Forms and documents needed to process a claim

Forms and Requirements

All of the forms and requirements for your specific claim type and situation will be provided in the claims packet sent to you.

If you would like to view and download all of the forms that may be needed for your claim, please enter your policy number below.

Please see the sections below to learn more about the claims process and form requirements for specific situations.

Claim Forms

Claimant’s Statement - needed for all claims

Proof of Death Form - this may not be needed - refer to the table with the Proof of Death requirement by claim type

Proof of Heirship Affidavit – AGLC5081 - this is only needed for certain Estate Beneficiaries - see Common Beneficiary Situations

Affidavit Concerning Custody of a Minor - this is only needed for certain Minor Beneficiaries - see Common Beneficiary Situations

Claim Forms

Claimant’s Statement - needed for all claims

Proof of Death Form - this may not be needed - refer to the table with the Proof of Death requirement by claim type

Proof of Heirship Affidavit - this is only needed for certain Estate Beneficiaries - see Common Beneficiary Situations

Affidavit Concerning Custody of a Minor - this is only needed for certain Minor Beneficiaries - see Common Beneficiary Situations

Claim Forms

Claimant’s Statement - needed for all claims

Proof of Death Form this may not be needed - refer to the table with the Proof of Death requirement by claim type

Proof of Heirship Affidavit - this is only needed for certain Estate Beneficiaries - see Common Beneficiary Situations

Affidavit Concerning Custody of a Minor - this is only needed for certain Minor Beneficiaries - see Common Beneficiary Situations

Claim Forms

Claimant’s Statement - needed for all claims

Proof of Death Form this may not be needed - refer to the table with the Proof of Death requirement by claim type

Proof of Heirship Affidavit - this is only needed for certain Estate Beneficiaries - see Common Beneficiary Situations

Affidavit Concerning Custody of a Minor - this is only needed for certain Minor Beneficiaries - see Common Beneficiary Situations

Claimant’s Statement: Required for most claims; not required for expedited processing. Each beneficiary must complete and submit a statement. Provided in claims packet.

Original or copy of the policy (if available): If the policy is not available, please note this on the top of the Claimant’s Statement

Documentation required as Proof of Death: Required for all claims. The document required varies depending on the dollar amount of the benefit payment or circumstances of death, see table below. The required form of proof will be indicated in the claims packet sent to the beneficiary. Note: Only one proof of death is required for the deceased, even when there are multiple claimants and/or policies.

Proof of death requirements by claim type

Total benefit amount for policy

$15,000 or less

Claim type

Natural death

Date of death is 2 or more years after policy issue or reinstatement date

Death occurred within United States, Canada or U.S. territories (Puerto Rico, Guam, American Samoa, U.S. Virgin Islands)

Document Required

Any one of the following:

Obituary
Funeral service program
Funeral home bill
Proof of Death form
Copy of Death Certificate ^1,2

Total benefit amount for policy

$15,001 - $50,000

Claim type

Natural death

Date of death is 2 or more years after policy issue or reinstatement date

Death occurred within United States, Canada or U.S. territories (Puerto Rico, Guam, American Samoa, U.S. Virgin Islands)

Document Required

Any of the following:

Proof of Death form
Copy of Death Certificate ^1,2

Total benefit amount for policy

$50,000 - $100,000

Claim type

Natural death or suicide

Date of death is 2 years after policy issue or reinstatement date

Death occurred within United States, Canada or U.S. territories (Puerto Rico, Guam, American Samoa, U.S. Virgin Islands)

Document Required

Copy of Death Certificate ^1,2

Total benefit amount for policy

Greater than $100,000

Claim type

Homicide

Date of death is within 2 years of policy issue or reinstatement date

Foreign death (occurred outside of United States, Canada or U.S. territories - Puerto Rico, Guam, American Samoa, U.S. Virgin Islands)

Accidental death (only if claiming benefits for policy with Accidental Death Benefits Rider)

Document Required

Certified copy of Death Certificate ^1,2,3

Note: The death certificate cannot be returned

¹ We cannot accept a death certificate where the cause of death is “pending.”
² For deaths in Florida, the death certificate must be the long version that includes the cause of death.
³For foreign deaths, certified death certificate from the country where the death occurred, translated into English.

Forms and documents needed to process a claim

Please see the sections below to learn more about the claims process and form requirements for specific situations.

Forms and documents lookup

Documents needed to file a claim

Proof of death requirements by claim type

Total benefit amount for policy

Claim type

Document Required

Total benefit amount for policy

Claim type

Document Required

Total benefit amount for policy

Claim type

Document Required

Total benefit amount for policy

Claim type

Document Required