Report a Death


Policy Number:

Name of Insured:    

Name of Deceased:    

Date of Birth:    

Date of Death:    

Cause of Death:    

Is Spouse Living:

Name of Spouse:  

If No-Date of Death:    

Person Reporting Death:    

Relationship:    

Postal Address:    

Postal Address:    

Town:    

County:

Postal Code:    

Phone Number:    

E-mail Address:  

Name of Funeral Home:  

Funeral Home Postal Address:  

Funeral Home Postal Address:  

Funeral Home Town:  

Funeral Home County:

Funeral Home Postal Code:  

Funeral Home Phone Number:  

Would you like UHL to send claim forms to you:

Comments:
 

We will begin the process by evaluating the policy status to determine benefits and will post requirements necessary to complete the claim process.