Affidavit of Lost Policy Instructions

Affidavit of Lost Policy

If you are unable to locate your original life insurance policy, you may use an Affidavit of Lost Policy in its place. This affidavit may be used in lieu of an original policy for the following cases:

  • Making a death claim on a policy
  • Surrendering a policy for its cash value

PLEASE NOTE: An Affidavit of Lost Policy must be signed by the owner and his/her signature must be witnessed by a valid Notary Public. For your protection, all Affidavits of Lost Policy will be verified with the policy owner's signature we have on file.

Instructions on Completing an Affidavit of Lost Policy

  1. Open the Affidavit of Lost Policy form below in Adobe Acrobat Reader
  2. Fill out the fields in the form and then print it out
  3. Have a Notary Public witness your signature
  4. Mail the form to the Company home office:
    American Savings Life Insurance Company
    935 East Main Street, Suite 100
    Mesa, AZ 85203-8849

If you have any questions, you may call us at 480-835-5000 or toll-free at 1-800-880-2112.

Download Affidavit of Lost Policy

Download Form

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