Life Interruption Claim Process

Life Interruption Cover

Making a claim for Life Interruption Group Cover

Please download the application form and read the following instructions, which will enable you to fill it out correctly.

Completing claim form:


  1. Advisers involvement – tick yes so that your adviser is able to assist with your claim, and is sent a record of it.

  2. Type of Cover – Tick the appropriate boxes in this section, closest to what you are claiming on.

  3. Members details – complete

  4. Information on injury or illness – complete all of this section

  5. Make sure your bank account number is listed and the account holder.

  6. Work capacity details – check to see the illness or injury, if it comes under irreversible loss of function or Total but temporary loss of function – please complete section 6.

  7. Occupation details to complete.

  8. Declaration and consent – print your and sign your name under , Members Name and Member Signature only – do not sign the policy owner section.


Medical Doctors Questionnaire – This is for your Doctor or specialist to complete and supply any supporting documentation and sign off on the declaration , the bottom of page 7Prognosis certificate  - To be signed off by the Doctor or Specialist


NB: Additional documents, hospital admittance/hospital discharge, ACC documents, certificates from your Doctor, diagnostic forms, letters from your specialist – include all relevant supporting documents concerning your claim.


If you have any issues, please contact the team at TMF

You can see a sample of the correct way to fill in the form (individual or group) on the left of this page.


Once you have filled in your application, please scan and email to TMF for processing



Individual Claim Application Form >>



Group Claim

Application Form >>