Funeral Claim
The issue of this form is NOT an admission of liability on the part of the Company. Please answer all questions fully and return form without delay to
ALLIANZ NIGERIA INSURANCE PLC
1
Policy Details
Policy Type
Policy Number
2
DETAILS OF LIFE
FULLNAME
DATE OF DEATH
LAST RESIDENTIAL ADDRESS OF DECEASED
NAME OF NEXT OF KIN/BENEFICIARY
RELATIONSHIP
NEXT OF KIN/BENEFICIARY PHONE NUMBER
3
DETAILS OF PHYSICIAN WHO ATTENDED TO THE LIFE ASSURED DURING ILLNESS OR ACCIDENT
NAME OF DOCTOR
HOSPITAL NAME
HOSPITAL ADDRESS
HOSPITAL PHONE NUMBER
Doctors Signature
4
DOCUMENTS TO BE ATTACHED
Official certificate of death
Proof of Age
Stamped medical certificate of cause of death
Police report if death is by accident Policy document
Policy document
Submit
Send Filled Content
Receivers' Email