Protektor Forms

Orion, Evergreen & Easy Benefit Plan

• General Forms for Easy Benefit Plan, Orion & Evergreen

  • Withdrawal Benefit Claim
  • Retirement Benefit Claim
  • Beneficiary Nomination
  • Prior Claim
  • Direct Debit (Automated Collection) Authority
  • Admission of Liability & Debt
  • Indemnity & Release from Liability
  • Divorce Settlement Application
  • Divorce Spouse Consent
  • Orion/Evergreen Secure Services Registration Guide
  • Easy Benefit Plan Online Application
  • Orion Member Data
  • Orion Investment Option
  • Evergreen New Member. Need help?
  • Evergreen Fund Switch Form. Need help?

• Death Claim Forms

  • Family Benefit Claim
  • Death Claim Form - Details of Dependants
  • Annexure A: Dependent adult not wishing to claim
  • Annexure B: Statement of income and expenses
  • Annexure C: Statement of assets and liabilities
  • Annexure D: Statement by permanent life partner
  • Annexure E: Statement of dependency
  • Annexure F: Police report relating to unnatural deaths
  • Annexure G: Non-family member confirmation of dependants (affidavit)
  • Authority to Pay Death Claim – Pure Risk Only

• Disability Claim Forms

  • Disability Benefits Application
  • Disability Benefits (monthly income)
  • Medical Questionnaire
  • Group Assurance Frequently Asked Questions

Group Assurance

• Forms for Group Assurance Products

  • Group Life Benefit Application Form
  • Family Benefit Claim Form
  • Spouses Life Cover Claim Form
  • Education Guardian Benefits
  • Disability Benefits Application (lump sum)
  • Disability Benefits Application (monthly income)
  • Application for Maternity Leave Benefits
  • Medical Questionnaire

Protektor

• General Protektor Forms

  • Application with an Adviser
  • Application without an Adviser
  • Declaration of Disability
  • Beneficiary Nomination
  • Full Withdrawal Advice
  • Partial Withdrawal Advice
  • Retirement Claim
  • Portfolio Switch

• Death Claim Forms

  • Death Claim
  • Annexure A: Dependent adult not wishing to claim
  • Annexure B: Statement of income and expenses
  • Annexure C: Statement of assets and liabilities
  • Annexure D: Statement by permanent life partner
  • Annexure E: Statement of dependency
  • Annexure F: Police report relating to unnatural deaths
  • Annexure G: Non-family member confirmation of dependants (affidavit)