Equitable Reserve Association

DEATH CLAIM

Proof of Death

These forms are to be used by the claimant when filing a proof of death statement, and the forms are state-specific. Please choose the appropriate form based on your state. In addition, prior to receiving the state-specific PDF form, you will be asked to complete a notification form. This is for your benefit and will send a notification to the home office to establish the date for interest accrual.

• All States EXCEPT CO (PDF) (online form will proceed the PDF)
• State of Colorado (CO) (PDF) (online form will proceed the PDF)

Assign Proceeds

This form is used to assign proceeds to another entity (i.e. to a funeral home) other than the beneficiary.

• Assign Proceeds (PDF)

WAIVER OF PREMIUM CLAIM

This form will require proof of disability and attending physician's statement. The forms are state-specific. Please choose the appropriate form based on your state.

• All States EXCEPT CO, IL, IN, KY, MN, OH (PDF)
• State of Colorado (CO) (PDF)
• State of Illinois (IL) (PDF)
• State of Indiana (IN) (PDF)
• State of Kentucky (KY) (PDF)
• State of Minnesota (MN) (PDF)
• State of Ohio (OH) (PDF)

All forms are provided in PDF format and will require the Adobe Acrobat Reader.