OneFamily Bereavement Notification Form

We are very sorry to hear about your loss. To help make things easier during this time, you can notify us online by completing the form below. We will be in touch shortly to let you know what happens next.

If you would prefer to talk to us about your bereavement please contact us.

To complete this form, you will need to know the following:

The Name, address and date of birth of the deceased
The policy number
The date of death
Your address and contact details, or
The address and contact details of the personal representative, sometimes referred to as the Claimant, Beneficiary or the Executer, who will be dealing with the claim or estate

Policy Details

Please provide us with details of the deceased customers account and policy number if you have them.

All fields marked with an * are mandatory.

Death notification

death notification forms

"*" indicates required fields

Step 1 of 2

Policy number

Type of Policy*

Title of deceased*

If other, please specify - deceased

Name of the deceased*

First Last

Address line 1 Address Line 2 Town Postcode Country

Deceased date of birth*

Deceased date of death*

Date death was registered

Death certificate number

Your title*

If other, please specify

Your name*

First Last

Relationship to deceased*

If other, please specify your relationship to the deceased

Address line 1 Address Line 2 Town Postcode Country

Contact number*

Email

Your date of birth

Permissions

Wherever possible we will communicate through email and text messages, please tick here if you would prefer to receive all updates by post.

If you are completing this form on behalf of the personal representative, please select ‘Yes’ below and provide their details, thank you.*

Yes

No

Personal representative's title

Personal representative's name

First Last

Personal representative's address

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

Personal representative's relationship to deceased*

Personal representative's number*

Personal representative's email

Are the notifier and claimant the same person?

Yes

No

Notifier date of birth

Claimant date of birth

Is there an FFO option on this policy

Wherever possible we will communicate through email and text messages, please tick here if the personal rep would prefer to receive all updates by post.