TRICARE For Life Executor/Executrix of Estate Notification

Used to inform TRICARE For Life of the unfortunate passing of a loved one and to notify us who is handling the estate of the deceased.

Download Executor/Executrix of Estate Notification (PDF) 

Executor/Executrix of Estate Notification

TRICARE For Life must have this form on file to release information on the estate of the deceased. You must have the following information to complete the form properly:

• Name and sponsor number of the deceased(the Social Security Number of the family member who served)
• The name of the legally appointed representative of the estate
• If you are not the legally appointed representative, provide:
  • Your name and address
  • Your signature
  • The name of the deceased
  • The date of death
  • Your relationship to the deceased
• Name and address of any additional representatives