Verification Request Form

Great Southern Life verification request form for use by funding companies or funeral homes.

"*" indicates required fields

Assignment Company/ Funeral Home Name**

Requester Name*

Assignment Company/ Funeral Home Phone Number*

Requester Email*

Policy Number*

Deceased Name*

Deceased Date of Birth*

Assignment Number*

Beneficiary Name*

Upload Assignment and Verification Request

Drop files here or

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 15 MB, Max. files: 5.

An assignment form, signed by the beneficiary or beneficiaries, is required. Please note that this is for verification only. If you are submitting claimant statements, a death certificate, or other documents, upload them on our claims page: Greatsouthern.com/claims or send to forms@greatsouthern.com