GapPlusPlan.com for UBA Members

409 W VICKERY BLVD, FORT WORTH, TX 76104 | 866.438.4274

Claim Forms

Member Driven Value.

Group Accident Claim Forms for
Guarantee Trust Life Insurance 

For Gap AME Plans purchased
on 09-03-15 until 10-05-16. 

Click on the Buttons Below to Download Claim Forms:

Click here to download the accidental death claim form
click here to download the accidental dismemberment and loss of sight claim form
click here to download the accident medical expense claim form