Due to company will update form version from times to times,
kindly download latest version direct from Gesica or Epartner.
If want to download from below link, kindly login E-Partner first.
– Death Claims Requirement Checklist
(Check List)
– Death Claim Form
(Fill in by CLIENT)
– Doctor’s Statement*
* for policy less than 5 years from date of commencement or
date of reinstatement, whichever is later
(Fill in by DOCTOR)
CTC = Certified True Copy
1. Doctor’s Statement*
* for policy less than 5 years from date of commencement or
date of reinstatement, whichever is later
2. CTC of Detailed Post Mortem Report, if any
3. For Great Senior policy, the Doctor’s Statement is NOT required. However, if death is due to accident, please refer to Additional Requirement for Accidental Death.
1. Original copy of Letter of Authorisation /Consent (3 copies)
– CTC of Death Certificate
– CTC of Deceased’s NRIC
– CTC of Claimant’s NRIC
If cause of death is unknown, the Company will advise further on receipt of the Death Certificate.
1. Accidental Death Benefit Claim Form
– Copy of Newspaper Cutting, if any
– CTC of Deceased’s Driving License
– CTC of Police Investigation Report, if any
– CTC of Police Report
– CTC of Detailed Post Mortem and Toxicology Report
– Confirmation letter from National Registration Department
– Embarkment Certificate for foreign death duly certified
*Embarkment certificate: means a permission certificate to bring corpse (dead body) back to Malaysia.
– Certified True Copy of full passport book / Citizenship Certificate is required
– Spouse – CTC Of Marriage Certificate
– Children – CTC Of Birth Certificate of Claimant
– Parent – CTC Of Birth Certificate of Deceased
– Grant of Probate/Letter of Administration, for policy without nomination
If the Deceased is a non-Malaysian or if the death event occurred outside Malaysia (except Singapore),
please attach :-
(i) CTC of Deceased’s Full Passport Book/Citizenship Certificate
(ii) CTC of Confirmation letter from National Registration Department (for death outside of Malaysia)