Start a claim

About the deceased

Please use this form to start the claims process. Information regarding the deceased will be used to identify Allianz Life policies or contracts held by the deceased.

If you are an Allianz Rep/Agent or current policy holder, please register or login 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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About the deceased

About You

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