![]() | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
TITLE 50: INSURANCE
CHAPTER I: DEPARTMENT OF INSURANCE SUBCHAPTER l: PROVISIONS APPLICABLE TO ALL COMPANIES PART 920 UNCLAIMED LIFE INSURANCE BENEFITS SECTION 920.ILLUSTRATION A ILLINOIS DEPARTMENT OF INSURANCE LOST POLICY FINDER SERVICE FORM
Section 920.ILLUSTRATION A Illinois Department of Insurance Lost Policy Finder Service Form
320 W. Washington Street Springfield IL 62767 Main Phone 866-445-5364 Local 217-557-6955 TDD 217-524-4872 insurance.illinois.gov
Illinois Department of Insurance Lost Policy Finder Service
The Illinois Department of Insurance can forward a consumer's request to locate and identify individual life insurance policies or annuity contracts of a deceased family member.
*******IMPORTANT: Life insurers will respond directly to you ONLY IF they have reason to believe the deceased has individual policies or contracts with them AND you are authorized to receive this information.*******
CONFIDENTIAL PERSONAL INFORMATION PLEASE WRITE CLEARLY IN BLACK OR BLUE INK
Deceased Person's Information
*Please attach separate page if more space is needed
Relationship of Requestor to the Deceased Person (check all that apply)
Upon receipt of the fully completed request form and proof of death, such as a death certificate copy, the Department of Insurance will:
● Forward the form and attachments, along with the proof of death, to all Illinois-licensed life insurers. ● Ask that the insurers search their records to determine whether they have any individual life insurance policies or annuity contracts in the name of the deceased. ● Ask that the insurers respond directly to the requestor only if they have any individual life insurance policies or annuity contracts naming the deceased, and if the requestor is authorized to receive this information.
REQUESTOR'S CERTIFICATION
I certify that I have made a diligent search of the deceased person's records and property, including bank statements and safety deposit boxes, and have asked family members to identify all individual life policies or individual annuity contracts that I have reason to believe covered the life of the deceased person named above. I understand that life insurers will respond directly to me only if they have reason to believe the deceased has any individual policies with them and I am authorized to receive this information.
I understand that the Department of Insurance's only role with this request is to forward to all Illinois licensed life insurers this completed form and the proof of death. I understand that the Department may reject this request if the Department, in its sole discretion, deems it to be incomplete, frivolous, or unduly burdensome. I understand that an insurer may require additional information from me, including the original death certificate and documentation of my legal authority to request or obtain information about the deceased.
For privacy and protection of confidential personally identifiable information, I understand all original documents I submit to the Illinois Department of Insurance will not be returned. I further understand all original documents I submit with this request will be destroyed pursuant to Department retention schedules.
I certify that the information I have provided is complete and accurate.
Requestor's Signature: ______________________________________________________ |