Contact form - Claims Conference

Request to Replace Paneem with Paper Life Certificate

Registration Number - The Registration Number can be found on the letter you received from us *

First Name *

Last Name *

NAME_THIRD

Date of Birth

Month *

Day *

Year *

The life certificate is only sent to the mailing address or email address the Claims Conference has on file for you.

Please indicate whether you would like to receive the form via mail or email: *

Home address

Email address

If you need to change your address or want us to use a new email address, please submit a written and signed notification of your new contact details to the office nearest to you ; in your message, please include your request that you would like to receive a paper life certificate to be sent to you.

Completed By *

Please note, it may take up to six weeks for the paper life certificate to reach you by mail.