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Death Claim Form Annexure B - Sworn Statement of Dependency on the Deceased

Death Claim Form Annexure B - Sworn Statement of Dependency on the Deceased 2025

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The document is a form for submitting a death claim to Old Mutual Namibia, specifically Annexure B, which includes a sworn statement of dependency on the deceased. It requires detailed information about the deceased, the claimant's relationship and financial dependency on the deceased, and supporting documentation. The form emphasizes the legal obligations of trustees under the Pension Funds Act to investigate dependants and allocate death benefits accordingly. Misrepresentation may affect claims.

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How to use or fill out Death Claim Form Annexure B - Sworn Statement of Dependency on the Deceased

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Click ‘Get Form’ to open it in the editor.
Begin by filling out Section A with the details of the deceased. Include their full name, date of birth, and date of death. Ensure accuracy as this information is crucial for processing your claim.
Proceed to Section B, where you will declare your relationship with the deceased. Provide your full name, identity number, residential address, and contact details. Indicate your employment status and current income.
Answer the questions regarding financial dependency on the deceased. Clearly state how you were supported financially and provide any relevant proof such as bank statements if available.
In Section C, review the sworn declaration carefully. Confirm that all information provided is accurate before signing and dating the form.

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What is a dependant of the deceased?

Dependant under tax law For tax purposes, you are a dependant of the deceased if at the time of their death you were: their spouse or de facto spouse (of any sex) a former spouse or de facto spouse (of any sex) a child of the deceased under 18 years old. in an interdependency relationship with the deceased.

How do I claim a provident fund after death?

Submission of claims Completed funeral claim form. Certified Copy of Death Certificate. Certified Copy of Deceaseds ID Document. Certified Copy of the Beneficiaries ID Document. Copy of Notice of Death/Still Birth (BI 1663) Proof of Banking Details of the Beneficiary (Bank Statement, stamped by the bank)

How to settle a death claim without nomination?

Documents to be collected ❖ Document to ascertain the legal heirs (e.g., ration card of the deceased, legal heir-ship certificate). Receipt from the claimant (Annexure 4). Succession Certificate - if total claim amount exceeds Rs.

How do I fill out a deceased claim application?

Dear Sir, Re: Deceased Account. Late Shri/Smt .. Account No (s) I/We advise the demise of Shri/Smt. on. . He/She holds the above account(s) at your branch. Annexure-II. ESTATE CLAIM FORM. UNION BANK OF INDIA.

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