Download a copy of the Checklist - MetLife Alico

Loss of Life - Group Policy HolderMake a Claim - ChecklistFor Loss of Life of the policy holderForms to fill:Completed by each Beneficiary*: Claimant Statement (Form CL-39)Completed by Treating Physician: Physician Statement (Form CL-40)*In the case of minor beneficiaries, the guardian must sign the claimant’s statement on their behalf. Each form must be notarized by a Notary Public or signed in front of the MetLife AlicoClaims Manager.GROUP Policy Holder:Required Check Box Documents NotesYES Claim Forms (Claimant and Physician Statements) Fully completed and signed by beneficiary(ies) and the physician / surgeonYESNotification of loss of life of the policyholderIncludes:• Full name of the insured (including father’s name)• Policy number• Date of passing• Cause• Any information relevant to the claim (hospital name, doctors involved, etc…)YES Copy of medical report Detailing the reason and date of loss of lifeYESPassport copy of the policy holderYESPassport or ID copies of the beneficiary (ies)YESYESYESYESOriginal Death CertificateOriginal Policy DocumentsExact addresses and contact details of all beneficiariesLetter from the employerT&Cs state that the policy contract terminates and must be returned after the policy holder’sloss of lifeStating the date of last day the deceased reported to their office on a full time basis as well asthe date when the deceased’s contract was ended by the companyYES Salary Slip Showing the last monthly basic salary drawnIf applicableOriginal Guardianship / Tutorship CertificateCertificate is issued by court and specifies the powers given to the guardian or tutor wheneverthere are minors among the beneficiaries. The claim can only be paid to the guardian or tutorentitled by law or order of court to “cash proceeds and give valid discharge”

If applicableIf applicableIf applicableIf applicableOriginal Succession CertificateCopy of the Police ReportPost Mortem / Autopsy or Coroner’s ReportNewspaper clipping(s)Required in cases where the names of the beneficiaries are not specified or when beneficiariesare mentioned as “legal heirs”If loss of life was a result of accident r murder or whenever a report is made specifically inconnection with a certain loss of lifeIf applicable Further supporting documents If this applies, the beneficiary(ies) will be contactedPlease remember:1. To help us process your insurance claim as quickly as possible, we ask you to follow the above steps carefully. Otherwise your claim could be delayed or potentially rejected.2. In certain cases, MetLife Alico may also need you to attend a medical examination before we can complete your claim. If this applies in your case, we will let you know.Need Help?How to Contact usHow to SUBMIT A CLAIMCountry Call Us E-mail Us Fax Us For Group Policies(Medical cards & any insurance heldUAE 800 25426 customerservices.gulf@metlifealico.com +971 6 556 2464through the Employer)For Individual PoliciesKuwait +965 2 247 4277 service-kuwait@metlifealico.com +965 2 247 4266Oman 800 70708 service-oman@metlifealico.com +968 2 470 0463Bahrain 800 08033 service-bahrain@metlifealico.com +973 17 311 229Qatar 800 9711 service-qatar@metlifealico.com +974 4 4663409Please contact your H.R. forClaim Submission ProcessPlease send original documents to:Claims Department - MetLife AlicoCrescent Tower Bldg, 17th Floor,P.O. Box 5984, Sharjah – UAEwww.metlifealico-gulf.com