Claim Form | South African Funeral Cash Plan

Name *

First

Last

Marital Status

ID / Passport Number *

Date of Birth //

Policy Number *

Inception Date //

Name of Deceased *

First

Last

ID / Passport Number of Deceased *

Date of Birth Deceased //

Date of Death *//

Relationship

State Other Relationship

Claim Amount (in Rands) *

Cause of Death *

Name of Account Holder (Beneficiary) *

Name of Bank *

Account Number *

BI 1663 Notification of Death (3 pages) - you will get this from the hospital or mortuary. *

Click or drag a file to this area to upload.

Be sure to make copies before going to Home Affairs for the Death Certificate, they do not need to be certified.

Death Certificate obtained from Home Affairs using the BI 1663 *

Click or drag a file to this area to upload.

Deceased's ID / Passport, if it is the new ID card we only need a copy of the front *

Click or drag a file to this area to upload.

Claimant's ID (Main Member or Beneficiary as listed on application/latest amendment) *

Click or drag a file to this area to upload.

Should the policy be continued (Circle)? *

If “yes” please state which existing Member over 18 now becomes the Main Member

Full Name *

First

Last

ID / Passport Number

Date of Birth //

Signature of Member *

Claim Notification Form