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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

Please make a selection.

About the claim follow-up

Whom should we contact to follow up on the claim?

First name Veuillez inscrire un prénom.

Last name Veuillez inscrire un nom.

Initials

Primary telephone number Please enter a valid telephone number.

ext. Please enter a valid extension.

Secondary telephone number (optional) Please enter a valid telephone number.

ext. 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.

Cancel

Do you have questions about your claim?

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1 844 442-4636

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Contact the Customer Service Department

Do you need more time?

Accelerated life insurance benefit claim

Your claim

Are you filing this claim for yourself?

In what capacity are you filing this claim?

About the claim follow-up

Whom should we contact to follow up on the claim?

Mailing address used for the claim process

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