Forethought Life Insurance Company Death Claim Details

When you are looking for a life insurance policy, you will likely be required to fill out a Forethought life insurance claim form. This form is used to apply for the policy and to file claims in the event of a death. The application process can be difficult, but it is important to understand all of the requirements in order to ensure that your loved ones receive the benefits they deserve. By understanding the process and how to complete the Forethought life insurance claim form, you can help ensure that your family is taken care of in the event of your death. To learn more about filing a Forethought life insurance claim, please visit our website today.

The listing features details about the forethought life insurance claim form. It's going to provide you with the assumed time it would require you to prepare the form plus some additional details.

QuestionAnswer
Form NameForethought Life Insurance Claim Form
Form Length2 pages
Fillable?Yes
Fillable fields40
Avg. time to fill out8 min 34 sec
Other namesforethought withdrawal forms, global atlantic beneficiary claim form, forethought preneed, global atlantic forethought claim form

Form Preview Example

CLAIM FORM

(See Instructions on Reverse Side)

 

 

Policy/Certificate Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INSURED

Date of Death

/

/

 

Name of Insured

 

 

 

 

 

 

 

 

 

 

Age

Date of Birth

/

/

 

Social Security Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cause of Death*

 

Natural

Accidental

Suicide

 

 

 

 

 

 

 

 

 

 

 

 

*Provide death certificate if policy/certificate was underwritten, issued as first-day coverage or preferred rate AND insured died within two years of issue OR from an accidental death or suicide.

FIRM

Funeral Firm

 

 

 

 

 

Telephone Number (

)

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

City

State

 

Zip

 

 

 

 

 

 

 

 

 

 

UNERALF

 

 

 

 

 

Mail check for excess benefits or correspondence to:

TOTAL COST OF FUNERAL PROVIDED

 

$

 

 

 

 

 

Agent (for delivery to Beneficiary)

Beneficiary

 

 

 

 

 

 

 

 

 

 

 

 

BENEFICIARY

Name of Beneficiary

(Not Funeral Firm)

Address

 

Telephone Number (

)

 

 

 

 

 

City

State

Zip

 

 

 

 

 

 

 

 

REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION BY BENEFICIARY/ESTATE

IRS regulations require that we obtain the beneficiary’s Social Security number in order to generate a 1099 for any interest paid on life insurance death benefits or growth and/or interest on annuity contracts in the amount of $10.00 or more. If paying the estate, please provide a Tax Identification Number of the estate in the box below.

If there is no estate, we may pay excess benefits to a relative of the insured instead of the estate itself (except for individual policies in Kansas). Therefore, with the exception of Kansas individual policies, if the estate is named as beneficiary, please indicate who should receive any excess.

Enter your Taxpayer Identification Number in the box below. For most individuals, this is your Social Security number.

Social Security Number/Taxpayer Identification Number

– –

Certification. Under penalties of perjury, I certify that:

1)The number shown on this form is my correct Taxpayer Identification Number, and

2)I am not subject to backup withholding either because I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the IRS has notified me that I am no longer subject to backup withholding.

Certification Instructions. You must cross out item (2) above if you have been notified by the IRS that you are subject to backup withholding because of underreporting interest or dividends on your tax return. However, if after being notified by the IRS that you were subject to backup withholding you received another notification from the IRS that you are no longer subject to backup withholding, do not cross out item (2).

 

 

 

Signature of Beneficiary

 

Date

 

WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant.

UTHORIZATION

AUTHORIZATION OF PAYMENT FOR FUNERAL GOODS AND SERVICES

 

 

 

 

I certify that the above information is true to the best of my knowledge and that the funeral goods and services were furnished. I further certify

 

 

 

 

that the amount of benefits claimed is in accordance with the terms of the funeral planning agreement if applicable. I understand that

 

 

Forethought Life Insurance Company reserves the right to request more information or a certified copy of the death certificate.

 

A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Funeral Director

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

PAYMENT

As the person legally responsible for the funeral arrangements of the deceased Insured, I authorize payment to the Funeral Firm in the

 

amount of the total cost of the funeral goods and services furnished.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Person Legally Responsible for the Funeral

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

A8008-01

 

© 2006 Forethought

 

 

 

Page 1 of 2

1106

 

CLAIM FORM

FORETHOUGHT LIFE INSURANCE COMPANY

P.O. BOX 216

BATESVILLE, INDIANA 47006-0216

FAX (888) 425-2463

Complete the attached forms

Send by fax or mail the following to Forethought Life Insurance Company

Completed and signed forms

A copy of the Death Certificate if policy/certificate was issued as first-day coverage or preferred rate and insured dies within two years of issue or from accidental death or suicide.

We reserve the right to request the original itemized statement of funeral goods and services and a certified copy of the death certificate before benefits are paid.

To obtain the current death benefit quote prior to filing a claim, simply call the 24-hour Forethought Information Line at 1-800-959-6886.

Any quote which you are given is only an estimate of death benefits available. (If you call the information line, you must also fax completed copies of the forms with signatures to Forethought Life Insurance Company before benefits will be paid).

A8008-01

 

© 2006 Forethought

WHITE — Company YELLOW — Funeral Firm

PINK — Family

1106

Page 2 of 2

How to Edit Forethought Life Insurance Claim Form

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step 1 to filling out forethought preneed claim form

Put the essential particulars in the If there is no estate, Social Security Number/Taxpayer, Certification, The number shown on this form is, Certification Instructions, Signature of Beneficiary, Date, WARNING: It is a crime to provide, N O T A Z R O H T U A T N E M Y A P, AUTHORIZATION OF PAYMENT FOR, I certify that the above, Signature of Funeral Director, Date, and As the person legally responsible field.

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Provide the key data the N O T A Z R O H T U A T N E M Y A P, As the person legally responsible, Signature of Person Legally, Date, A8008-01, Page 1 of 2, and © 2006 Forethought 1106 part.

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