We are very sorry to hear of your loss and will do what we can to make this process as smooth as possible. We will contact the beneficiary within 2-3 business days upon receipt of this form, if needed, to gather additional information to complete the claim process. Please be aware that a claim will not be finalized unless and until we have received all the requested or required information as determined by the policy(ies).

Please note: If you are not the named beneficiary on the policy(ies), we are 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.

If you have questions, please contact us at 1-800-MYAMFAM ext. 78080