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CD04520718State of New Jersey Department of the TreasuryDIVISION OF PENSIONS & BENEFITS BENEFICIARY SERVICES P.O. Box 295, Trenton, NJ 086250295APPLICATION FOR ACCIDENTAL DEATH BENEFITSINSTRUCTIONS
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How to fill out application for accidental death

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How to fill out application for accidental death

01
Start by gathering all the required documents and information such as your personal identification details, the details of the deceased person, and any relevant accident details.
02
Read the application form carefully and make sure you understand all the questions and requirements.
03
Begin by filling out your personal information, including your name, address, contact details, and relationship to the deceased person.
04
Provide the necessary details about the deceased person, such as their name, age, occupation, and any other relevant information.
05
Describe the accident in detail, including the date, time, location, and circumstances surrounding it.
06
Attach any supporting documents, such as accident reports, medical records, or witness statements, if necessary.
07
Review the completed application form to ensure all the information provided is accurate and complete.
08
Submit the application form and any accompanying documents to the appropriate authority or insurance company as per their instructions.
09
Keep a copy of the completed application and any supporting documents for your records.
10
Follow up with the authority or insurance company to track the progress of your application and address any additional requirements or queries they may have.

Who needs application for accidental death?

01
Anyone who has suffered the accidental death of a loved one and wishes to make a claim for compensation or insurance benefits may need to fill out an application for accidental death.
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An application for accidental death is a form that is typically submitted to an insurance company or government agency to request compensation for a death that occurred as a result of an accident.
The beneficiary or next of kin of the deceased individual is typically required to file an application for accidental death.
The application for accidental death can usually be filled out online or in person by providing information about the deceased individual, the accident that caused their death, and any relevant insurance policies.
The purpose of an application for accidental death is to request financial compensation for the death of an individual that occurred as a result of an accident.
Information that may need to be reported on an application for accidental death includes details about the deceased individual, the accident that caused their death, any relevant insurance policies, and contact information for the beneficiary or next of kin.
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