VA · Official form

VA Form 29-4125, Claim for One Sum Payment - Government Life Insurance

VA Form 29-4125 is the beneficiary's claim for a lump-sum payout of a government life insurance policy, such as National Service Life Insurance, after the insured veteran's death.

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What is VA Form 29-4125?

VA administers several older government life insurance programs, including National Service Life Insurance (NSLI), Veterans' Special Life Insurance, and Veterans' Reopened Insurance. When an insured veteran dies, each named beneficiary claims their share, and this form is the claim for payment in one sum rather than in installments. A companion form, VA Form 29-4125a, is used to elect monthly payments instead.

The form identifies the insured, the policy if known, and the beneficiary, and asks about the veteran's death. VA matches the claim against its insurance records, so an exact policy number helps but is not always required. Note that SGLI and VGLI claims are handled by the Office of Servicemembers' Group Life Insurance with different forms, not this one.

Who files VA Form 29-4125?

Named beneficiaries of NSLI and other VA-administered government life insurance policies
Surviving spouses, children, or other designated beneficiaries after the insured veteran's death
Executors or representatives claiming on behalf of an estate when it is the beneficiary
Guardians filing for minor or incapacitated beneficiaries

How to fill out VA Form 29-4125

Locate the policy details if you can: the policy number, prefix (such as V or RS), and any VA insurance correspondence.
Complete the sections identifying the insured veteran, the death, and yourself as beneficiary.
Attach a certified copy of the death certificate.
Sign and date the claim; each beneficiary files their own claim for their share.
Mail the claim to the VA Insurance Center address in the form instructions, or ask about submitting through va.gov; contact the VA insurance line if you are unsure whether a policy exists.

Quick fill VA Form 29-4125 on this page

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These are the form's own fields, in the order they appear on the pages. Fill in what you know; anything left blank stays a fillable field in the PDF, so you can finish it in any PDF reader. Nothing you type here is sent to VA.

Page 1 12 fields

1. FIRST, MIDDLE, LAST NAME OF INSURED VETERAN.

4. DATE OF DEATH. Enter 2 digit month, 2 digit day and 4 digit year.

2. SOCIAL SECURITY NUMBER.

3. INSURANCE POLICY NUMBER. (If more than one policy, please complete a separate form for each policy number).

5. First, Middle, Last Name of Beneficiary. 4. FIRST, MIDDLE AND LAST NAME OF BENEFICIARY (Please print).

6. SOCIAL SECURITY NUMBER OF BENEFICIARY.

5. RELATIONSHIP TO INSURED.

7. DATE OF BIRTH OF BENEFICIARY. Enter 2 digit month, 2 digit day and 4 digit year.

9. BENEFICIARY'S MAILING ADDRESS (Number and Street or P.O. Box (MUST BE COMPLETED).

10. MAILING ADDRESS (City, State, ZIP Code) (MUST BE COMPLETED).

11. EMAIL ADDRESS.

12. DAYTIME TELEPHONE NUMBER (Include Area Code).

Page 2 19 fields

20. FULL NAME OF ESTATE.

13. FULL NAME OF TRUST.

18. TRUST AGREEMENT DATE. Enter 2 digit month, 2 digit day and 4 digit year.

17. EMAIL ADDRESS.

19. E I N OR T I N NUMBER (FOR TRUST).

14. FULL NAME OF TRUSTEE.

15. MAILING ADDRESS (Number and Street).

16. DAYTIME TELEPHONE NUMBER.

21. FULL NAME OF COURT-APPOINTED EXECUTOR/ADMINISTRATOR.

22. MAILING ADDRESS (Number and Street or P.O. Box, City, State, ZIP Code (MUST BE COMPLETED).

24. EMAIL ADDRESS.

23. DAYTIME TELEPHONE NUMBER.

25. E I N OR T I N NUMBER (FOR ESTATE).

26. FULL NAME OF ORGANIZATION, CHARITY, OR LEGAL ENTITY.

27. FULL NAME OF AUTHORIZED REPRESENTATIVE.

28. MAILING ADDRESS (Number and Street or P.O. Box, City, State, ZIP Code (MUST BE COMPLETED).

30. EMAIL ADDRESS.

29. DAYTIME TELEPHONE NUMBER.

31. E I N OR T I N NUMBER (FOR ORGANIZATION, CHARITY, OR LEGAL ENTITY)

Page 3 16 fields

32. NAME OF FINANCIAL INSTITUTION.

33. TYPE. CHECKING. Check box

34. TYPE. SAVINGS. Check box

34. BANK ROUTING NUMBER (NINE DIGIT FIELD).

35. BANK ACCOUNT NUMBER.

37. DATE SIGNED. Enter 2 digit month, 2 digit day and 4 digit year.

38. B. MAILING ADDRESS OF FIRST WITNESS.

38. C. TELEPHONE NUMBER OF FIRST WITNESS (Include Area Code).

38. A. PRINTED NAME OF FIRST WITNESS.

38. D. SIGNATURE OF FIRST WITNESS.

38. E. DATE SIGNED. Enter 2 digit month, 2 digit day, 4 digit year.

38. B. MAILING ADDRESS OF FIRST WITNESS.

38. C. TELEPHONE NUMBER OF FIRST WITNESS (Include Area Code).

38. A. PRINTED NAME OF FIRST WITNESS.

38. D. SIGNATURE OF FIRST WITNESS.

38. E. DATE SIGNED. Enter 2 digit month, 2 digit day, 4 digit year.

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Frequently asked questions

Does this form cover SGLI or VGLI claims?

No. SGLI and VGLI are administered through the Office of Servicemembers' Group Life Insurance and use their own claim forms. VA Form 29-4125 is for the older VA-administered policies such as NSLI.

What if I do not know the policy number?

File anyway with as much identifying information about the veteran as you have, such as full name, service number, Social Security number, and dates of service. VA can search its insurance records to locate the policy.

Can I choose monthly payments instead of a lump sum?

Yes. Use VA Form 29-4125a to claim payment in monthly installments where the policy allows it. The one sum option on this form pays the full share at once.

VA Form 29-4125, Claim for One Sum Payment - Government Life Insurance

What is VA Form 29-4125?

Who files VA Form 29-4125?

How to fill out VA Form 29-4125

Quick fill VA Form 29-4125 on this page

Frequently asked questions

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