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Declaration by Claimant and Discharge Form Old Mutual Life Assurance Company South Africa Limited reg. no 1999/004643/06 Please print in block letters using black or blue ink. Policy Issued on the life of Title Initial s First name s Surname ID number Date of birth d m c y Addres Postal code I/We the undersigned declare that 1. I am/we are the legal holder/s of the policy 2. my estate/our estate/the estate of the policyholder has not been sequestrated and is at present solvent and 3. this policy has not been ceded to anyone except insofar as it may be pledged to Old Mutual in respect of a loan* I/We hereby apply for the payment of the proceeds of the claim under the abovementioned policy and confirm that payment of such proceeds by Old Mutual shall represent the full and final discharge of Old Mutual s liability under the said policy. I/We confirm that the declaration above is correct. Signed at day of this Signature of legal owner/s Note If someone other than the legal owner/s sign/s ....

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How to fill out the Discharge Form online

Filling out the Discharge Form online can streamline your process for claiming policy proceeds. This guide offers you clear instructions on each section and field of the form, ensuring that you can complete it accurately and efficiently.

Follow the steps to fill out the Discharge Form online

  1. Click ‘Get Form’ button to obtain the form and open it in your preferred digital editor.
  2. Complete the policy details section. Fill in the policy number and the full name of the person for whom the policy was issued. Ensure that you include their title, initials, first name(s), and surname in block letters.
  3. Provide the ID number and date of birth of the policyholder. Ensure you format the date correctly: day, month, and year.
  4. Input the current address of the policyholder along with the postal code. This information is essential for verification purposes.
  5. Read through the declaration statements carefully. Confirm you are the legal holder of the policy, that the estate is solvent, and that the policy has not been ceded to anyone else, unless pledged to Old Mutual.
  6. Fill out the signature section, ensuring that all legal owners of the policy sign where indicated. If applicable, include the signature of the spouse and provide information about the marital property act.
  7. In the payment instruction area, specify how the proceeds should be paid. You can choose to transfer the amount to an Old Mutual Banking Services account or provide your own bank account details, including bank name, branch name, account number, branch code, and name of the account holder.
  8. Complete the identification section. This part must be filled out by the person who identifies the legal owners. Include their full names, ID number, and an official stamp if required.
  9. Review your entries carefully to ensure all information is accurate. Once you are satisfied, you can save your changes, download a copy, print it, or share the form as necessary.

Complete your Discharge Form online today to expedite your claim process.

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The report of separation form issued in most recent years is the DD Form 214, Certificate of Release or Discharge from Active Duty.

A patient discharge form is a form used by medical facilities to communicate vital information of a patient to the next healthcare provider. It is used to communicate patients' post-surgery instructions, medications, allergies, and if the doctor has seen any complications.

A discharge authority form is used to release the security (e.g. property or cash security) you've provided for a home loan.

A discharge summary is a clinical report prepared by a health professional at the conclusion of a hospital stay or series of treatments. It is often the primary mode of communication between the hospital care team and aftercare providers.

A hospital discharge letter is a brief medical summary of your hospital admission and the treatment you received whilst in hospital.It is usually written by one of the ward doctors.

The report of separation form issued in most recent years is the DD Form 214, Certificate of Release or Discharge from Active Duty.

DD Form 214, Discharge Papers and Separation Documents The Report of Separation contains information normally needed to verify military service for benefits, retirement, employment, and membership in veterans' organizations.

6 Components of a Hospital Discharge Summary Reason for hospitalization: description of the patient's primary presenting condition; and/or. ... Significant findings: ... Procedures and treatment provided: ... Patient's discharge condition: ... Patient and family instructions (as appropriate): ... Attending physician's signature:

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232