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Death claim where there is a *sum insured Critical illness claim for stroke
Death claim where there is an investment only payable Critical illness claim for other illnesses
Critical illness claim for heart attack Childrens Critical Illness Claim
* T he sum insured is a lump sum amount also referred to as life cover, this amount will be specified in the policy document. For Futura and ITA policies, a sum insured should always apply.
For Vista policies, a sum insured option may not have been chosen so the investment account may be the only amount payable.
Death claim where there is a sum insured
including childrens claims
Send to:
Step 3: Supporting evidence
To help assess the claim as quickly as possible, please arrange to send the supporting evidence
detailed below. If documents are not currently available and will follow at a later date, please
Policy number: indicate this on the checklist. If we need to gain a better understanding of the claim we may
need to contact the doctor(s) that treated the deceased or any other relevant party to claim.
This may cause a delay in payment.
Life insured name:
Attached To follow
CLICK TO DOWNLOAD
Policy number(s) if known
Family name
CLICK TO DOWNLOAD
Please refer to the Benet payment claim form for an explanation of the documents we
Forename(s)
Claimant 1
Sum assured
Title Mr Mrs Miss Ms Dr Other (please give details)
Country where the policy was negotiated
can accept and for a list of who can suitably certify a copy of your documents and the
Family name
Forename(s)
Please give details of any previous names or aliases used (including maiden name)
2. Details of the deceased
Full name of the deceased
Nationality
Place of birth (town or city)
certification wording to be used.
Family name Do you hold nationality in another country? Yes No
Attached
Forename(s) If Yes, please confirm the country
Please give details of any previous names or aliases used (including maiden name) Current residential address
Nationality Religion Telephone number (including international country code) Mobile number (including international country code)
Attached Attached If this claim is in respect of a child please provide birth certificate/adoption papers
Please note: If Boal & Co. Pensions (Jersey) Limited are nominated as trustee, For any assistance please email us at benet.claims@zurich.com
then we will send you a deed of indemnity form which you will need to complete.
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Death claim where there is an investment element
Send to:
Step 3: Supporting evidence
To help assess the claim as quickly as possible, please arrange to send the supporting evidence
as detailed below. If documents are not currently available and will follow at a later date please
Policy number: indicate this on the check list.
Please refer to the Benet payment claim form for an explanation of the documents we
If you are not satisfied with our handling of your claim, please refer to our complaints procedure.
Any benefit payment made will be subject to any applicable trade or economic sanctions.
Contact details
We adhere to strict confidentiality procedures when we communicate with our clients. For security purposes, we will regard the details you
can accept and for a list of who can suitably certify a copy of your documents and the
provide as your authorised contact details; it is therefore important that they are accurate and that you let us know if any of these details change.
Life insured
Forename(s)
Please give details of any previous names or aliases used (including maiden name)
Country of birth
Nationality
Place of birth (town or city) Proof of ID (suitably certified)
Do you hold nationality in another country? Yes No
If Yes, please confirm the country
Attached
Please note: If Boal & Co. Pensions (Jersey) Limited are nominated as trustee,
then we will send you a deed of indemnity form which you will need to complete.
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Critical illness claim for cancer
including childrens claims
Send to:
Step 3: Supporting medical evidence
for cancer
Policy number:
To help assess your claim as quickly as possible, please send a copy of all medical reports
and/or test results in your possession. If you are unable to supply the supporting medical
Life insured name: evidence and/or we need to gain a better understanding of your condition we will contact
your treating doctor directly. This may cause a delay in the claim assessment.
To make a critical illness claim for cancer, please click on the below forms. Please complete
both forms and then return with your claim. Copy of histology report showing histological classification of cancer
Critical illness benefit claim form Benefit payment claim form Copy of any other medical reports/test results/doctors letters
Contact details for the doctor(s) best placed for Zurich International
life to contact
Zurich International Life Zurich International Life
Instructions
Please complete this form in English and in CAPITAL letters. All questions must be answered accurately with full disclosure of all relevant
information. If there is insufficient space for any answer please continue on a separate piece of paper and attach to this form. Please return
this questionnaire to your local Zurich office, details of which are on page 5.
If you are not satisfied with our handling of your claim, please refer to our complaints procedure.
Any benefit payment made will be subject to any applicable trade or economic sanctions.
Contact details
You should use this form if you need to make a death or benefit claim.
Please complete this form in English and in CAPITAL letters and send it to your local Zurich International Life (Zurich) office, details of which are
on page 8. All claimants or legal representatives should sign the form. If this has not been done, we will be unable to accept the instruction and
your payment will be delayed.
If you are not satisfied with our handling of your claim, please refer to our complaints procedure.
Any benefit payment made will be subject to any applicable trade or economic sanctions.
Contact details
We adhere to strict confidentiality procedures when we communicate with our clients. For security purposes, we will regard the details you
Step 4: Proof of identity
Please refer to the Benet payment claim form for an explanation of the documents we
provide as your authorised contact details; it is therefore important that they are accurate and that you let us know if any of these details change.
We adhere to strict confidentiality procedures when we communicate with our clients. For security purposes, we will regard the details you
provide as your authorised contact details; it is therefore important that they are accurate and that you let us know if any of these details change.
1 Policy and contact details
For completion by claimant(s)
1. Personal details
can accept and for a list of who can suitably certify a copy of your documents and the
Policy number(s) if known
Policy number(s) if known
Life insured
Full name of the life insured
Title Mr Mrs Miss Ms Dr Other (please give details)
Title Mr Mrs Miss Ms Dr Other (please give details)
Family name
Forename(s)
CLICK TO DOWNLOAD Family name
Forename(s)
Claimant 1
CLICK TO DOWNLOAD certification wording to be used.
Please give details of any previous names or aliases used (including maiden name)
Title Mr Mrs Miss Ms Dr Other (please give details)
Attached
Family name
Date of birth D D M M Y Y Y Y
Forename(s)
Country of birth Place of birth (town or city)
Please give details of any previous names or aliases used (including maiden name)
Nationality Do you hold nationality in another country? Yes No
Is this a US* based telephone number? Yes No *The definition of US includes the 50 United States of America,
the District of Columbia, Guam, Puerto Rico, US Virgin Islands, Telephone number (including international country code) Mobile number (including international country code)
Are you a US* tax payer? Yes No
American Samoa and the Northern Mariana Islands.
Are you a US* citizen? Yes No
Country of telephone number Country of mobile number
Send to:
Step 3: Supporting medical evidence for
heart attack
Policy number:
To help assess your claim as quickly as possible, please send a copy of all medical reports
and/or test results in your possession that relate to your claim. If you are unable to supply the
Life insured name: supporting medical evidence and/or we need to gain a better understanding of your condition
we will contact your treating doctor direct. This may cause a delay in the claim assessment.
To make a critical illness claim for heart attack, please click on the below forms.
Please complete both forms and then return with your claim. Copy of ECG report/tracings at the time of hospital admittance
Critical illness benefit claim form Benefit payment claim form Blood Test results of cardiac enzymes to include troponin level
If you are not satisfied with our handling of your claim, please refer to our complaints procedure. Any benefit payment made will be subject to any applicable trade or economic sanctions.
Any benefit payment made will be subject to any applicable trade or economic sanctions. Contact details
We adhere to strict confidentiality procedures when we communicate with our clients. For security purposes, we will regard the details you
Contact details provide as your authorised contact details; it is therefore important that they are accurate and that you let us know if any of these details change.
We adhere to strict confidentiality procedures when we communicate with our clients. For security purposes, we will regard the details you
provide as your authorised contact details; it is therefore important that they are accurate and that you let us know if any of these details change.
1 Policy and contact details
For completion by claimant(s)
1. Personal details
Please refer to the Benet payment claim form for an explanation of the documents we
Policy number(s) if known
Policy number(s) if known
Life insured
Full name of the life insured
Title Mr Mrs Miss Ms Dr Other (please give details)
can accept and for a list of who can suitably certify a copy of your documents and the
Title Mr Mrs Miss Ms Dr Other (please give details)
Family name
Forename(s)
CLICK TO DOWNLOAD Family name
Forename(s)
Claimant 1
CLICK TO DOWNLOAD
certification wording to be used.
Please give details of any previous names or aliases used (including maiden name)
Title Mr Mrs Miss Ms Dr Other (please give details)
Family name
Date of birth D D M M Y Y Y Y
Forename(s)
Country of birth Place of birth (town or city)
Please give details of any previous names or aliases used (including maiden name)
Attached
Nationality Do you hold nationality in another country? Yes No
Telephone number (including international country code) Mobile number (including international country code)
Send to:
Step 3: Supporting medical evidence
for stroke
Policy number:
To help assess your claim as quickly as possible, please send a copy of all medical reports
and/or test results in your possession that relate to your claim. If you are unable to supply the
Life insured name: supporting medical evidence and/or we need to gain a better understanding of your condition
we will contact your treating doctor directly. This may cause a delay in the claim assessment.
To make a critical illness claim for stroke, please click on the below forms. Please complete
both forms and then return with your claim. Confirmation of diagnosis by Consultant Neurologist
Critical illness benefit claim form Benefit payment claim form Copy of CT or MRI scan with report
If you are not satisfied with our handling of your claim, please refer to our complaints procedure. Any benefit payment made will be subject to any applicable trade or economic sanctions.
Any benefit payment made will be subject to any applicable trade or economic sanctions. Contact details
We adhere to strict confidentiality procedures when we communicate with our clients. For security purposes, we will regard the details you
Contact details provide as your authorised contact details; it is therefore important that they are accurate and that you let us know if any of these details change.
We adhere to strict confidentiality procedures when we communicate with our clients. For security purposes, we will regard the details you
provide as your authorised contact details; it is therefore important that they are accurate and that you let us know if any of these details change.
1 Policy and contact details
For completion by claimant(s)
1. Personal details
Please refer to the Benet payment claim form for an explanation of the documents we
Policy number(s) if known
Policy number(s) if known
Life insured
Full name of the life insured
Title Mr Mrs Miss Ms Dr Other (please give details)
can accept and for a list of who can suitably certify a copy of your documents and the
Title Mr Mrs Miss Ms Dr Other (please give details)
Family name
Forename(s)
CLICK TO DOWNLOAD Family name
Forename(s)
Claimant 1
CLICK TO DOWNLOAD
certification wording to be used.
Please give details of any previous names or aliases used (including maiden name)
Title Mr Mrs Miss Ms Dr Other (please give details)
Family name
Date of birth D D M M Y Y Y Y
Forename(s)
Country of birth Place of birth (town or city)
Please give details of any previous names or aliases used (including maiden name)
Attached
Nationality Do you hold nationality in another country? Yes No
Telephone number (including international country code) Mobile number (including international country code)
Send to:
Step 3: Supporting medical evidence for
other illnesses
Policy number:
To help assess your claim as quickly as possible, please send a copy of all medical reports
and/or test results in your possession that relate to your claim. If you are unable to supply the
Life insured name: supporting medical evidence and/or we need to gain a better understanding of your condition
we will contact your treating doctor directly. This may cause a delay in the claim assessment.
To make a critical illness claim for other illnesses, please click on the below forms.
Please complete both forms and then return with your claim. Copy of any other medical reports/test results/doctors letters
Critical illness benefit claim form Benefit payment claim form Contact details for the doctor(s) best placed for Zurich International
life to contact
If you are not satisfied with our handling of your claim, please refer to our complaints procedure. Any benefit payment made will be subject to any applicable trade or economic sanctions.
Attached
Any benefit payment made will be subject to any applicable trade or economic sanctions. Contact details
We adhere to strict confidentiality procedures when we communicate with our clients. For security purposes, we will regard the details you
Contact details provide as your authorised contact details; it is therefore important that they are accurate and that you let us know if any of these details change.
We adhere to strict confidentiality procedures when we communicate with our clients. For security purposes, we will regard the details you
provide as your authorised contact details; it is therefore important that they are accurate and that you let us know if any of these details change.
1 Policy and contact details
For completion by claimant(s)
1. Personal details
Forename(s)
CLICK TO DOWNLOAD Family name
Forename(s)
Claimant 1
CLICK TO DOWNLOAD
Please give details of any previous names or aliases used (including maiden name)
Telephone number (including international country code) Mobile number (including international country code)
Attached Attached
Telephone +65 6876 6750 Telefax +65 6876 6751. Registered in Singapore No. T05FC6754E.
Calls may be recorded or monitored in order to offer additional security, resolve complaints and for training, administrative and quality purposes.
Zurich International Life is a business name of Zurich International Life Limited which provides life assurance, investment and protection products
and is authorised by the Isle of Man Financial Services Authority.
Registered in the Isle of Man number 20126C.
Registered office: 43-51 Athol Street, Douglas, Isle of Man, IM99 1EF, British Isles.
Telephone +44 1624 662266 Telefax +44 1624 662038 www.zurichinternational.com
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