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Living Benefit To help us facilitate your claim, we appreciate receiving the requirement stated below. For your convenience, the claim forms can be downloaded on this page. An Acrobat Reader software is required to download the form. Disability Benefit Claimants Statement - Disability Attending Physician’s Statement-Disability Admitting History / Clinical Abstract Certificate of Employment, if previously employed All available laboratory tests as specified in the Attending Physician’s Statement Claimant’s Valid Identification Document (ID) Payor’s Benefit Payor’s Death Death Certificate (Original or Certified True Copy) Attending Physician’s Statement-Death Claim - should be filled out by insured’s Attending Physician Claimant’s ID Payor’s Disability Please refer to requirement on Disability Benefit Hospital Income Benefit Hospital Income Benefit Claim Form Hospital Billing Statement Admitting History / Clinical Abstract Claimant’s Valid Identification Document (ID) Accident Benefit Accident Benefit Claim Form Hospital Billing Statement Admitting History / Clinical Abstract Claimant’s Valid Identification Document (ID) Health Benefit Health Benefit Claim Form Detailed Hospital Billing Statement Admitting History / Clinical Abstract Claimant’s Valid Identification Document (ID) Female Benefit (Eve / Her Life) Female Benefit Claim Form Hospital Billing Statement, for claim on Childbirth Admitting History / Clinical Abstract Record of Operation, for claim on surgical benefit All available laboratory tests as specified in the Attending Physician’s Statement Claimant’s Valid Identification Document (ID) Accelerated Major Disease Benefit/ Major Disease Benefit / Critical Illness Benefit Claimants Statement Attending Physician’s Statement Myocardial Infarction Coronary Artery Bypass Surgery Stroke Cancer Kidney Failure Major Organ Transplant Paralysis Blindness Multiple Sclerosis Loss of Limbs Coma Amyotrophic Lateral Sclerosis Aplastic Anemia Chronic Liver Disease Chronic Relapsing Pancreatits End Stage Lung Disease Heart Valve Replacement Loss of Hearing Loss of Speech Major Burns Medullary Cystic Disease Muscular Dystrophy Parkinson’s Disease Poliomyelitis Progressive Bulbar Palsy Progressive Muscular Atrophy Surgery to Aorta Terminal Illness Total and Permanent Disability Systemic Lupus Erythomatous Hemolytic Streptococcal Gangrene Occupationally Acquired HIV Encephalitis Severe Rheumatoid arthritis Benign Brain Tumor Spinal Muscular Atrophy Primary Lateral Sclerosis Fulminant Viral Hepatitis Primary Pulmonary Arterial Hypertension Major Head Trauma Bacterial Meningitis Apallic Syndrome Alzheimer’s Disease / Irreversible Organic Degenerative Brain Disorders (Dementia) Cardiomyopathy Other Serious Coronary ArteryDisease AIDS due to blood transfusion Creutzfeldt_Jakob Disease Admitting History / Clinical Abstract Record of Operation, if any All available laboratory tests as specified in the Attending Physician’s Statement Claimant’s Valid Identification Document (ID)

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