Funeral Claimant's Certificate

Complete and Accurate information must be given in this Certificate. Zimnat Life reserves the right to verify the authenticity of all submitted documents and tp prosecute any fraudulent actions
All Fields marked with * are mandatory.

Enter Residential address at death
Enter Occupation at death
Enter date when illness started
Duration (Days) of last illness

Supporting Documents (Clear attachments)

For pre-burial funeral claims
For pre-burial funeral claims
Required
Put N/A for funeral claims
Required if cause of death is accidental
Required
National ID, passport or Drivers License
Required

Claiment Details (Details of the person submitting this applications)

WARRANTY

I do hereby warrant that the above particulars are true and correct in each and every respect.
In the event thatthis benefit is paid as a result of any misrepresentation, non-disclosure, misdescription or fraudulent action by me, i fully understant that i shall be required to repay or return the benefit and that the company shall be entitled to take legal action to recover the benefit and any costs incurred