Form INS2502 "Missing Life Insurance/Annuity Search Request" - Ohio

What Is Form INS2502?

This is a legal form that was released by the Ohio Department of Insurance - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2019;
  • The latest edition provided by the Ohio Department of Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form INS2502 by clicking the link below or browse more documents and templates provided by the Ohio Department of Insurance.

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Download Form INS2502 "Missing Life Insurance/Annuity Search Request" - Ohio

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Consumer Service Division
Ohio Department of Insurance
rd
50 W. Town St., 3
Fl.
Mike DeWine – Governor
Suite 300
Jillian Froment – Director
Columbus, OH 43215
(614) 644-2673
(800) 686-1526
Missing Life Insurance/Annuity Search Request
Fax (614) 644-3744
www.insurance.ohio.gov
CONFIDENTIAL PERSONAL INFORMATION
Instruction Sheet
Missing Life Insurance/Annuity Search Service: The Ohio Department of Insurance (the “Department”)
provides a missing policy search service to Ohio residents and their families to help them identify Ohio in force
individual life insurance policies on the life of a deceased family member or Ohio individual annuity contracts
where the deceased family member is an annuitant.
INSTRUCTIONS: An executor or legal representative of:
(1) a deceased resident of Ohio; or
(2) a deceased, former resident of Ohio, who may have resided in Ohio at the time a policy was issued or an
annuity purchased
may submit a Missing Life Insurance/Annuity Search Request to the Department by completing the
information on page two (2) of this form, signing it before a Notary Public, and mailing it, in an envelope
marked “Confidential” along with an original or a photocopy of the certified death certificate to:
Missing Life Insurance/Annuity Search Request
Ohio Department of Insurance
50 West Town Street, Suite 300
Columbus, OH 43215
Upon receipt of the completed Request form and death certificate, the Department will:
(1) forward the completed Missing Life Insurance/Annuity Search Request form and any attachments, along
with the death certificate to all Ohio licensed life insurance companies; and
(2) ask that they search their records to determine whether they have any Ohio in force individual life
insurance policies on the life of the deceased person or Ohio individual annuity contracts where the
deceased person is an annuitant; and
(3) ask that they respond directly to the requestor ONLY IF they have any in force individual life insurance
policies insuring the life of the deceased or any in force individual annuity contracts naming the
deceased as an annuitant, AND IF the requestor is authorized to receive this information. The
Department will not make further inquiries to the companies on the requestor’s behalf in connection
with this request.
Accredited by the National Association of Insurance Commissioners (NAIC)
INS2502 (Rev. 01/2019)
Page 1 of 2
Consumer Service Division
Ohio Department of Insurance
rd
50 W. Town St., 3
Fl.
Mike DeWine – Governor
Suite 300
Jillian Froment – Director
Columbus, OH 43215
(614) 644-2673
(800) 686-1526
Missing Life Insurance/Annuity Search Request
Fax (614) 644-3744
www.insurance.ohio.gov
CONFIDENTIAL PERSONAL INFORMATION
Instruction Sheet
Missing Life Insurance/Annuity Search Service: The Ohio Department of Insurance (the “Department”)
provides a missing policy search service to Ohio residents and their families to help them identify Ohio in force
individual life insurance policies on the life of a deceased family member or Ohio individual annuity contracts
where the deceased family member is an annuitant.
INSTRUCTIONS: An executor or legal representative of:
(1) a deceased resident of Ohio; or
(2) a deceased, former resident of Ohio, who may have resided in Ohio at the time a policy was issued or an
annuity purchased
may submit a Missing Life Insurance/Annuity Search Request to the Department by completing the
information on page two (2) of this form, signing it before a Notary Public, and mailing it, in an envelope
marked “Confidential” along with an original or a photocopy of the certified death certificate to:
Missing Life Insurance/Annuity Search Request
Ohio Department of Insurance
50 West Town Street, Suite 300
Columbus, OH 43215
Upon receipt of the completed Request form and death certificate, the Department will:
(1) forward the completed Missing Life Insurance/Annuity Search Request form and any attachments, along
with the death certificate to all Ohio licensed life insurance companies; and
(2) ask that they search their records to determine whether they have any Ohio in force individual life
insurance policies on the life of the deceased person or Ohio individual annuity contracts where the
deceased person is an annuitant; and
(3) ask that they respond directly to the requestor ONLY IF they have any in force individual life insurance
policies insuring the life of the deceased or any in force individual annuity contracts naming the
deceased as an annuitant, AND IF the requestor is authorized to receive this information. The
Department will not make further inquiries to the companies on the requestor’s behalf in connection
with this request.
Accredited by the National Association of Insurance Commissioners (NAIC)
INS2502 (Rev. 01/2019)
Page 1 of 2
Consumer Service Division
Ohio Department of Insurance
rd
50 W. Town St., 3
Fl.
Mike DeWine – Governor
Suite 300
Jillian Froment – Director
Columbus, OH 43215
(614) 644-2673
(800) 686-1526
Missing Life Insurance/Annuity Search Request
Fax (614) 644-3744
www.insurance.ohio.gov
CONFIDENTIAL PERSONAL INFORMATION
Requestor’s Contact Information (Please print)
Date of Request
Print Full Name of Requestor
Mailing Street Address of Requestor
City, State, Zip of Requestor
Requestor’s E-mail Address
Requestor’s Daytime Phone Number
Deceased Person’s Information (Please print)
Full Name of Deceased Insured
(First, MI, Last)
Other legal names previously used
(i.e. maiden name)*
Date of Birth
Social Security Number
Current & Previous Address(es)*
City, State, Zip Code
* Please attach separate page if more space is needed.
Relationship of Requestor to Deceased Person (check all that apply)
Spouse
Executor or Legal Representative
Child
(18 or Older)
Attorney
Other (please specify)
Requestor’s Certification and Notarized Signature:
I certify that I have made a diligent search of the deceased person’s records and property, including bank statements, safety deposit
boxes, etc., and have made inquiries to family members to identify all in force individual life policies or individual annuity contracts
that I have reason to believe covered the life of the deceased person named above. I understand that life insurance companies will
respond to me directly ONLY IF they have reason to believe that this deceased person has any individual policies in force with them
AND that I am authorized to receive this information. I further understand that the Department’s only role in connection with this
request is to forward to all Ohio licensed life insurance companies this completed Missing Life Insurance/Annuity Search Request
form and a photocopy of the certified death certificate that I have provided. I understand that a life insurance company may require
additional information from me, including documentation of my legal authority to request or obtain information about the deceased
person that I have named. For the purposes of privacy and protection of confidential personally identifiable information, I understand
that all original documents that I submit to the Ohio Department of Insurance will not be returned to me. I further understand that all
original documents will be destroyed pursuant to Department Retention Schedules.
I certify that the information that I have provided is complete and accurate in all respects.
Requestor’s Signature:_____________________________________________________
Sworn to and subscribed in my presence this _______ day of _______________, 20____.
By____________________________________________
NOTARY
Notary Signature__________________________________________________________
SEAL
Notary Public, State of______________________________. My Commission Expires___/___/_____.
My Notary Commission is recorded in the County of _______________________________________.
Accredited by the National Association of Insurance Commissioners (NAIC)
INS2502 (Rev. 01/2019)
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