We would like to help you with your claim application. Please fill out the form below and complete all fields marked with (*).

Before submitting your application, please prepare the following documentation for your convenience in the next steps.

1. Police Report

2. Autopsy Report / Post Mortem Report (if available)

3. Medico-Legal Report (if available)

4. Medical History (if plan is less than 1 year or if cause of death is accident)

5. Attending Physician's Statement Print | Download

6. Registered Death Certificate with seal and issued by the Local Civil Registrar or Philippine Statistics Authority (PSA)

7. Photocopy of Valid IDs of Planholder (Government-issued ID’s)

8. Statement of Claimant Form Print | Download

9. Photocopy of Valid IDs of the beneficiaries / claimants (Government-issued ID’s)

10. Marriage Contract (if claimant is the spouse or if the planholder's daughter is already married)

LPA Number:*

Claimant's First Name:*

Claimant's Middle Initial:*

Claimant's Last Name:*

Mobile Number:*

Email Address:*

Cause of Death:*

Date of Death:*

Date of Medical Certificate:*

Relationship to the Planholder:*

Police Report*

Autopsy Report*

Medico-Legal Report*

Medical History*

Attending Physician's Statement*

Registered Death Certificate*

Photocopy of Valid IDs of Planholder*

Statement of Claimant Form*

Photocopy of Valid IDs of the Beneficiaries*

Marriage Contract