Deceased’s Information

• Full Name

  • First Name
  • Last Name
• Certificate Number
• Date of Birth
• Date of Death
• Place of Death
• Cause of Death
• Funeral Home Handling Services
• Funeral Home’s Phone Number

Your Information

• Full Name

  • First Name
  • Last Name
• Relationship to Deceased
• Daytime Phone Number
• Email Address
• Please select one: I will download the claim form
  Please mail a claim form to the beneficiary

   

  Please select one: Yes, the number provided above is a text-capable cell phone. I request and authorize Woman’s Life Insurance Society to provide status updates and reminders related specifically to this claim process via text message(s) to the phone number provided. I understand and acknowledge that I am not required to consent, and that I may contact Woman’s Life directly at any time. Message and data rates may apply.
  No, I am not interested in claim status updates via text messages.

Beneficiary’s Information

• Full Name

  • First Name
  • Last Name
• Address
• • City
  • State
  • Zip Code
• Date of Birth
• Express Claims Processing*: Yes – this claim qualifies for Express Claim Processing
  Acceptable proof of death will be emailed to claims@womanslife.org or faxed to (810) 966-0933. No – this claim does not qualify for Express Claim Processing
• Additional Comments

• Submit