Life insurance claim

Details marked with * must be completed in full.

Your details
Details of the death claim
dd/mm/yyyy
dd/mm/yyyy
As stated on the death certificate
If yes: please state their name. If no: please confirm their marital status – single/divorced. If divorced: please confirm the date of divorce if known.
Where there is no surviving owner
(full names, addresses and telephone numbers where possible)
Contact for claim - Please note for plans in trust/jointly owned we will only write to surviving owner/s

Only complete this section if the contact for the claim is to be different to you.

If the plan is in trust/jointly owned or assigned we will only be able to supply claim information to the plan owner. If not jointly owned you will have to provide executor(s) details. We will contact them with regards to the claim. Please note we may need to see a death certificate, which we will confirm in our notification letter.