Report the Passing of a Loved One

We know losing a loved one can be a difficult and overwhelming experience and we want to make our part of your journey as easy as possible. Please complete the form below and one of our Home Office representatives will begin the claim process and contact you within 5 business days.

If you prefer to speak directly with us instead of completing this online form, please do not hesitate to call us Monday-Friday, 8:00am to 4:30pm, at 800-234-4124 and select menu option 3.

Report the Passing of a Loved One

Information About the Person Who Passed Away

First Name*

Last Name*

Maiden/Alternate Last Name

Date of Birth*

Date of Death*

Your Information

First Name*

Last Name*

Relationship to Deceased Member*

Email Address*

Phone Number*

Additional Phone Number

Mailing Address

Please let us know any additional information or questions you may have.

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