Insurance Company Contact Request Form - Manual Submission
To manually submit the Insurance Company Contact Request Form follow the steps below:
Step 1:
Download Insurance Company Contact Request Form, fill in all fields and print from your computer. If you do not have capability to download and/or print the form, please contact:
Sam Brooks, Assistant Director
(225) 342-1253
sbrooks@ldi.state.la.us
Step 2:
Please mail the completed form and a scanned copy of the Death Certificate to:
Louisiana Department of Insurance Divsion of Life and Annuities 1702 N. 3rd Street Baton Rouge, LA 70802