Certificate of Continued Disability Form
Critical Illness Claim Form Form
Death Claim Form Form
Disability Claimant’s Statement Form
Confidential Extract from Records Form (PMA) Form
Funeral Claim Form
Hospital Cash Plan Claim Form
Personal Accident Claim Form
Physical Impairment Claim Form
Retrenchment Claim Form
Statement by Police Form
Please submit all completed funeral claim forms and follow ups to namibia.funeralassistance@liberty.com.na
Maerua Mall Office Park 5th Floor, Office 5001 Jan Jonker Road Windhoek t +264 61 294 2343 f +264 61 294 2441 Fraud Hotline 0800 001124