Foresters Life Insurance and Annuity Company Affidavit and Agreement Pertaining to Proceeds of Lost or Destroyed Contract/PolicyAffidavit and Agreement • July 31st, 2015
Contract Type FiledJuly 31st, 2015I, , being duly sworn, depose and say that I am the Beneficiary under Contract/Policy No. which was issued by Foresters Life Insurance and Annuity Company (“FLIAC”); that said contract/policy has been lost or destroyed and I have no knowledge as to its whereabouts; that no person or persons, corporation or association, has any claim or interest in said contract/policy by virtue of any sale, assignment or pledge thereof, as follows: