Follow the steps to successfully complete your claim form.

1. Press the 'Get Form' button to obtain the form and access it for editing.
2. Begin by completing the Employee Statement section. Provide your personal information, including your last name, first name, date of birth, and social security number. Ensure you include your contact details, preferred communication method, and your language preference.
3. In the family information section, indicate your marital status, partner's name and date of birth, and confirm whether they are employed.
4. Next, provide information about your disability. Specify the nature of your disability (illness or injury), details about your medical condition, and any hospitalizations or surgeries related to it. Ensure that you fill in the dates accurately.
5. List all medical providers treating you. Include their names, contact information, and dates of visits. If necessary, you may attach additional sheets for multiple providers.
6. Disclose your preferences regarding income tax withholding. If applicable, specify if you would like federal and/or state income taxes withheld from your benefit checks.
7. Sign and date the Employee Authorization section to certify that your information is accurate and complete. This is essential for the processing of your claim.
8. Submit the form by faxing it to the designated number or mailing it to the provided address for Unum. You may also choose to share your authorization with any third parties you wish to involve in the process.
9. After submitting the form, you should save a copy for your records. Additionally, keep track of your claim status through any available online service options.

Complete your UNUM CL-1104 form online today for a smoother claims process.