Report a Death

Please use this form to notify us of a passing. Begin by entering information about the deceased, followed by your own contact details.

Once submitted, we’ll locate the appropriate Allianz® policies or contracts and send the listed beneficiary/beneficiaries a claim form packet with instructions for completing the claim.

If you are a financial professional or current Allianz® policyholder, please register or log in before completing the form below.

First Name*

Last Name*

Date of death*

Date of birth*

Last 4 digits of SSN*

Policy/Contract Number

+ Add one more policy

About You

Allianz may need to contact you as the claims process proceeds. Please provide your contact information below.

Please note: All beneficiaries listed on the policy/contract will then be contacted directly, receive a claim form packet in the mail, and speak with Allianz about the claim process and paperwork.

Your relationship to the deceased*

Please Specify (If Other is selected)

First name*

Last name*

Email address*

Phone number*

ext.

Address 1*

Address 2

Address 3

City*

State/Province

Country*

Zip/Postal Code

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