Please select one of the following claim forms:

• Death Claim Form
• Long Term/Home Health Care Form
• Accelerated Death Benefit Form (For Terminal Illness)
• Waiver of Premium Initial Claim Form
• Continuance Waiver of Premium Claim Form
• Permanent Waiver of Premium Claim Form

Please complete the appropriate claim form, sign and mail it to the address indicated on the form. If faxing your claim form to us, we ask that the original be sent via mail to assure timely service of your claim. Our fax number appears in the upper left-hand corner of our claim forms for your convenience.

Mail your proof to:	Trustmark Insurance Company Attn: Department P383 PO Box 7937 Lake Forest IL 60045
Or fax your information to:	1-847-615-3128