Individual Claims Forms

Note: All forms are Adobe Acrobat Portable Document Files (PDF’s). Click on the Adobe icon to receive the latest Acrobat Reader for free.


For all individual life death claims, we must have an original or certified death certificate.

Please click each topic to collapse/expand each section to see the forms available.


  • The Individual Claim Department may be contacted directly at:
  • Security Mutual Life Insurance Company of New York
  • Attn: Individual Claims
  • P.O. Box 1625
  • 100 Court Street
  • Binghamton, NY 13902-1625

  • For Individual Death Claims
  • Telephone: 1-800-846-6305
  • E-mail: [email protected]
  • Fax: 1-607-773-2276

  • For Individual Accident Claims
  • Telephone: 1-800-927-8846 Option 2
  • E-mail: [email protected]
  • Fax: 1-607-773-2276