Prepaid Funeral Benefits Request for Assistance - Oklahoma Insurance Department

Funeral Home Prepaid Benefits Request for Assistance

Complete the following form if you are requesting assistance with Funeral Home Prepaid Benefits purchased in Oklahoma. We will research the request and reply via email.

"*" indicates required fields

Date of Request*

Individual Requesting Assistance

First Name*

Last Name*

Mailing Address*

City*

State*

Zip Code*

Phone Number

Email Address

How do you prefer to be contacted?

Phone

Both

Prepaid Benefit Contract Holder Information

First Name*

Middle Name*

Last Name*

Alternative or Maiden Names

Relationship to individual requesting assistance

Funeral Home (FH) that Originated the Prepaid Benefits

FH Name*

City*

State

Zip Code*

Were prepaid benefits funded by Life insurance or Trust backed?

Approximate Date of Purchase

If Life insurance, what is the name of the insurer?

Reason for request:

Please attach any supporting documents you may have:

File

Max. file size: 50 MB.

Supporting documents