Transcription of LN Life Claims Department PO Box 8066 McKinney, TX 75070 …
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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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REQUEST FOR VERIFICATION, CALIFORNIA DEPARTMENT OF SOCIAL SERVICES, Authorization for Release of Information, APPLICANT, Information, Of Social Services, Department, Social Services, Release, Case Management, California, Services, Social, Life Claims Claimant’s Statement, S information, Release information