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Notification of Death Form

Complete the below form to notify us of the death, or call us at 800.231.0801.

Your Information

Name(Required)
First Last

Relationship to Insured(Required)

Address(Required)
Street Address Address Line 2 City State ZIP / Postal Code

Preferred Phone Number(Required)

Email Address

Insured Information (Deceased)

Full Name(Required)
First Middle Last

Birth Date(Required)
Month
Day
Year

Policy Number(Required)
If multiple, please provide all policy numbers, separated by commas.

Type of Policy

Life Insurance

Annuity

Date of Death(Required)
Month
Day
Year

Cause of Death(Required)

Manner of Death(Required)

Did Death Occur in the U.S.?(Required)

Yes

No

Beneficiary Name(s)

Additional Information
Example: Beneficiary contact information, special instructions, or that there will be funeral home assignment

Claim Forms(Required)
Please indicate how you would like to receive your claim forms. If you select Mail me forms, the claims packet will be mailed to you via first class mail. Note that mailing times vary and you should allow up to 2 weeks for delivery. Choosing to download from Americo.com will expedite the claims process, allowing the beneficiary to receive their funds sooner.

Mail me forms

I will download from Americo.com**

**By selecting this option, you opt to download your claim forms directly from Americo.com. Americo will not send any claim forms to you unless you contact us directly at our address, email, or phone number.

Name
This field is for validation purposes and should be left unchanged.

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Your Information

Insured Information (Deceased)

Existing Policies

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