Life Insurance Policy Search Form – Online Submission

To electronically submit the Insurance Company Contact Request Form to the Louisiana Department of Insurance, please fill out the fields below. We send these requests to all life insurance companies which are currently licensed to sell policies in Louisiana. Please know that companies that have been licensed in the past and are no longer licensed in our state will not receive a search request. Some companies may not be able to search their files electronically, so it is possible that there may be some active policies which cannot be located.

Date of request

* Required fields Information of the Deceased

First Name: *

Middle Initial:

Last Name: *

Street: *

City: *

State: *

Zip: *

Date of Birth: *

Open the calendar popup.

Date of Death: *

Open the calendar popup.

Social Security Number:

Inquirer's Information

Email Address:

First Name: *

Middle Initial:

Last Name: *

Street: *

City: *

State: *

Zip: *

Relationship to Deceased: *

Daytime Phone Number: *

Any Additional Information:

Death Certificate Submission

Instructions: To attach a copy of the Death Certificate, click on the browse button below. A window will appear which will allow you to browse through your local computer to find the correct file. Select the file and click the Open button.

Please only use jpg, tif, gif, bmp, png or wmf image formats. Please limit the file size to less than 4 megabytes.

Attached Death Certificate:

Opt Out Method: If you do not wish to submit a copy of the Death Certificate online, please check the opt-out option and then select a method below that you wish to use to send the certificate.

Opt Out

Death Certificate Submission Method: Please select a send method.

Your request cannot be handled without a copy of the death certificate. If it is not submitted online, then it must be submitted by one of the other options listed below.

Fax
Mail
Other If Other, type method here:

Contact Information:

Office of Consumer Services
1-800-259-5300

Mailing Address:

Louisiana Department of Insurance
Divsion of Life and Annuities
1702 N. 3rd Street
Baton Rouge, LA 70802

Fax Number: (225) 219-7815

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