File Online Claim Form
Please use the link below to submit an online Proof of Claim and Release Form.THIS CLAIM FORM CONTAINS FOUR (4) SECTIONS, ALL OF WHICH MUST BE COMPLETED BEFORE THE FORM IS SUBMITTED, INCLUDING THE VERIFICATION ON THE LAST PAGE. YOUR CLAIM FORM WILL NOT BE SUBMITTED UNTIL AFTER YOU COMPLETE THE VERIFICATION AND PRESS THE [GREEN “SUBMIT” BUTTON].
Please print the verification for your records.
To complete the online Claim Form and Release, click NEXT.
Note: These documents are in PDF format. To view the
documents, you will need Adobe Acrobat Reader
on your computer or other internet-enabled device.
