ContractUniversal Claim Form • April 1st, 2021
Universal Claim Form Fax this direction Fax this form: 1-800-880-9325Or mail: P.O. Box 100195, Columbia, SC 29202 From: Number of pages: File Your Claim Online ▶ Simply log into your account at Coloniallife.com and click on “File an Online Claim”.▶ As an added convenience, you may also select Direct Deposit when filing online.▶ Not a member? Log onto Coloniallife.com and click on “Register” then “Join the Policyholder Website” to set up your account. Optional Service Release Agreement Please indicate below for optional services you desire. Any marks used (check mark, X, initials, etc.) will be considered as your authorization and will be processed as if they were selected.I authorize Colonial Life to facilitate processing this claim by releasing its details to the following individual(s) inquiring on my behalf.Note: Leave blank if you do not want anyone accessing your claim information. Sales representative Employer Spouse, family member or significant other Name: I want Colonial
Universal Claim FormUniversal Claim Form • October 11th, 2013
OPTIONAL SERVICE RELEASE AGREEMENT – Please initial below for optional services. Any other marks used (check mark, x, etc.) will not be considered as authorization and will be processed as blank.
Fax this directionUniversal Claim Form • September 17th, 2007
OPTIONAL SERVICE RELEASE AGREEMENT – Please initial below for optional services. Any other marks used (check mark, x, etc.) will not be considered as authorization and will be processed as blank.
ContractUniversal Claim Form • April 1st, 2021
Universal Claim Form Fax this direction Fax this form: 1-800-880-9325Or mail: P.O. Box 100195, Columbia, SC 29202 From: Number of pages: File Your Claim Online u Simply log into your account at Coloniallife.com and click on “File an Online Claim”.u As an added convenience, you may also select Direct Deposit when filing online.u Not a member? Log onto Coloniallife.com and click on “Register” then “Join the Policyholder Website” to set up your account. Optional Service Release Agreement Please indicate below for optional services you desire. Any marks used (check mark, X, initials, etc.) will be considered as your authorization and will be processed as if they were selected.I authorize Colonial Life to facilitate processing this claim by releasing its details to the following individual(s) inquiring on my behalf.Note: Leave blank if you do not want anyone accessing your claim information. Sales representative Employer Spouse, family member or significant other Name: I want Colonial
Universal Claim FormUniversal Claim Form • July 6th, 2012
OPTIONAL SERVICE RELEASE AGREEMENT – Please initial below for optional services. Any other marks used (check mark, x, etc.) will not be considered as authorization and will be processed as blank.
ContractUniversal Claim Form • April 26th, 2018
Universal Claim Form Fax this direction Fax this form: 1-800-880-9325Or mail: P.O. Box 100195, Columbia, SC 29202 From: Number of pages: Optional Service Release Agreement Please indicate below for optional services you desire. Any marks used (check mark, X, initials, etc.) will be considered as your authorization and will be processed as if they were selected.I authorize Colonial Life to facilitate processing this claim by releasing its details to the following individual(s) inquiring on my behalf.Note: Leave blank if you do not want anyone accessing your claim information. Sales representative Plan administrator Spouse, family member or significant other Name: I want Colonial Life to update me on the status of my claim through electronic messaging at my contact number indicated on this form. I un- derstand that messages will be left with anyone who answers the phone or on my answering machine. Note: To avoid blocked calls, you should program the number 1-800-325-4368 into your p
