Death Claim Form:

Decedent Information:

Deceased/Insured Name:(Required)

Date of Death:(Required)

Date of Birth:(Required)

Person submiting Claim:

First name(Required)

Last name(Required)

Funeral Home (If Applicable)

Phone(Required)

Email(Required)

Multi-line address

Country/Region

Address

City

Zip / Postal code

By providing your phone number, you agree to receive text messages from United Benefits Inc. Message & data rates may apply. Message frequency varies.

United Funeral Directors Benefit Life Insurance Company
United Funeral Benefit Life Insurance Company
United Pre-Need Funeral Plans, Inc
Hawthorn Life Insurance Company

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