Travel Funeral Repatriation Insurance Claim
1. Policyholder Details
Full Name
Policy Number
Contact Number
Email Address
Address
2. Deceased Details
Full Name of Deceased
Relationship to Policyholder
Date of Birth
Date of Death
Place of Death (City, Country)
Cause of Death
3. Funeral/Repatriation Details
Date of Repatriation
Destination Country
Funeral/Repatriation Service Provider
Contact Details of Service Provider
Total Claim Amount (Currency)
Details of Expenses
4. Supporting Document Checklist
Death Certificate
Policy Document Copy
Proof of Expenses
Other (Specify Below)
5. Declaration
I confirm that the information provided is true and complete.
Signature
Date