Life Insurance Claim Form

Submit your life insurance claims online. 

Required
 
1 Start 2 Dependent Info 3 Benefit Claimed 4 Beneficiary 5 Consent 6 Preview 7 Complete
 
 

Life Claim Form - Employer's Statement

 

Instructions

  1. This secure online form should be completed in its entirety by the employer.
  2. To avoid delay in benefits, please answer all questions completely (please provide as much beneficiary information as possible) and legibly.
  3. If you have any additional information (such as accident report, obituary, etc) which would help in the review of this claim, please fax to 1.800.255.6609.
  4. If you have any questions concerning completion of this form, please contact Group Life and Disability Claims at 1.800.245.1522, fax 1.800.255.6609 or Principal Life Insurance Company, Group Life and Disability Claims Department, Des Moines, IA 50392-0002.
  5. If you maintain the beneficiary designations, please fax a copy to 1.800.255.6609 Group Life Claims Department.

 

Employer Information

*Required

(ex: N12345-00001 or 1234567-10001)