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Fillable ANNUITY CLAIMANT'S STATEMENT - Erie Insurance

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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. ·...
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