Miss. R. Civ. P. Form 13
As amended through October 31, 2024
1. On or about the ____________ day of ________________, 20_____________, defendant issued a policy whereby the defendant insured the life of ___________________________________ who died on the _______ day of __________________ , 20____, of which the defendant has had notice.
2. As a result, the amount of the policy is now due and the plaintiff is the beneficiary of the proceeds of the policy.
Wherefore plaintiff demands judgment against defendant in the sum of _______________ dollars, interest and costs.
Miss. R. Civ. P. Form 13