What if I miss a required field?

If you omit required information, the insurer will typically flag the form and request completion; this causes processing delays. Provide complete responses and attach requested documents to avoid back-and-forth.

Can I sign electronically?

Yes, provided the electronic signature meets ESIGN (15 U.S.C. ch. 96) and applicable state e-signature standards (UETA or ESRA) and the insurer accepts e-signed submissions. Ensure a retained audit trail and any consumer disclosures where required.

Do I need a notary or witnesses?

Some states or specific situations require notarization or witnesses. Check the insurer’s instructions and state rules; when in doubt, obtain notarization to reduce future disputes.

What supporting documents are essential?

At minimum, include a certified death certificate and claimant ID. For estate or representative claims, attach letters testamentary, power of attorney, or probate documents as applicable.

How long until payment?

Timing depends on claim completeness and investigation. Simple, complete claims often resolve within weeks, while contested or complex claims may take months; provide requested documentation promptly.

Who can sign for a claimant?

The claimant, named beneficiary, or an authorized legal representative can sign. Representatives must supply documented authority such as power of attorney or court appointment to be accepted.

Electronic Signature
Templates
Insurance
AIG Life Insurance Claimant Statement Form

AIG Life Insurance Claimant Statement Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

Claim Form - Life Insurance Plan

IMPORTANT: “Statement of Claimant” must be completed in all cases. If there are two or more beneficiaries or other claimants, each beneficiary must complete a “Statement of Claimant”. Each beneficiary must make a separate statement.

Statement of Claimant

Policy Number(s):

1. Decedent Information - (Please print in ink or type)

Name

Residence at time of death

2. Beneficiary or Claimant Information

Name

Residence

Are you subject to back-up withholding? (Has the IRS contacted you directly to inform you that you are subject to back-up withholding?)

Yes No

In what capacity or title do you Claim this Insurance? Check one:

Beneficiary Assignee Trustee Executor/Administrator Guardian Other

3. Statement of Lost Policy (Complete only if policy is unavailable for return)

I am unable to locate the original life insurance policy. I agree to return the policy to the company if found.

4. Payment of Fund - Please Select One

Single Sum Payment (If the proceeds are to be paid as one settlement, payment will be made under the Fidelity Life Immediate Convenience Account, if eligible.) Installment Payments (Please refer to the policy for options. If policy is not available, please contact our office.)

Installment Option Elected

Payment Frequency:

Monthly Quarterly Semi-Annually Annually

5. Signatures

The undersigned hereby makes claim to said insurance (or contractual portion thereof, if more than one claimant) and agrees that the furnishing of this form or any of the forms supplemental thereto by the Company shall not constitute nor be considered an admission by it that there was any insurance in force on the life in question nor a waiver of any of its rights or defenses.

Any person who knowingly and with intent to defraud any insurance company or any other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

Notice to California Residents

For your protection California law requires the following to appear on this form:

Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.

Information Authorization

Any physician, medical practitioner, hospital, clinic or other medically related facility, insurance company, the Medical Information Bureau or other organization, institution or person, that has any records or knowledge about the insured is hereby authorized to disclose any such information. A photographic copy of this authorization shall be as valid as the original. (This information will only be obtained for contestable claims.)

“Under the penalties of perjury, I certify that the information supplied on this form is true, correct and complete.”

Claimant Signature

Date

Please Print Name

Agent Signature

Date

Please Print Name

Agent Number

Notary

State of

County of }SS.

Date: , personally appeared before me at ,

State of , the above Claimant, who is known to me and who subscribed the foregoing statement before me and stated under oath that the statements and answers above made and subscribed are true and full.

In Witness Whereof, I have hereunto subscribed my name and affixed my official seal.

(Seal)

My Commission Expires: Notary Public

What the AIG Life Insurance Claimant Statement Form Is

The AIG Life Insurance Claimant Statement Form is a structured questionnaire beneficiaries or other claimants complete to support a death benefit claim. It gathers claimant identity, relationship to the insured, policy and beneficiary details, date and cause of death, and references to supporting documents such as death certificates and medical records. Insurers use the form to establish entitlement, confirm policy terms, and start payment processing. The form may be submitted on paper or electronically; when submitted electronically it must meet ESIGN (15 U.S.C. ch. 96) and applicable state e-signature rules to be legally effective.

Why this Form Matters for Claim Resolution

Providing a complete, accurate claimant statement reduces verification back-and-forth, shortens processing time, and helps avoid denials or payment delays; it also establishes an auditable record under ESIGN and UETA where applicable.

Who Completes and Reviews the Claimant Statement

Typical participants include the beneficiary or claimant, insurer claims staff, and any authorized representative or attorney.

Beneficiary or claimant: completes the form, signs attestations, and supplies identifying documents and death certificate copies.
Claims examiner: reviews the submission, requests missing items, and confirms beneficiary designation against policy records.
Authorized representative or attorney: may sign or submit on claimant's behalf with written authorization and identification.

Each party has distinct responsibilities: the claimant supplies facts and signatures; the insurer verifies identity and entitlement; representatives provide consent and supporting proofs.

Primary Users and Roles

Claimant — Beneficiary

An individual named as beneficiary or a legal representative. Responsible for completing factual sections, signing attestations, providing proof of identity and relationship, and responding to follow-up requests to prevent processing delays.

Claims Examiner — AIG

An insurer representative who validates policy status, confirms beneficiary entitlement, reviews submitted documents, and authorizes payment or requests further information according to internal procedures and applicable regulations.

Core Sections of a Professional Claimant Statement

A complete form is organized for clarity and verifiability so reviewers can quickly confirm entitlement and supporting documents.

Claimant Identity

Full legal name, date of birth, social security or tax ID when required, mailing address, phone, and email used for verification and payment correspondence.

Policy Details

Policy number, insured's full name, issue date, and any rider information needed to locate and confirm coverage in insurer records.

Relationship Statement

Description of the claimant's relationship to the insured and basis for the claim (primary beneficiary, contingent, estate, or assignee).

Death Information

Date, place, and cause of death as known; reference to death certificate or coroner's report numbers; indicates if an autopsy occurred or is pending.

Supporting Documents

List of attachments such as certified death certificate, medical records, police report, or proof of guardianship when applicable for legal verification.

Attestation and Signature

Signature block for claimant or authorized representative, date, and any notarization or witness section required under policy or state law.

Essential Data Elements to Provide

Full Legal Name: Exact name on ID

Policy Number: Identifier for insurer

Date of Death: MM/DD/YYYY format

Relationship: Beneficiary status

Supporting Docs: Death certificate, ID

Signature Date: MM/DD/YYYY signed

Step-by-Step: Completing the Claimant Statement

Follow these steps in order to prepare a clean, verifiable submission and minimize follow-up requests from the insurer.

01

Gather documents: Collect death certificate, policy, and ID copies.
02

Complete form: Fill every required field accurately.
03

Sign and date: Sign in ink or apply approved e-signature.
04

Submit: Send via insurer portal, mail, or approved e-submission.

Where to Send and How the Form Is Processed

Different submission channels have distinct handling steps; choose the one specified by AIG to avoid routing delays.

Online Claims Portal: Upload form and attachments; receive immediate confirmation.
Email Submission: Use insurer-designated secure address with subject line and attachment naming convention.
Paper Mail: Send certified copies to claims address; allow mailing time.
Authorized Representative: Include power of attorney or probate document if signing on claimant's behalf.

Online Completion: Typical Workflow Settings

When completing the form electronically, verify workflow settings to ensure signatures and attachments are captured in the audit trail.

Field	Configuration
Signature Field	Required, date-stamped
Attachment Field	Required for death certificate
Authentication	Email + SMS code recommended
Retention	Audit trail preserved automatically

Digital Signing and System Requirements

Confirm that the chosen e-signature process produces an audit trail and stores documents securely before submitting electronically.

Authentication: Email + optional SMS/KBA for higher assurance
File Formats: PDF or PDF/A preferred for long-term retention
Integrations: Works with common platforms like Salesforce and Google Workspace

Typical Processing Timelines and What to Expect

Processing times vary by insurer and claim complexity; providing accurate information and required documents shortens timelines.

Initial Acknowledgement:

Insurer typically acknowledges receipt within 3–10 business days.

Document Review:

Verification and underwriting review often take 10–30 business days.

Requests for Additional Info:

Expect follow-up within 14–45 days if investigation is needed.

Payment Issuance:

Payments usually issued within 7–30 business days after approval.

Complex Investigations:

Suspected fraud or contested claims can extend timelines considerably.

Consequences of Incomplete or Incorrect Submissions

Claim Delay: Missing documents delay payment

Denial Risk: Incorrect beneficiary info may lead to denial

Reputational Risk: Frequent errors trigger escalated reviews

Fraud Investigation: Inaccurate statements may prompt fraud probes

Backup Withholding: Incorrect TIN can trigger 24% withholding

Legal Exposure: Signing as representative without authority risks liability

Practical Tips for Accurate and Efficient Completion

Apply these best practices to reduce processing time, avoid denials, and preserve legal enforceability when submitting claimant statements.

Pre-verify beneficiary details

Confirm policy numbers, beneficiary names, and dates with the policyholder’s documents or policy schedule before completing the form to avoid mismatches that cause denials or delays.

Use certified documents

Attach a certified copy of the death certificate and any required court documents for estates or guardianships; uncertified photocopies are often rejected.

Follow authentication guidance

When e-signing, choose authentication levels that meet insurer requirements; retain the audit trail showing signer identity, IP, and timestamps for legal defensibility.

Document representative authority

If a representative signs, include a power of attorney, letters testamentary, or other legal authorizations to prevent later challenges to authority.

Examples: How Electronic Claim Submissions Are Used

The following examples illustrate practical outcomes when claimant statements are completed and submitted correctly, including electronic workflows.

Fertility Centers Example

A healthcare provider used an electronic claimant submission to coordinate benefits quickly and securely

The portal captured signatures and attachments in one session
As a result, claims were processed with a complete audit trail and reduced follow-up for missing items, preserving patient privacy under HIPAA while shortening resolution time.

Real-World Insurer Workflow

A mid-size insurer routed claimant statements via a secure e-portal with conditional fields for representatives

Conditional fields prevented incomplete submissions
This decreased manual review tasks, sped up verifications, and improved claimant communication during the approval process.

Common eSignature Options for Claimant Statements and Key Pricing

Compare typical vendor starting prices and essential capabilities for handling claimant statements; signNow is listed first per table convention.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies	Varies	Varies

Frequently Asked Questions and Common Issues

Answers to common practical questions about completing, authenticating, and submitting the AIG Life Insurance Claimant Statement Form.

Need help? Contact support

What if I miss a required field?
If you omit required information, the insurer will typically flag the form and request completion; this causes processing delays. Provide complete responses and attach requested documents to avoid back-and-forth.
Can I sign electronically?
Yes, provided the electronic signature meets ESIGN (15 U.S.C. ch. 96) and applicable state e-signature standards (UETA or ESRA) and the insurer accepts e-signed submissions. Ensure a retained audit trail and any consumer disclosures where required.
Do I need a notary or witnesses?
Some states or specific situations require notarization or witnesses. Check the insurer’s instructions and state rules; when in doubt, obtain notarization to reduce future disputes.
What supporting documents are essential?
At minimum, include a certified death certificate and claimant ID. For estate or representative claims, attach letters testamentary, power of attorney, or probate documents as applicable.
How long until payment?
Timing depends on claim completeness and investigation. Simple, complete claims often resolve within weeks, while contested or complex claims may take months; provide requested documentation promptly.
Who can sign for a claimant?
The claimant, named beneficiary, or an authorized legal representative can sign. Representatives must supply documented authority such as power of attorney or court appointment to be accepted.

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