Death claims

To report the death of a person who is insured by a Horace Mann life insurance policy or annuity, please provide us with the following information.

Information of the deceased

First name Middle initial Last name Nickname or other names used Cause of death Natural Unknown Accidental Name of insured (if different than deceased) Date of birth

Policy number(s), if known (enter all that apply):

Life policy number Annuity / supplemental contract number Group policy / certificate number Auto policies? Unknown Yes No Property policies? Unknown Yes No Address City State ZIP code Date of death

Death reported by

First name Last name Address City State ZIP code Daytime phone Alternate phone number Email Relationship to deceased Additional comments

Funeral home information

Funeral home name Address City State ZIP code Phone

Notice of Death Claim

Information of the deceased

Death reported by

Funeral home information

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