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  • Claim Notifi Cation Form: SCNF.01.14

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    Ali
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    This document is a claim notification form that collects details about the insured, contact person, and claim. It requests information such as the insured's name, gender, birthdate, policy number, date and cause of death or diagnosis. It also collects contact information for the contact person like their name, address, phone numbers and relationship to the insured. Finally, it includes spaces for the informant's name, relationship to insured, contact details, and signature.

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    Original Title

    claim-notification

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    This document is a claim notification form that collects details about the insured, contact person, and claim. It requests information such as the insured's name, gender, birthdate, policy number, date and cause of death or diagnosis. It also collects contact information for the contact person like their name, address, phone numbers and relationship to the insured. Finally, it includes spaces for the informant's name, relationship to insured, contact details, and signature.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    25 views1 page

    Claim Notifi Cation Form: SCNF.01.14

    Uploaded by

    Ali
    This document is a claim notification form that collects details about the insured, contact person, and claim. It requests information such as the insured's name, gender, birthdate, policy number, date and cause of death or diagnosis. It also collects contact information for the contact person like their name, address, phone numbers and relationship to the insured. Finally, it includes spaces for the informant's name, relationship to insured, contact details, and signature.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    of 1

    Claim Notification Form

    1 Insured Details
    Insured Name (Last Name, First Name, Middle Name) A.K.A.

    Gender Bithdate (day/month/year) Policy/Plan No. Type of Claim

    Date of Death/Diagnosis/Confinement/ Place of Death, if applicable Cause of Death/Diagnosis


    Disability (day/month/year)

    Name of minor beneficiary/ies, if any

    2 Contact Details

    Contact Person (Last Name, First Name, M.I.) Relationship to the life insured
    Father Mother Others, specify
    Address (no.,street, municipality/city, province, country, zipcode) P.O. Box is not acceptable

    Home Phone Work Phone Mobile Phone E-mail Address


    (country code, aread code & tel. no.) (country code, aread code & tel. no.) (country code & mobile no.)

    Name of Informant (Last Name, First Name, M.I.)

    Relationship to the life insured


    Beneficiary Relative Advisor Advisor’s Secretary Others, specify
    Address (no.,street, municipality/city, province, country, zipcode) P.O. Box is not acceptable

    Home Phone Work Phone Mobile Phone E-mail Address


    (country code, aread code & tel. no.) (country code, aread code & tel. no.) (country code & mobile no.)

    Signature Printed Name Date Accomplished (day/month/year)


    X

    3 For Sun Life Customer Center Staff Use Only

    Requirements released by

    Requirements not yet released. State Reason

    Other Remarks, if any

    SCNF.01.14
    *SCNF.01.14*

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