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DEFERRED ANNUITY CLAIM FORM STATEMENT OF BENEFICIARY Mail completed form to: Antitrust Life Insurance Company PO Box 14500 Des Moines IA 503063500 1. ANNA IT CON TRACT N UMB ER S one form may be used

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How to fill out claim statement - 1st

01

To fill out a claim statement, follow these steps:

02

Start by providing your personal information, including your name, address, and contact details.

03

Specify the date and time of the incident for which you are filing the claim.

04

Describe the incident in detail, including what happened and any damages or injuries that occurred.

05

Include any supporting evidence or documentation, such as photos, videos, or witness statements.

06

State the amount of compensation or relief you are seeking and explain why you believe you are entitled to it.

07

Sign and date the claim statement, affirming that the information provided is true and accurate.

08

Keep a copy of the claim statement for your records and submit it to the appropriate authority or insurance company.

Who needs claim statement - 1st?

01

Anyone who has experienced a loss, damage, or injury and wants to seek compensation or relief may need a claim statement. This can include individuals involved in accidents, victims of property damage, or individuals seeking reimbursement for medical expenses.

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