LIFE INSURED'S INFORMATION. CLAIMANT'S STATEMENT– DEATH CLAIM. Last Name. First Name. Middle Name. Address. Date of Birth (MM/DD/YYYY). Place of Birth.

Claimant statement form. Copy of death certificate of the Life Assured, issued by government authority. Claimant address proof*.

We the claimant/s, claim the benefits of the policy/ies and declare that the answers and statements are true to the best of my/our knowledge and belief, and ...

Death Claim. Claimant's Statement. What documents ... • Claimant's Statement (Form No. 02227A). • Death certificate or funeral director's statement of death.

The undersigned hereby makes a claim to the insurance of the deceased with THE PHILIPPINE AMERICAN LIFE AND GENERAL INSURANCE.

Generally, the proofs of death required are as follows: CLAIMANT'S STATEMENT must be made by the person to whom the insurance is payable. If there is more than ...

Instructions: 1. Completely and clearly fill out this form if you are a beneficiary of legal age or a minor beneficiary's guardian. 2 ...

Important Notes. 1. This form is to be completed by the claimant or nominated beneficiary. 2. To enable us to process your claim promptly, please ensure ...

When an insured person passes away, use this form to submit a claim for investments or life insurance benefits. Information required to complete the form. You ...

Please use this form to submit a claim under a policy with one or more of the following Kemper Life companies: United Insurance. Company of America, The ...