Accelerated life insurance benefit claim

We understand you have been diagnosed with a terminal illness and we are truly sorry. With this form, you can file an online claim to receive an advance on your life insurance payout. This option is available to help you meet your current needs and ease your financial burden. We are here to help you through this process.

Your claim

Are you filing this claim for yourself?

Yes
No
Please make a selection.

About the claim follow-up

Whom should we contact to follow up on the claim?

Veuillez inscrire un prénom.
Veuillez inscrire un nom.
Please enter a valid telephone number.
Please enter a valid extension.
Please enter a valid telephone number.
Please enter a valid extension.
Email address used for claim follow-up
You will receive an acknowledgement of receipt after the claim is sent. Please enter a valid email address.
I don't have an email address
Please check the box if you do not have an email address.
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