File A Claim

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Customer Service

File A Claim

On behalf of Banner Life Insurance Company, please accept our condolences on your loss. We understand that this is a difficult time so we want to make it easy for you to file a claim. Please review our Claim Overview for additional information on the claim process. Completing this on-line form will begin the claim review process. Items marked with an asterisk (*) are required.

Section 1 - Type Of Claim:

Type of Claim *

Please contact the Claims Department directly at 1-800-683-8428, extension 6974.

Policy Number

Section 2 - Information About You:

Name *

Address 1 *

Address 2

Address 3

City *

State *

Zip *

At least one phone number is required. *

Primary Telephone Number (XXX)-XXX-XXXX

Secondary Telephone Number (XXX)-XXX-XXXX

Email Address

Confirm Email Address

Fax Number (XXX)-XXX-XXXX

Your relationship to the deceased insured *

If you are an agent or broker, please indicate how you were contacted.

Chars. Remaining

Section 3 - Insured's Personal Information:

Name *

Address 1

Address 2

Address 3

City

State *

Zip

Date of Birth ex. (1974)

Social Security Number (no hyphens or spaces)

Date of Death * ex. (1974)

Cause Of Death
Chars. Remaining

Section 4 - Beneficiary Information:

Same as Section 2

Name

Address 1

Address 2

Address 3

City

State

Zip

Telephone Number (XXX)-XXX-XXXX

Email Address

Confirm Email Address

Section 5 - Where and to whom would you like the claim packet sent?

Same as Section 2

Name *

Address 1 *

Address 2

Address 3

City *

State *

Zip *

How would you like us to respond to you? *

Email
Telephone	(XXX)-XXX-XXXX
Fax	(XXX)-XXX-XXXX

U.S. Mail
	Name
	Address 1
	Address 2
	Address 3
	City
	State
	Zip

If you have any questions or would like to speak to a claims representative, please call 1-800-638-8428 extension 6974.

Please note that by furnishing forms or investigating a claim, the Company shall not be held to admit the validity of any claim or waive any condition or provision of the policy.