What is the life insurance claim form template?
Families file life insurance claims at the worst possible time. A claim can stall over one missing detail. This life insurance claim form template asks for everything once, calmly, with short pages and plain wording.
The first page covers the person who died: their name, dates, the place of death, the manner and cause of death as shown on the death certificate, and the policy numbers. A certified death certificate upload is required, and choosing Accident asks what happened. The second page covers the beneficiaries. Each one gets a section with their name, relationship, contact details, share and how they'd like to be paid. Choosing More than one beneficiary under How many beneficiaries are claiming? repeats the section for a second beneficiary, with an option to add a third.
The last page asks about the person filing, any minor beneficiaries and any part of the benefit assigned to a funeral home, then closes with a declaration and signature. The claim is saved as a PDF in your FileIt vault, with the death certificate and every other document attached.
- Best for
- Life insurers, brokers, employers with group life cover, and funeral homes helping families
- Filled in by
- A beneficiary, an executor, or someone helping the family
- Time to complete
- About 15 minutes
- Includes
- Death certificate upload, accident follow-up, a repeating beneficiary section, payout choices, funeral assignment, signature
Who uses a life insurance claim form?
- A life insurer or broker offering families an online claim instead of a mailed packet
- An HR team helping a family claim an employee's group life benefit
- An executor claiming a policy that names the estate
- Siblings who are joint beneficiaries filing one claim together
- A funeral home helping a family record an assignment of part of the benefit
- A parent or guardian claiming on behalf of a minor beneficiary
Questions on this life insurance claim form
63 questions over 3 pages · includes signature, file upload, conditional questions, multiple pages, consent checkbox.
1 The insured and the policy
- Full name of the insured*
- Date of birth
- Date of death*
- Place of death (city, state or country)*
- Manner of death as shown on the death certificate* Natural causes · Accident · Pending investigation · Undetermined
- Cause of death
- What happened?* asked only when it applies
- Policy number or numbers*
- Was this cover provided through an employer?
- Employer asked only when it applies
- Certified death certificate*
- Policy document or statement, if you have it
2 Beneficiaries
- How many beneficiaries are claiming?* Just one · More than one beneficiary
- Full name*
- Relationship to the insured* Spouse or partner · Child · Parent · Sibling · Other relative · Trust · Estate · Other
- Date of birth
- Email*
- Phone*
- Address*
- Share (%)
- How would they like to be paid?* Lump sum by direct deposit · Lump sum by check · An installment or settlement option, if the policy has one
- Bank* asked only when it applies
- Routing number* asked only when it applies
- Account number* asked only when it applies
- Photo ID
- Full name* asked only when it applies
- Relationship to the insured* asked only when it applies Spouse or partner · Child · Parent · Sibling · Other relative · Trust · Estate · Other
- Date of birth asked only when it applies
- Email asked only when it applies
- Phone* asked only when it applies
- Address* asked only when it applies
- Share (%) asked only when it applies
- How would they like to be paid?* asked only when it applies Lump sum by direct deposit · Lump sum by check · An installment or settlement option, if the policy has one
- Bank* asked only when it applies
- Routing number* asked only when it applies
- Account number* asked only when it applies
- Photo ID asked only when it applies
- Add a third beneficiary? asked only when it applies
- Full name* asked only when it applies
- Relationship to the insured* asked only when it applies Spouse or partner · Child · Parent · Sibling · Other relative · Trust · Estate · Other
- Date of birth asked only when it applies
- Email asked only when it applies
- Phone* asked only when it applies
- Address* asked only when it applies
- Share (%) asked only when it applies
- How would they like to be paid?* asked only when it applies Lump sum by direct deposit · Lump sum by check · An installment or settlement option, if the policy has one
- Bank* asked only when it applies
- Routing number* asked only when it applies
- Account number* asked only when it applies
- Photo ID asked only when it applies
3 About you and sign-off
- You are filing as* A named beneficiary · Executor or administrator of the estate · Parent or guardian of a minor beneficiary · Trustee of a trust · Someone helping the family
- Letters testamentary, guardianship papers or trust documents asked only when it applies
- Is any beneficiary under 18?*
- Who is the minor's guardian or custodian?* asked only when it applies
- Has part of the benefit been assigned to a funeral home?*
- Funeral home* asked only when it applies
- Amount assigned* asked only when it applies
- The signed assignment asked only when it applies
- Other policies the insured held that you know of
- Anything else we should know
- Declaration*
- Signature*
- Date*
The life insurance claim form, page by page
1 The insured and the policy
Under The person who died, the form asks for the full name of the insured, date of birth, date of death and place of death. Manner of death as shown on the death certificate offers natural causes, accident, pending investigation, undetermined or another answer, and Cause of death takes the wording from the certificate. An accident asks What happened?
Under The policy, the filer gives the policy number or numbers and says whether the cover was provided through an employer, naming it if so. The certified death certificate upload is required, and the policy document or statement can be added if the family has it.
2 Beneficiaries
How many beneficiaries are claiming? is required, with Just one or More than one beneficiary. A note explains that each beneficiary fills in their own section and that shares are usually set by the policy.
Beneficiary 1 asks for the full name, relationship to the insured (from spouse or partner and child to trust or estate), date of birth, email, phone, address and share (%). How would they like to be paid? offers a lump sum by direct deposit, a lump sum by check, or an installment or settlement option if the policy has one. Direct deposit asks for the bank, routing number and account number. A photo ID can be uploaded.
Choosing More than one beneficiary repeats the whole section as Beneficiary 2, and Add a third beneficiary? opens Beneficiary 3.
3 About you and sign-off
You are filing as asks whether the filer is a named beneficiary, an executor or administrator, a parent or guardian of a minor, a trustee, or someone helping the family. Anyone other than a named beneficiary can upload letters testamentary, guardianship papers or trust documents.
Is any beneficiary under 18? is required and asks who the minor's guardian or custodian is. Has part of the benefit been assigned to a funeral home? is required, and a yes asks for the funeral home, the amount assigned and the signed assignment. Free-text boxes cover other policies the insured held and anything else the insurer should know. The filer agrees to a declaration, signs and dates the claim.
Make the template yours
- Add your claims phone number and a named contact to the cover text
- Rewrite the declaration in your own approved wording
- Add a tax ID question if your process collects it in the claim rather than separately
- Change the payout options to match the settlement options your policies offer
- Add more beneficiary sections in the designer for large families
- Restrict the vault folder these claims file into, since they include personal and bank details
Tips for a better life insurance claim form
- Ask for certified copies of the death certificate early, since several organisations may need one
- Use the cause of death exactly as written on the certificate
- Check the beneficiary names against the policy, not just family records
- If a funeral home has been assigned part of the benefit, include the signed assignment
- Keep a copy of the submitted claim for your own records
Every response becomes a PDF in your vault
The claim is saved as a signed PDF in your vault, titled with the filer's name, with the death certificate, IDs and any legal papers attached to the same document. Your claims team gets an email straight away, and the filer can be sent a copy.
The Responses table lists every claim. Opening one shows the PDF and its attachments together, and the CSV export gives a log of claims by date of death, policy and number of beneficiaries.
- Start from this template. It opens in the FileIt Forms designer — change any question, add pages, set the rules for when questions appear.
- Share it. Turn on a public link, or send it to people by email, each with their own link. They don’t need a FileIt account.
- Get the answers as PDFs. Each response is saved as a PDF in the vault folder you choose, with uploaded files attached — and listed in a Responses table you can export to CSV.
Life insurance claim form: frequently asked questions
Is this life insurance claim template free?
Yes. It's a starter template in FileIt's Forms app, available on every plan, including free.
How are multiple beneficiaries handled?
Choosing More than one beneficiary repeats the beneficiary section for a second person, and Add a third beneficiary? opens a third. You can copy in more sections in the designer.
Is a death certificate required?
In this template, yes. The certified death certificate upload is required, because insurers almost always ask for it.
Does the form decide who gets paid?
No. It records the claim. Who receives the benefit, and how much, is decided by the policy and the insurer.
Is this legal advice?
No. For questions about estates, guardianship or entitlement, speak to a qualified professional.
Can a family member fill it in on someone else's behalf?
Yes. You are filing as includes Someone helping the family, and the person filing doesn't need a FileIt account.