Please complete all relevant sections. Failure to do so may delay the processing of this claim.

All applications MUST be accompanied by ORIGINAL documents.

1. Original Death Certificate of the deceased insured person
2. A receipt for the funeral expenses paid by the claimant or funeral director’s invoice for outstanding funeral expenses.
3. Original Marriage Certificate.

Notes: For applicants residing overseas, please provide notarized copies of the documents listed above. If there are uncashed cheques related to the deceased, these cheques MUST be returned to the National Insurance Office immediately. This claim should be submitted within 12 months of the date of death. Written authorization must be provided if benefit is being paid to the funeral home or alternative payee.