Tontozo

Tontozo Funeral Claim Form

Underwritten By Reg no:120485

Search Application To Claim

Main Member Date Of Birth

Surname *

First & Middle Name *

(As on NRC)

NRC No. *

Email Address

Mobile *

Gender

Male Female

Date Of Birth *

Physical Address *

Claimant’s Details

Is Claimant Dependent Member ? OR Main Member ? OR Administrator Person ?

Select Claimant *

Surname *

First & Middle Name *

(As on NRC)

NRC# *

Email Address

Date Of Birth *

Gender

Male Female

Mobile *

Relationship to Main Member *

Physical Address *

(Note : Add Street, Area, Village, Province, and Postal Code if you have.)

Deceased’s Details

Who is deceased person ? *

Surname *

First & Middle Name *

(As on NRC)

NRC# *

Date of Death *

Gender

Male Female

Type of Death*

Natural Unnatural

Details on cause of death

If the death is due to an accident, was it reported to the police?

Yes No

Claim Payment Method*

Bank Details for EFT Payments
(Note : Please attach a copy of the latest bank statement- must not be older than 3 months, or confirmation of account details on the bank’s letterhead)

Account Holder Name*

Account Number*

Bank Name*

Branch Code*

Branch Name*

Account Type*

Claimant’s Declaration

I, in my capacity as a claimant, hereby certify that the above information submitted by me, is to the best of my belief and knowledge and both are true and correct. *

I further confirm that I have not withheld, concealed or misstated any information.I further understand that any misstatement or non- disclosure of information, which materially affects the assessments of this claim, will entitle Tontozo and MLife Life to declare this claim null and void. *

My name is , I confirmed *

Death Certificate Image*

Identity Proof Photo*

I am not Robot*

Bank Detail Photo

Relationship to Main Members(if the deceased is a Dependant)

Signature*

(Not happy with signature? Press clear and sign again)

NRC# *

Date Of Birth*

NRC# *

Date Of Birth *

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Tontozo Funeral Claim Form

Search Application To Claim

* Tontozo reserves the right to call for additional documents where necessary to validate the claim.

Main Member Details

Claimant’s Details

Deceased’s Details

Payment Details

Claimant’s Declaration