1 Step 1 CLAIMS SUBMISSION FORM Attach photo herecloud_uploadUpload Attach Supporting Documentcloud_uploadUpload Name Phone Number NIN Date of Birthdate_range Address Name of closed Contributing Institution Account Name Account Type--Select Option --Individual accountJoint AccountCompany accountTrust account Account Number Next of Kin Next of kin phone number Payment Options (tick)BankMobile Money Name of Bank Branch Account Name Account Number Carrier-- Select Option --MTNAirtel Phone Number Registered Name Submit keyboard_arrow_leftPrevious Nextkeyboard_arrow_right