All fields are mandatory unless marked as (optional).
Personal information
Personal information collected on this form will be used to administer your request. To understand the detail of how we use your information you can read the privacy policy or listen on 0800 085 8352.
The date of death stated on the death certificate. Please use the format DD/MM/YYYY. Date of Death can only have current or past dates.
Usual or last known address
You can find your letter reference on the top of a letter or statement from us e.g. XT12345678/LSC/EG. If you do not know your policy number, please put UNKNOWN.
You can find your letter reference on the top of a letter or statement from us e.g. XT12345678/LSC/EG. If you do not know your policy number, please put UNKNOWN.
You can find your letter reference on the top of a letter or statement from us e.g. XT12345678/LSC/EG. If you do not know your policy number, please put UNKNOWN.
You can find your letter reference on the top of a letter or statement from us e.g. XT12345678/LSC/EG. If you do not know your policy number, please put UNKNOWN.
You can find your letter reference on the top of a letter or statement from us e.g. XT12345678/LSC/EG. If you do not know your policy number, please put UNKNOWN.
You can find your letter reference on the top of a letter or statement from us e.g. XT12345678/LSC/EG. If you do not know your policy number, please put UNKNOWN.
You can find your letter reference on the top of a letter or statement from us e.g. XT12345678/LSC/EG. If you do not know your policy number, please put UNKNOWN.
You can find your letter reference on the top of a letter or statement from us e.g. XT12345678/LSC/EG. If you do not know your policy number, please put UNKNOWN.
You can find your letter reference on the top of a letter or statement from us e.g. XT12345678/LSC/EG. If you do not know your policy number, please put UNKNOWN.
You can find your letter reference on the top of a letter or statement from us e.g. XT12345678/LSC/EG. If you do not know your policy number, please put UNKNOWN.