I certify that I have made a diligent search of the deceased person's records and property, including bank statements and safety deposit boxes, and have asked family members to identify all life policies or 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 directly to me only if they have reason to believe that the deceased has any policies with them and that I am authorized to receive this information.

I further understand that the Department of Insurance's only role with this request is to forward all North Carolina licensed life insurance companies this completed form. I understand that the company may require additional information from me, including a certified copy of the death certificate and documentation of my legal authority to obtain information about the deceased.

NCDOI will forward requests made through the Lost Policy Finder service to all North Carolina licensed life insurance companies. Where a requestor has provided a valid email address, NCDOI will notify the requestor, at the conclusion of the search process by all insurers, whether a policy, contract or certificate has been identified by any insurer.

An insurer may require submission of additional information and documents, including documentation of the requestor's legal authority to request or obtain information about the deceased.