Home » File A Claim

File A Claim

Fill out this form to file a claim with Senior Life Insurance Company.

Your Information

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Phone Number *

Alternate Phone Number

Email

Relationship to Deceased *

Deceased Information

Policy Number

First Name *

Last Name *

Date of Birth

Date of Death

Cause of Death

Manner of Death

Location of Death

City

State

Beneficiary Information

Name

Date of Birth

Social Security Number

Address

City

State

Zip Code

Phone Number

Heirs to Insured

Name

Name

Name

Other Information

Funeral Home Name

Assignment(s) taken on this claim?