Claim Forms
Other Forms
- Affidavit of Lost Policy Form
- Bank Draft Authorization Form (In English) / (en Español)
- HIPAA Form (release PHI from provider) / Other HIPAA Form (release PHI to agent, family member, other 3rd party)
- Health Policy Cancellation Form
EASY UPLOAD MOBILE APP
The Easy Upload mobile app or the Form Upload tool found on the Client Services site can be used to securely send documents to us regarding a specific Life & Health policy or Annuity contract, even if you aren’t a registered contract/policy holder. Simply click on the Start Uploading button. You will need to know the contract/policy number and the owner’s zip code to use this feature.
