John Hancock
John Hancock
www.johnhancock.comwww.johnhancocknewyork.comContact Us
Annuities Group Pensions Insurance College Savings Mutual Funds Long Term Care
Find
Home > Claims > Death Claim
Printer Friendly Version
Claims OverviewDeath ClaimAccelerated Benefit ClaimWaiver ClaimClaims FAQ
 


* Must be filled in
Your Contact Information:
Date:November 21, 2009
Your Name: *
Your Phone Number: * -   -   ext 
Your Email Address:
Your Fax Number: -   - 
Your Relationship to the Insured?
Insured's Information:
Insured's Name: *
Insured's Date of Birth: * (MM/DD/YYYY)

Policy Number(s) (list all):
Is this a survivorship policy?
NoYes 1st Death2nd Death
Date of Death: * (MM/DD/YYYY)
Cause of Death:
Name of the Country Death Occurred: *
USOther 
If Beneficiary is deceased, Date of Death: (MM/DD/YYYY)
Beneficiary Contact Information (if different from "Your Contact Information"):
Beneficiary Name: *
Beneficiary Phone Number: -   -   ext 

Address: *
Who should receive the Claim Form? *
BeneficiaryOther

Name and Mailing Address for mailing claim form (required if "Other" was selected in previous question):
Notes:


Submit the email form  Clear the email form 

Insurance products are issued by: John Hancock Life Insurance Company (U.S.A.), Boston, MA 02116 (not licensed in New York) and John Hancock Life Insurance Company of New York, Valhalla, NY 10595.

Download the free Adobe Acrobat Reader to view and print PDF files.
Email to usHelp
CareersPrivacy PolicyLegal