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Please enter Street number, name, Area, LGA and State
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Claims Information

Claims Experienced in the last 3 years

Year No of Death(s) Total Claims Paid
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2
3

In accordance with section 8 (1) of the Pensions Reform Act of 2014, which states, "Where an employee dies, his entitlement under the life insurance policy maintained under section 4(5) of this act shall be paid by an underwriter to the named beneficiary in line with Section 57 of the insurance act" . We hereby request that you please furnish us with the named beneficiar(ies) and the sharing proportion as provided by each employee on the scheme (using the exemplary formats below) to enable us update our records accordingly. This will ensure compliance with the law and also facilitate settlement in the case of occurence of the insured event.

S/N Name of Employee Name of Beneficiary Relationship % Alloted
1
2
3

Please provide the following details of the Employees in a schedule in PDF if they exceed 3:

Name of Employee, Name of Beneficiary, Relationship & % Alloted

Download sample template
A PDF document containing a list of beneficiaries to be covered (Max file size: 2MB)
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Declaration

I declare that the above information is correct and shall form a basis of the contract

AXA Mansard is joining the rest of the world in being environmentally responsible. We invite you to join us in this cause by using only the electronic copy of your policy document which will be sent to your registered email address. You can also access it from your online account at www.axamansard.com or on MyAXA Plus App (available on Play Store or IOS Store).

Should you still want to receive a hard copy of your document in addition to the electronic copy, please place a request with your account officer or send an email to insure@axamansard.com. Your choice to decline making such request will serve to indicate that you do not agree to partner with us to preserve the environment.

By clicking "Submit" you have agreed to the terms and condition stated above.

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