We would like to help you with your claim application. Please fill out the form below and complete all fields marked with (*).

Before submitting your application, please prepare the following documentation for your convenience in the next steps.

1. Registered Death Certificate with seal and issued by the Local Civil Registrar or Philippine Statistics Authority (PSA)

2. Birth Certificate of Planholder

3. Photocopy of Valid IDs of Planholder (Government-issued ID’s)

4. Statement of Claimant Form Print | Download

5. Photocopy of Valid IDs of the beneficiaries / claimants (Government-issued ID’s)

6. Marriage Contract (if claimant is the spouse or if the planholder's daughter is already married)

7. Birth Certificate of BENEFICIARY/IES

8. Medical History (if plan is less than 1 year or if cause of death is accident)

9. Attending Physician's Statement Print | Download

LPA Number:*

Claimant's First Name:*

Claimant's Middle Initial:*

Claimant's Last Name:*

Mobile Number:*

Email Address:*

Cause of Death:*

Date of Death:*

Relationship to the Planholder:*

Registered Death Certificate*

Birth Certificate of Planholder*

Photocopy of Valid IDs of Planholder*

Statement of Claimant Form*

Photocopy of Valid IDs of the Beneficiaries / Claimants*

Marriage Contract

Birth Certificate of Beneficiary/ies*

Medical History

Attending Physician's Statement