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Group Life Insurance Scheme Claim Form

Your Details
Employee Details
Membership
Payment Details
Summary
Confirmation

Your Details

Forename(s)

Surname

Your Role

(If Other please enter details)

Company

(Your email address will be used to send you a notification of your submitted claim.)

Telephone Number

Contact Type

Telephone Email

Scheme Details

Scheme Name

Scheme Number

Claim Type

Lump Sum Dependants Pension Lump Sum & Dependants Pension Member Flex Lump Sum Member Flex Dependants Pension Member Flex Lump Sum & Dependants Pension Spouse/Partner Flex Lump Sum Police, Fire and Rescue

Police, Fire and Rescue Claim Details

Is your claim in relation to a:

Partner Claim Dependant Child Claim Member Life Insurance Claim

Death Certificate Requirements

We are able to verify the majority of UK registered deaths without requiring the original death certificate.

However, there are occasions when we are not able to do this. If any of the following apply, please tick the box below and send us the original death certificate.

death happened abroad,
claim is submitted within 2 weeks of date death registered or
coroner has only issued an interim certificate

If none of the circumstances above apply then we will let you know if we do still need to see the original certificate.

Contact Us

0800 158 2714

Monday - Friday 9am - 5pm

Bereavement Helpline Leaflet

Adobe PDF

You will need the free Adobe Acrobat Reader to view some of the documents in this section.

Aviva Life & Pensions UK Limited.Registered in England Number 3253947.Wellington Row,York,YO90 1WR.
Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Firm reference number 185896.