Available Forms

SURENCY LIFE FORMS



          
Accelerated Benefits Form
If applying for accelerated benefits, the member must fill out this form and submit it to Surency Life & Health.
   
Accidental Death Claim Form    
If loss of life occurs due to an accident, check the Accidental Death Claim box on this form and submit it, along with all necessary documentation, to Surency Life & Health.  
   
Dismemberment Claim Form 
If dismemberment occurs, submit this form along with all necessary documentation to Surency Life & Health.
   
Life Claim Form    
If loss of life occurs, submit this form along with all necessary documentation to Surency Life & Health.
 
   
Submit completed forms to Surency by mail:
Attn: Surency Life
P.O. Box 789773
Wichita, KS 67278-9773