Submit Funeral Claim

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.

Policy Number *

Name of Deseased *

Deseased ID No *

Relationship to Principal

Address at Death

Enter Residential address at death

Occupation at Death

Enter Occupation at death

Date of Death

Age at Death

Place of Death

Date of first illness

Enter date when illness started

Duration of last illness

Duration (Days) of last illness

Main cause of death

Did the deceased die by Suicde or because of violation of any law?

If you are not the Policyholder, state in what capacity you make this claim

Supporting Documents (Clear attachments)

Burial Order

For pre-burial funeral claims

Form BD 12

For pre-burial funeral claims

Death Certificate *

Required

Hospital/Clinic Letter

Put N/A for funeral claims

Police Report

Required if cause of death is accidental

Policy Document *

Required

Deceased proof of Age *

National ID, passport or Drivers License

Claimant proof of ID *

Required

Claiment Details (Details of the person submitting this applications)

Claimant Address

Claimant Occupation

Claimant Phone

Claimant Email

Claimant Employer

Employer Tel.

EcoCash Number

Bank

Account Name

Account Number

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

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.

Supporting Documents (Clear attachments)

Claiment Details (Details of the person submitting this applications)

WARRANTY

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.