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Claimant's Statement

Last updated: May 13, 2025
Claimant's Statement

A claimant's statement is a formal document submitted to an insurance company to request the disbursement of benefits following the death of a policyholder. It includes details about the deceased, the beneficiary, and relevant claim information.

Fields

Field Description Example
full_name_of_deceased The full name of the deceased individual. John Doe
usaa_number_of_deceased The unique USAA identification number assigned to the deceased. 987654321
date_of_birth The birth date of the deceased. 1950-06-15
contract_numbers The policy contract numbers associated with the deceased. A12345-67890, B54321-98765
date_of_death The date of death of the policyholder. 2024-09-10
cause_of_death The cause of death as stated on the claim form. Natural Causes
manner_of_death The classified manner of death: Natural, Suicide, Accident, Homicide, Unknown, or Other. Natural
signature_of_beneficiary The name of the beneficiary signing the claim form. Jane Smith
date_of_signature The date the beneficiary signed the claimant's statement. 2024-09-15
beneficiary_date_of_birth The birth date of the beneficiary. 1975-08-25
beneficiary_ssn_or_tin The Social Security Number or Tax Identification Number of the beneficiary. 123-45-6789
beneficiary_name The full name of the beneficiary or authorized representative. Jane Smith
citizenship_status The citizenship status of the beneficiary (U.S. Citizen, Resident Alien, Non-Resident Alien). U.S. Citizen
beneficiary_mailing_street_address The mailing street address of the beneficiary. 123 Elm Street
beneficiary_mailing_city The city of the beneficiary's mailing address. Springfield
beneficiary_mailing_state The state of the beneficiary's mailing address. IL
beneficiary_mailing_zip_code The ZIP code of the beneficiary's mailing address. 62704
beneficiary_phone_number The phone number of the beneficiary. 555-123-4567
beneficiary_physical_street_address The physical street address of the beneficiary. 123 Elm Street
beneficiary_physical_city The city of the beneficiary's physical address. Springfield
beneficiary_physical_state The state of the beneficiary's physical address. IL
beneficiary_physical_zip_code The ZIP code of the beneficiary's physical address. 62704
mailing_address_same_as_physical Indicates if the mailing address is the same as the physical address (Yes or No). Yes