Death Notice Template (Sample) printable pdf download

Death Notice Template (Sample)

The Insular Life Assurance Company, Ltd.

Insular Life Corporate Centre, Insular Life Drive

Filinvest Corporate City, Alabang, 1781 Muntinlupa City

E-mail: .ph

Website:

Tel.: (632) 582-1818 • Fax: (632) 771-1717

Death Notice

(TO BE COMPLETED BY INFORMANT)

Policy No.

Date

Name of deceased insured

Last Address

Date of Death

Time

A M / P M

Place of Death

Cause of Death

Date and Place of Interment

Name of Memorial Service Provider

On behalf of

(name/s of beneficiary/ies represented)

who is/are my

I would like to request a set of your claim forms. I fully understand that the

liability of Insular Life shall be determined after these forms are completed and

submitted along with other required documents.

Name in Print & Signature

Contact Details:

Landline No:

Cellphone No:

E-mail:

Complete Address:

RECEIVED Claim Forms and Requirement Sheet by:

Name in Print & Signature

Date

IL-DN-102010-APH

Death Notice Template (Sample)