Employer-Provided Burial Benefit Claim Form
Deceased Employee Information
Full Name
Employee ID
Date of Birth
Date of Death
Department/Position
Claimant Information
Claimant Full Name
Relationship to Deceased
Contact Number
Contact Address
Required Documents
Death Certificate (Attach Copy)
Proof of Relationship (Attach Copy)
Other Relevant Documents
Declaration
I hereby certify that the information provided is true and complete to the best of my knowledge.
Claimant Signature
Date