Death Claim form

*Death Abroad Questionnaire

• Please tick the relevant box for each item.
• All documents must be original or certified copies.
• Missing documents may delay assessment of the claim.
• Where there is more than one claimant, each claimant must submit their own supporting documents.

General Declaration

a) I/We confirm that I/we am/are legally entitled to make this claim on behalf of the deceased, and that all information provided is, to the best of my/our knowledge, true, complete and not misleading.

b) I/We agree to supply any additional evidence (e.g. death certificate, grant of probate, letters of administration, power of attorney) if required.

c) I/We understand that knowingly providing false, incomplete or misleading information may result in the claim being declined, recovered or legal action being taken against me/us.

d) I/We authorise payment of any benefit due under this policy to the person or entity named below (if different from the signatory), and confirm they are entitled to receive such payment.

Data Privacy

e) I/We authorise the Insurer, its reinsurers, claims assessors and appointed agents to obtain, store, process and share any personal data (including special categories of personal data) relating to the deceased and me/us from physicians, hospitals, employers, public authorities or any other third party as required to evaluate and administer this claim.

f) I/We acknowledge my/our rights to access, correct or erase personal data; to restrict or object to processing and to lodge a complaint with the UK ICO (www.ico.org.uk) or the Guernsey DPA (https://www.odpa.gg/)

g) I/We acknowledge that I/We have the right to access the Insurer’s Privacy Policy via their website: https://www.1edgeinsurance.gg/wpcontent/uploads/2025/04/1EDGE-Privacy-Policy.pdf and the Policy Distributor’s Privacy Policy via their website, as detailed in the Policy Schedule.

h) I/We are /am aware that data processing will be in accordance with:

the UK General Data Protection Regulation and Data Protection Act 2018;

the Data Protection (Bailiwick of Guernsey) Law, 2017; and

any applicable guidance of the UK Information Commissioner’s Office or Guernsey Data Protection Authority.

Obtain & Share Medical Information

i) I/We authorise any physician, hospital or other medical practitioner who treated the deceased to release all medical reports and records to the Insurer, its reinsurers, claims assessors and appointed agents.

j) I/We understand that the statutory rights under the Access to Medical Reports Act 1988 do not survive death, and that this authorisation is given under my/our authority as personal representative and under the Access to Health Records Act 1990 (as applicable).

By signing below, you acknowledge that you have read, understood and consent to all declarations set ou in this SECTION 7 (A) - (J)

*If you withhold consent the Insurer may be unable to assess your claim.

NOTE 1: RELATIONSHIP TO THE DECEASED

Below is a summary of the available claimant roles, their definitions, and the documentation you will need to provide:

Trustee
If you are a trustee, you are the legal owner of a policy held in trust and are responsible for distributing the proceeds in accordance with the trust deed.

Required document: You must provide a copy of the trust deed (and any trustee resolutions) confirming that the policy is held in trust and naming you as trustee.

Assignee
If you are an assignee, the policyholder has validly assigned their rights under the policy to you. In the case of an absolute assignment, all rights under the policy have transferred to you and you stand in the policyholder’s place. In the case of a collateral (security) assignment, you may claim only up to the amount of the outstanding debt or obligation secured by the policy.

Required document: You must provide the original or a certified copy of the deed of assignment, clearly showing whether it is absolute or collateral and confirming that it remains in force.

Nominee
If you are a nominee, the policyholder has formally nominated you with the insurer to receive the policy proceeds on death. A binding nomination (where permitted by the policy) will ordinarily override estate distribution, whereas a non-binding nomination is advisory and the proceeds may still form part of the estate.

Required document: You must provide the completed nomination form on file with the insurer, clearly marked as “binding” or “non-binding” as appropriate.

Executor
If you are an executor, you are named in the deceased’s valid will and have applied for, and obtained, a Grant of Probate from the Probate Registry.

Required document: You must provide the original Grant of Probate or a certified copy.

Administrator
If you are an administrator, you have been appointed by the court to administer an intestate estate (where no valid will exists) and have obtained a Grant of Letters of Administration.

Required document: You must provide the original Grant of Letters of Administration or a certified copy.

Other
If you are claiming in any other capacity (for example, as next-of-kin or an un-nominated beneficiary), you have no automatic right to the proceeds unless you can demonstrate legal authority.

Required document: You must provide one of the following, as applicable: a Grant of Probate, a Grant of Letters of Administration, or a court order appointing you as the estate representative.

NOTE 2 - DEATH CERTIFICATE

The claimant must supply either 

1. the original death certificate; or 
2. a certified copy issued by the UK General Register Office.

Photocopies, scans or photographs of a certificate cannot be accepted because UK birth, death and marriage certificates are protected by Crown copyright and may not be lawfully reproduced. If a certified copy is required, it may be ordered online at www.gov.uk/order-copy-birth-death-marriage-certificate.

NOTE 3: GRANT OF REPRESENTATION (TITLE TO CLAIM)

A Grant of Representation is a court-issued document confirming your legal authority to collect and distribute the deceased’s estate.

• In England, Wales & Northern Ireland this is called Probate (if there is a will) or Letters of Administration (if there is no valid will).
• In Scotland it is called a Confirmation.

The Insurer reserves the right to request a Grant of Representation in all cases if it deems it necessary to protect the estate or other beneficiaries.

NOTE 4: PAYMENT DETAILS

Payment of your claim will be made by direct credit to your bank account, so it is important that you complete this section properly. Please remember that once the payment reaches your account, it will take a minimum of 2 or 3 days to clear and allow you access to your money. 

Please submit the completed form and supporting documents via the digital upload link provided or alternatively send them to the authorised Policy Administrator at the address given in Your Schedule. Please also keep copies for your own records.

This product is underwritten by 1Edge Insurance PCC Limited acting on behalf of its cell, 1Edge Insurance Cell 2 ("1Edge”) and is licensed to carry on international long-term insurance business by the Guernsey Financial Services Commission ("GFSC") with GFSC reference number: 2771296. Recourse in respect of liabilities owed to a creditor is restricted to the available assets of the Cell for the time being without recourse against the core assets of 1Edge (as defined in section 467 of the Companies Law) or the assets of any other protected cell of 1Edge. 1Edge’s registered address is Suite 1 North, 1st Floor, Albert House, South Esplanade, St Peter Port, Guernsey, GY1 1AJ

Eleos Life Limited (FRN: 998550) is authorised and regulated by the Financial Conduct Authority. Eleos Life Limited is a company registered in England and Wales (Company Number 14010855), with its registered office at 71-75 Shelton Street, Covent Garden, London, United Kingdom, WC2H 9JQ.