Complete the Following Form

Name

Date of Job Loss

Phone

Street Address

City

State

Zip

Check the type of Job Loss Protection Benefits you have: Property Loans/Timeshares, Mortgage Payments
Consumer Loans/Automobiles, Watercraft, Furniture
Membership/Association/Affinity Group
Educational Products/Student Loans, Tuition, Child/Eldercare
Consumer Products/Cell Phone Services, Utilities
Other/Unknown

Comments

After you have verified the above information, please click the Submit button below.

Initial Notification of Job Loss

We know a period of unemployment can be stressful and it is sometimes hard to determine what to do next. We’re here to help and make this part as stress-free as possible.

The first step is to notify us. Please complete the following information to let us know you’re no longer working. We will send you the appropriate paperwork within 48 business hours of this notification via email unless you instruct us otherwise in the Comments section. We will contact you via telephone or email if we have additional questions.

Not Reporting a Job Loss

If you have questions about a Job Loss Protection benefit, and are not reporting a job loss, you may contact the benefits administrator:

Phone: 844-557-5677
Fax: 877-306-9484
Email: benefits@joblossbenefits.com