You are: individual
The Claimant’s Statement must be completed by an administrator or executor of the estate.
If the claim amount is more than the Small Estate amount allowable by the state where the policy is issued, or if the estate has been (or will be) probated, we will require either Letters Testamentary or Letters of Administration issued by the court of jurisdiction.
If the claim amount is less than the Small Estate amount allowable by the beneficiary’s state and if the estate will not be probated, we will require either a Proof of Heirship Affidavit (form provided in the claims packet) or a Small Estate Affidavit (form provided by the state).
The Claimant’s Statement must be completed by the trustee(s).
The Certification of Trustee section on the Claimant’s Statement must be completed and the trust’s Tax Identification Number (TIN) must be provided. A copy of the trust is not required.
If there are multiple trustees, each current trustee must sign the Claimant’s Statement in his/her capacity as co-trustee, unless the trust document confers on one trustee the authority to act alone. In that case, please provide the trust pages that prove that authority.
Legal documentation must be submitted listing officers who are currently authorized to sign forms and other documents relating to the insurance contract on behalf of the entity.
Any of the following documentation is acceptable: corporate resolution / corporate secretarial certification; or a copy of the corporate by-laws or board minutes on company letterhead.
The Claimant’s Statement must be signed by one of the named authorized officers indicating his/her title.
If the amount due to the beneficiary is more than the allowable amount for that minor’s state of residence under the Uniform Transfers to Minors Act, the Claimant’s Statement must be signed by the guardian legally appointed to the minor by the state. Letters of Guardianship for the Estate of the minor must also be furnished.
If the amount due to the minor beneficiary is less than the allowable amount for the minor’s state of residence, the Claimant’s Statement must be signed by the Custodian of the minor. The Affidavit Concerning Custody of a Minor form should be completed in place of Letters of Guardianship.
Any one of the following is required:
- Copy of the marriage certificate
- Divorce decree
- Court document proving the name change
Both of the following are required:
- Copy of the divorce decree
- Property settlement agreement
Either of the following is required:
- Copy of the beneficiary’s death certificate
- Obituary
A statement of outstanding indebtedness on the policy, provided by the Assignee, is required.
If there is no indebtedness, a Release of Assignment statement is required.
Note: Either statement must be signed by a corporate officer, indicating his or her corporate title. Also, please provide a currently dated Corporate Resolution.
Both of the following are required:
- Copy of the assignment form (provided by the funeral home) with the amount assigned to pay for funeral services, signed by the beneficiary(ies)
- Copy of the funeral bill
The Claimant’s Statement including the beneficiary's address and Social Security number must be completed and signed by the Attorney-in-Fact.
We will also require an affidavit affirming the Power of Attorney and a notarized copy of the Power of Attorney Agreement.