REPORT A LIFE INSURANCE CLAIM

Use “Report a Claim” to notify American Family Life Insurance Company of the death of someone insured by a policy underwritten by American Family Life Insurance Company.

Please provide the Deceased Insured Information and Policy Number (optional). All American Family Life Insurance policy numbers contain 8 digits and begin with either an alpha (S, U, L, P, J) or numeric (0, 1, 2, 3, 9) character.

Policy Holder Information

Policy Number of the Deceased Insured (Optional) Full Name of Deceased Insured Deceased Insured’s Date of Birth Deceased Insured’s Date of Death Cause of Death If Other, please specify. Which State and/or Country Did the Death Occur?

Information on the Person Reporting the Claims

Reporter's Name Relationship to the Deceased Address City State ZIP Code Phone Number Email (Optional) Other (Optional) e.g. Funeral home information

Please be aware that if you are not the named beneficiary on the policy (ies), we will be unable to provide any information or communications to you. Completion of this form does not admit that American Family Life Insurance Company has any insurance in force and does not waive any of its rights and defenses.