Claim Application Form (Natural and Unnatural Causes)

How to Claim

Notify Siyavika of the claim. A claim form will then be sent to you OR you can download the form from our website.

Send complete claim form with required documentation as set out on the claim form to our claims department. or fax: +27 86 679 2046.

Siyavika will access and pay the claim within 48hrs after receipt of documents. Siyavika will provide you with a proof of payment AND / OR notify you of any outstanding information.

Police Form (Unnatural Causes)

Standard Claim Requirements

Submit the following claim requirements to Siyavika Claims Department. Make sure that all supporting documents are attached.

  • Complete claim form in black ink and readable handwriting
  • Certified copy of the deceased’s identity document
  • Certified copy of the death certificate
  • Certified copy of the beneficiary nomination form
  • Fully completed BI 1663 form
  • A police report in the case of death due to unnatural causes
  • Beneficiaries banking details – proof of valid banking details
  • If claimant is a different person / entity from the beneficiary, please attach written certified authorisation from the beneficiary for claimant to receive claim amount
Guardrisk / Siyavika will verify all deaths with the Department of Home Affairs.

Depending on the circumstances, there may be other requirements.