1-800-621-8981 321 North Clark Street Chicago, Illinois 60610-5209

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• Insurance Claim
• Change of Beneficiary
• Automatic Payment Plan
• Dividend Assignment
• Charitable Gift Fund
• Information Request

Claim Forms

Please select the plan Claim Form you need from the list below. Once the form appears on your screen, print the form and follow the instructions provided. If you have any question which is the correct form for you to download, or the claim form for your plan does not appear here, please contact your Personal Endowment Representative at 1-800-621-8981.

• Excess Major Medical
• Group Hospital Money Plan
• Disability Income

All of these documents have been created using Adobe Acrobat and are saved as Portable Document Format (PDF) files. They can be viewed using Adobe Acrobat Reader. If you do not have the Adobe Acrobat Reader, download and install the reader by pushing the "Get Acrobat" Reader button below.

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