Proof Of Death Claim Form - Life Insurance Benefits

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Life Insurance Benefits
Standard Insurance Company
Life Benefits Department
Application Instructions
PO Box 2800 Portland OR 97208 800.628.8600 Tel
Please Read Carefully
The application for life insurance benefits consists of the forms included in this packet, as well as the additional information
noted under item 1 below. Please fill out every space on the Proof of Death form to avoid delays in our examination of your
application for benefits. If a section does not apply, or information is not available, please write “NONE” in the space, so that
we know you did not overlook the particular question. If an incomplete form is received, it may be returned for completion.
Note: original documents will not be returned.
Include the following information with the Proof of Death form.
� Beneficiary Statement(s).
(See attached. If there is more than one beneficiary, please make a copy of the front and back of the statement.)
� Photocopy of the death certificate.
� Copies of all enrollment forms and change of beneficiary cards.
� For AD&D and Seat Belt claims, attach photocopies of newspaper clippings, police or accident reports, and
any other information available regarding the accident.
Please have the Beneficiary(ies) carefully read and complete the Beneficiary Statement which contains information
about taxes and the Standard Secure Access account.
Beneficiaries may receive their funds via Standard Secure Access (SSA) in accordance with the terms of the group policy.
SSA is a convenient, interest-bearing checking account in which life insurance proceeds are deposited. With SSA, the
Beneficiary is able to earn interest on the life insurance proceeds while taking the time to weigh important financial
decisions that often follow the death of a loved one.
The Beneficiary will be mailed a checkbook once the claim is approved. In addition, all SSA accountholders have access
to 24-hour customer service via a voice response unit (VRU) and a dedicated customer service team.
Please make sure all required forms are completed and returned to our office. Our examination of the claim will
begin when all completed forms are received. Should you have questions, our office is available to assist you. Please call
(800) 628-8600 or email us at .
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