Secure digital service

Claim

Complete your application in a clear, guided process. You can upload supporting documents and sign online.

Secure online application

Submit a claim

Select the claim type, provide the claimant and incident details, then upload the supporting documents.

✓Your information is sent securely to the Rise Capital team.

1Claim

2Claimant

3Incident

4Documents

Claim details

Choose the type of claim and enter the policy information.

Claim type * Policy number * Policyholder full name * Policyholder National ID *

Claimant details

Enter the details of the person submitting this claim.

Claimant full name * Claimant National ID * Contact number * Email Relationship to policyholder * Residential address *

Incident information

Only the fields relevant to your selected claim type need to be completed.

Name of deceased Date of death Cause of death Patient name Admission date Discharge date Description of claim or incident *

Supporting documents and declaration

Upload clear copies. Additional documents can be requested during assessment.

Claimant National ID copy *PDF, JPG or PNG Claim supporting document *For example death certificate, burial order, admission or discharge record Additional documentOptional

Electronic signature (optional)

You may use your mouse or finger to sign inside the box, or leave it blank.

Declaration

I declare that the information and documents submitted are true and complete to the best of my knowledge. I authorise Rise Capital to verify the information and obtain any additional information reasonably required to assess this claim.

I have read, understood and accept this declaration.