or partner, if applicable.
5. List all children of the deceased, including stepchildren and adopted children. Use the comment section if you need additional space for this information.
6. If the policy is within the contestable period (less than two years), fill out the relevant policies that the deceased held with the insurance company and any others with different companies.
7. Detail when the deceased first exhibited symptoms of their last illness and when they first consulted a physician, along with the physician's name and address.
8. In Part 3, indicate how you would like the payment to be made, choosing from lump sum or other specified options. If you prefer direct deposit, provide your banking details.
9. Complete Part 4 by deciding on the withholding elections for Federal and State income tax, if applicable. Consult a tax advisor for guidance on these selections.
10. Sign and date the Authorization to Release Confidential Medical Information section, allowing the insurers to obtain necessary medical information related to the claim.
11. Review the form for any potential mistakes and ensure all required fields are completed before finalizing.
12. Once you have completed the form, you can save your changes, download a copy for your records, and print the form for submission.

Complete your life insurance claim form online today to streamline the process.