Forms

Instructions: Click the link to each form below to open the PDF document. Then SAVE the file to your computer to print and fill out. Note: online claim submission coming soon!

Start A New Claim (Online version)
Enter deceased’s information, ALL insurance coverage and beneficiary names. Please specify if coverage is through an employer (Group Claim).

Start A New Claim (Offline PDF: if you would like to fill it out, print and fax/email )
Enter deceased’s information, ALL insurance coverage and beneficiary names. Please specify if coverage is through an employer (Group Claim).

Beneficiary Assignment (Form A)/ Reassignment (Form B)
Have each beneficiary sign their own Form A and the Funeral Home completes one Form B for EACH insurance company (forms A & B must be notarized).

Bank Authorization Form
Please complete this form, sign and fax back or email, with a copy of a voided check in order to utilize our Wire and ACH transfer options.

Please mail all signed assignment and necessary claim documents to our office within 3 days of funding. If the death certificate is not yet available, please send it later under a separate cover. For your convenience we will provide pre-paid return envelopes to forward the documents in.

All of our forms are in Adobe PDF formats. If you need the Adobe Acrobat Reader please click the download link button.