Start claim | Equitable

First, tell us about you.

SECURE ONLINE CLAIMS

Which choice best describes you?*

* Required

First Name*

Please input a First Name

Last Name*

Please input a Last Name

Email Address*

Please input a valid Email Address

Confirm Email Address*

Please input a valid Email Address

Primary Phone Number

Please input a valid Phone Number

Date you were notified*

Please select a date

Social Security Number*

Please input a valid SSN

Address*

Please input an address

City*

Please input a City

State*

Please select a state

Zip*

Please input a ZIP code

Would you like to receive beneficiary claim form(s)?

Claims kit delivery method?

Yes, please email
Yes, please send by U.S. Postal

No, not needed

Address*

City*

State*

Zip*

Now tell us about the deceased.

First Name*

Please input first name of the deceased

Last Name*

Please input last name of the deceased

Date of Death*

Please select a date of death

Social Security Number*

Please enter the deceased's SSN

Policy/Contract Number

Cause of Death

Funeral Home Name

City

State

— Now tell us about beneficiary
#1

Beneficiary's relationship to the deceased*

First Name*

Please input the beneficiary's first name

Last Name*

Please input the beneficiary's last name

Email Address*

Please input a valid email address

Confirm Email Address*

Please input a valid email address

Primary Phone Number

Social Security Number*

Please input a SSN

Address*

City*

State*

Zip*

First, tell us about you.

Now tell us about the deceased.

— Now tell us about beneficiary
#1

Optional, request a Financial Professional

Would you like to add beneficiary information?

Would you like to add information about an additional beneficiary?

First, tell us about you.

Now tell us about the deceased.

— Now tell us about beneficiary #1

Optional, request a Financial Professional

Would you like to add beneficiary information?

Would you like to add information about an additional beneficiary?

Questions?

Call us

— Now tell us about beneficiary
#1