FILE A CLAIM

File a claim with Senior Life in just two simple steps.

1

2

STEP #1

Fill out the form below to file your claim.

Step 1: Fill out the form below.
Step 2: Submit your proof of death.
That's all! Once Senior Life has all necessary documentation, we will process your claim.

Your Information

Name: *

First

Last

Phone: *

Policy Number: *

Relationship to Deceased: *

Deceased Information

Name: *

First

Last

Cause of death: *

Was this death accidental? *

Date of Death *

Beneficiary Information

Name: *

First

Last

Phone: *

SSN: *

Mailing Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Funeral Home Information

Funeral Home Name: *

City: *

State: *

Disbursement Options

How would you like to receive your paper check? *

Phone