Free Delaware Affidavit of Death Template
Delaware Affidavit of Death
Introduction
I, [YOUR NAME], solemnly declare and affirm under penalty of perjury under the laws of the State of Delaware that I am the [RELATIONSHIP TO THE DECEASED] of the late [DECEASED PERSON'S NAME], who passed away on [DEATH DATE].
Statement of Facts
I certify the following facts pertaining to the death of [DECEASED PERSON'S NAME]:
-
[DECEASED PERSON'S NAME] was a policyholder with your esteemed company and held a life insurance policy with your organization.
-
The death of [DECEASED PERSON'S NAME] occurred on [DEATH DATE], at [PLACE OF DEATH], as evidenced by the attached death certificate issued by the Delaware Department of Health.
-
I am hereby formally notifying [INSURANCE COMPANY NAME] of the death of [DECEASED PERSON'S NAME] for the purpose of claiming any life insurance benefits payable under the aforementioned policy.
-
I understand that any benefits payable under the policy will be subject to the terms, conditions, and exclusions outlined in the policy contract.
-
Enclosed with this affidavit is a certified copy of the death certificate issued by the [ISSUING AUTHORITY NAME] for your records and verification purposes.
-
I request that [INSURANCE COMPANY NAME] promptly initiate the necessary procedures to process the life insurance claim and provide guidance on any additional documentation or steps required to facilitate the claim process.
-
Please direct any correspondence or communication regarding this matter to the undersigned at the address provided above.
Signature
I hereby affix my signature to this affidavit on this [DATE].
[YOUR NAME]
[RELATIONSHIP TO THE DECEASED]
Subscribed and sworn to before me this [DATE] by [YOUR NAME], who is personally known to me or who has produced [IDENTIFICATION DOCUMENT] as identification.
[NOTARY PUBLIC'S NAME]
My Commission Expires:
