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Waiver of Premium Claim Attn: Life Claims PO Box 10427 Van Nuys, CA 914100427 18006355832Employee statement (please print) Employee name: Last:First:MI:Employee address:Social Security #: Height:Weight:ZIP:Phone
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How to fill out waiver of premium claim

01
Obtain the Waiver of Premium claim form from your insurance provider.
02
Fill out your personal information including name, policy number, and contact details.
03
Provide details of the insured party such as their name, date of birth, and policy details.
04
Include a statement from a medical professional supporting the need for the waiver of premium.
05
Sign and date the form before submitting it to your insurance provider.

Who needs waiver of premium claim?

01
Individuals who are unable to work due to a disability or illness and are unable to pay their insurance premiums.
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Waiver of premium claim is a request to waive the premium payments for an insurance policy in case the policyholder becomes disabled or unable to work.
The policyholder or their legal representative is required to file a waiver of premium claim.
To fill out a waiver of premium claim, the policyholder needs to complete the claim form provided by the insurance company and submit any required documentation.
The purpose of waiver of premium claim is to ensure that the insurance policy remains in force even if the policyholder is unable to make premium payments due to a disability.
The waiver of premium claim must include details of the disability or inability to work, medical documentation, and any other information requested by the insurance company.
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