Unclaimed Funds Status

Please complete all fields marked with red asterisk (*) below and then click Submit.

PLEASE NOTE: Funds will be reissued only to the original payee, to the estate of the original payee or the payee's spouse when a copy of the death certificate is provided. Please attach any supporting documentation below.

If you have questions, please email PropertyRptg@medmutual.com or call (216) 687-7876.

Please enter your name and address as shown on the letter:

Name

Phone

Street Address

City

State

ZIP Code

Please complete the following using the information shown on the letter:

Check Date

Check Number

Amount

Do NOT include the $ dollar sign.

Check Status

The check was cashed
Please reissue to same address
Please reissue to new address below
Other [please provide explanation below]

Other Explanation

Replacement Check Info (complete if "Reissue to new address below" was selected)

Street Address

City

State

Zip

Please enter your First and Last Name in lieu of your signature

Signature

Signature Date

If you would like to provide supporting documentation, please attach file(s) below:

Death Certificate, Power of Attorney or Executor (png jpg img pdf doc docx file types allowed)You can upload a maximum of 3 files, each up to 4MB.

Unclaimed Funds Status

Please enter your name and address as shown on the letter:

Please complete the following using the information shown on the letter:

Replacement Check Info (complete if "Reissue to new address below" was selected)

Please enter your First and Last Name in lieu of your signature

If you would like to provide supporting documentation, please attach file(s) below:

You’re over the file size limit×Close

File upload limit reached×Close

Unsupported file formats×Close

You’re over the file size limit

File upload limit reached

Unsupported file formats