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SURVIVORS Claim Checklist

  • Claim Form – N.I. 51.This form is completed upon the death of an insured.
  • ALL fields must be completed. ALL changes MUST be initialed.
  • The form MUST be signed and dated by the applicant.
  • If the applicant is unable to sign, the thumbprint will be certified at the NIBTT.
  • If the claim is being submitted by a third party, at the “Particulars of Witness to Mark” the thumbprint should be certified by an approved authority.
  • Identification Card of the Insured.
  • Identification Card of the Applicant.
  • Deceased Insured’s Original & Copy of the Birth Certificate / Affidavit / Deed Poll / Divorce Decree Absolute / Death Certificate of the Deceased Insured.
  • Applicant’s - Original & Copy of the Birth Certificate / Affidavit / Deed Poll / Divorce Decree Absolute / Death Certificate of previous Spouse(s).
  • Child / Orphan’s – Original & Copy of Birth Certificate / Affidavit / Paternity Order / Custody Order/ Maintenance Order / Court Order. Any other documentation to prove paternity. If the child is disabled, the N.I. 34A MUST be completed by a Registered Medical Practitioner.
  • If the method of payment is Financial, the bank statement reflecting the name of the bank, the account number and the branch should be submitted. If the method of payment is Postal a utility bill, no older than three (3) months should be submitted.
  • If the claim is being submitted by a third party, the Identification Card of the third party MUST be presented.
  • The claim MUST be submitted within twelve (12) months from the date of death, if not a letter MUST be written with an explanation for the late submission.

Additional documents:
Widows / Widowers

  • Marriage Certificate

In the case of Common-law Unions:
A. If the insured was nominated at the NIBTT:

  • N.I. 42.
  • Affidavit from the applicant.
  • Affidavit from a prominent person e.g. Pastor, Police Sargent and above, Justice of the Peace, Registered Medical Practitioner etc.
  • Evidence of Co-habitation (documents should be dated current and from three (3) years prior to the date of death) e.g. Utility Bill, Deed, Joint Bank Statements, Will, Insurance where the applicant is named as beneficiary etc.

B. If the insured was NOT nominated at the NIBTT:

  • Affidavit from the applicant.
  • One (1) from a close relative (mother, father, brother, sister) of the deceased insured.
  • Two (2) affidavits from prominent persons e.g. Pastor, Police Sargeant and above, Justice of the Peace, Registered Medical Practitioner etc. In instances where an affidavit cannot be provided from a close relative then three (3) affidavits from prominent persons are applicable.

In the case of Dependent Parent:

  • Evidence of support e.g. affidavit, deed of covenant, bank statements, receipts etc.
  • Death Certificate of other parent, where applicable.