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Report a Death

Policy No.*
NB : Gem Policies Enter Numbers Only
Insured Details
Salutation
First Name*
Middle Name
Last Name*
Contact No.
Email
Please indicate what type of claim :*
- Death
- LEB
- Other
Other Type of Claim*
Date of Death*
Date Format: DD slash MM slash YYYY
Enter any other Policies that the deceased may have with us :
Please separate each policy with a comma ","
Claimant's Details
Salutation
First Name*
Middle Name
Last Name*
Address 1*
Address 2
Town/City*
Country*
Contact No.
Email
Please select your ID number
Please enter the number
Are you a named beneficiary on the policy?
- Yes
- No
- Unsure
Are you in possession of the policyholder's death certificate?
- Yes
- No
Are you in possession of the policy contract?
- Yes
- No
Signature of Claimant*
- Type-in Signature
- Digital Signature
Signature*
Signature*
Additional Comments
Please Provide any additional Information
Branch of Request/CSR
Date*
Date Format: MM slash DD slash YYYY