Get Death Claim Form.xls

This guide provides a step-by-step approach to completing the Death Claim Form.xls online. Following these instructions will help ensure that you fill out the required information accurately and completely.

Follow the steps to successfully complete your form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin filling in the deceased's full name and their occupation at the time of death. Ensure that you provide accurate information for each field.
3. Enter the deceased's residence at the time of death, including the street, city or town, and province.
4. Provide the details regarding the deceased's sex, height, approximate weight at the time of death, and hair color.
5. Indicate the deceased's age at the time of death. If there were any identification marks on the body, specify this information.
6. Complete the information regarding the date and place of death, including the name of the hospital or institution if applicable.
7. Answer questions about when you were first consulted for the condition leading to death, including the length of hospitalization and the date of your last visit.
8. Detail the immediate cause of death and any contributory causes, along with the duration of each related disease or impairment.
9. Specify if there was any special connection between the death and the occupation, residence, habits, or personal history of the deceased.
10. List the particulars of each condition for which you treated the deceased prior to their last illness, including nature, dates, duration, and treatment results.
11. Provide names and addresses of other physicians or practitioners who attended the deceased in the past three years, along with the relevant diseases or impairments.
12. Indicate if the death was due to suicide, homicide, or accident, and whether the deceased was under the influence of alcohol or drugs at that time.
13. Answer if there was an official inquiry or post-mortem examination on the deceased, and provide details as needed.
14. Finalize the form by providing the physician’s name in print, license number, signature, date, and addresses for both the physician and witness.
15. Once you have completed all sections, save your changes. You can then download, print, or share the form as needed.

Start filling out your Death Claim Form.xls online today to ensure timely processing.