Claim Form

You can complete our claim form online, or you can download this form as a PDF to complete offline and email an updated copy to us.

DOWNLOAD

Step 1 of 8

Notice of Death for Funeral Claims

Office Number: +266 62024606 | Whatsapp Number: +266 62024606
Email Address: lesothoadmin@trans-africa.co.za

A. How to Complete the Claim Form

Complete the form in black ink and in block letters.
Submit the Claim Form to Trans-Africa, together with the following supporting documents:
- A certified ID copy of the claimant (either main member or beneficiary)
- A certified ID copy of the deceased with the word "deceased" stamped on it
- A certified copy of the death certificate
- A copy of the BI-1663
- A copy of the Burial Order
- A bank statement with a bank stamp of the claimant or beneficiary on the policy
- A police report in the case of death due to unnatural causes
- All other documents that TRANSAFRICA LIFE may in its sole discretion require
Trans-Africa will contact you once your claim has been assessed. All deaths will be verified with the Department of Home Affairs. Depending on the circumstances, there may be other requirements. Please make sure that you meet all the requirements that we have set out in this form.

C. Details of the Administrator

* Where applicable

Full Name(Required)

Title First Name Last Name

Contact Person(Required)

Title First Name Last Name

Contact Number(Required)

Fax Number(Required)

Email Address(Required)

Enter Email Confirm Email

The Administrator hereby warrants that the following checks have been done:

Death confirmed with doctor/hospital who certified death.
Death confirmed with funeral parlour, i.e. body was in fact in their possession.

The Administrator warrants that the identity of the deceased, as well as the claimant has been verified.

E. Details of the Deceased

Full Name(Required)

Title First Name Last Name

Marital Status

Other: Please Specify

Date of Birth(Required)

Date of Death(Required)

Inception Date(Required)

ID Number(Required)

Main Cause of Death(Required)

Place of Death

City State / Province / Region Country

If Unnatural, Please State the Exact Cause of Death

Name of Doctor which Certified the Death Certificate(Required)

First Name Last Name

If yes, please state circumstances of death.(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone Number(Required)

Did the deceased commit suicide or was his/her death the result of his/her transgressing any law or as a result of someone else's alleged violence?

Yes

Please State Circumstances of Death

Claim Amount(Required)

Date of Funeral(Required)

F. Details of the Claimant

Full Name(Required)

Title First Name Last Name

ID Number(Required)

Relationship to Deceased(Required)

In what capacity are you lodging the claim?(Required)

Please Upload Authorization(Required)

Max. file size: 2 MB.

Contact Number (Cell)(Required)

Contact Number (Work)(Required)

Postal Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you aware of any other beneficiaries /claimants under this plan?(Required)

Yes

Yes: Please State(Required)

Claim Form

Notice of Death for Funeral Claims

A. How to Complete the Claim Form

B. Details of the Funeral Parlour

C. Details of the Administrator

D. Details of the Main Member

E. Details of the Deceased

F. Details of the Claimant

G. Bank Details of Claimant

H. Declaration by Claimant

Quick Links

Products

Complaince

Get in Touch

Office Hours