Application to Dispense with Grant of Probate/Letters of ... - Aviva

6. If deceased was Single, was he/she survived by parents, brothers and sisters
Please give names below (Dates of Birth required for persons under 18) Please indicate any family members deceased.
Name
Date of Birth
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I confirm that the answers to the above questions are correct and that I have not withheld any information in the event
of Aviva Life & Pensions Ireland Limited dispensing with Probate/Administration. If the Estate is €6,348.69 or under please
have Indemnity shown overleaf completed as indicated. The Company may also call for a Statutory Declaration. Certificate
of Discharge from Revenue Commissioners will be required in the case of No. 6 above.
Signature of Claimant
Date of Claimant / /