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LN Life Claims Department PO Box 8066 McKinney, TX 75070 …

R-3813 Page 1 of 4 Underwritten by Liberty National Life Insurance Company, a Globe Life companyLN Life Claims DepartmentPO Box 8066 McKinney, TX 75070f.: 214-250-5141 | carefully read all of the following information before completing this person who knowingly presents a false or fraudulent claim for payment of a loss is guilty of a crime and may be subject to fines and confinement in state , Louisiana, Rhode Island and West Virginia: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in : A person who knowingly and with intent to injure, defraud, or deceive an insurance company files a claim containing false, incomplete, or misleading information may be prosecuted under state.

Insured’s Information 1. Insured/Deceased’s Name in Full List any other names by which the deceased may have been known such as maiden name, hyphenated name, nickname, alias, or derivative form of first and/or middle name 2. Policy Number(s) 3. Insured/Deceased’s Birth Date 4. Date of Death Cause of Death 5.

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