Notice of Death Claim

To report the death of a person who is insured by a Horace Mann life insurance policy or annuity, please provide us with the following information.

Information of the deceased
First name (required)	Middle initial
Last name (required)
Nickname or Other names used (e.g., maiden name, hyphenated name, nickname, derivative form of first and/or middle name or any alias)	Cause of death? NaturalUnknownAccidental
Name of insured (if different than deceased)	Date of birth (required)
Policy number(s), if known (enter all that apply):
Life policy #	Annuity/supplemental contract #
Group policy/certificate #
Auto policies? UnknownYesNo	Property policies? UnknownYesNo
Address (required)	City (required)
State (required)	Zip (required)
Date of death (required)
Death reported by
First name (required)	Last name (required)
Address (required)	City (required)
State (required)	Zip (required)
Daytime phone #	Alternate phone #
Email
Relationship to deceased
Additional comments
Funeral home information
Funeral home name (required)
Address	City
State	Zip
Phone #

WBCL-0009

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