Depositor Claim Submission

1 Step 1

CLAIMS SUBMISSION FORM

Attach photo here

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Attach Supporting Document

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Name

Phone Number

NIN

Date of Birth

date_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

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