05. Claim Form – Deceased

Submit your form along with any required documents.

If you need assistance, please don’t hesitate to contact us.

Forms to download

Complete and submit this form if you are an executor, legal representative or beneficiary of a deceased worker and wish to collect a lump sum payment of the worker’s pro-rata entitlement.

To complete the pdf form electronically, you’ll need software such as Adobe Acrobat Reader, which you can download for free.

If you are unable to fill out the form electronically, you can download and print it. After completing it by hand, please return it to us with all necessary documents using one of the methods provided in the form.

  • Max. file size: 2 GB.
  • Drop files here or
    Max. file size: 2 GB.
    • Drop files here or
      Max. file size: 2 GB.