Erie Insurance Fillable Forms
Member Company ANNUITY CLAIMANT'S STATEMENT . . . . Erie Family Life Insurance Company Home Office 100 Erie Insurance Place Erie, Pennsylvania 16530 814.870.2000 Fax 814.870.4557 www.erieinsurance.com Toll Free 1.800.458.0811 . The following documentation, in addition to this completed Claimant's Statement, is necessary in order for Erie Family Life Insurance Company to process a death claim on an annuity. · DEATH CERTIFICATE - A certified copy of the death certificate should be obtained and forwarded to the Home Office MoreThis form must be executed before a WITNESS by the person or persons to whom .... 3) Name: Birth Date. -. -. Relationship. TIN/SSN. Percentage. %. Address Less
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