Start Your Claim

We understand the loss of a loved one is very stressful, and we’re here to help in any way we can. During this process, please feel free to reach out at any time.

Please fill out and submit the required information through the form below. It is also helpful if you fill out the non-required information as best you can. Using this electronic form enables us to pre-fill much of the claim packet for easier completion. Submitting this form officially notifies us and starts the claim process. We will contact you or the beneficiary listed to follow up and advise you of the next steps in the process.
* INDICATES REQUIRED FIELD -- Please correct the errors noted below to complete submission.

Tell Us About Yourself

Tell Us About the Deceased

Beneficiary Information

Funeral Home/Obituary Information

 The information collected in this form by Protective will be used to offer you services that meet your needs and for other business purposes. Please visit our Privacy Policy for more information about our information practices, including information about your privacy choices.