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Forms

Application Forms

Individual Plan Offerings Application Form

Soma Plan Application Form

Claim Forms

Certificate of Continued Disability Form

Critical Illness Claim Form

Death Claim Form

Disability Claimant’s Statement Form

Confidential Extract from Records Form (PMA)

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 [email protected]

Liberty Websites

Investor and Analyst Information
www.libertyholdings.co.za

Mind MyMoney Financial Education Programme
www.mindmymoney.co.za

Liberty on Jumia
www.jumia.ug/liberty_insurance


Life Insurance
General Insurance
Health Insurance
Address Madhvani Building, 2nd Floor Plot 99 - 101, Buganda Road, Kampala, Uganda
Tel +256 414 233 794 +256 312 246 500 +256 779 558 733
Email [email protected] [email protected] [email protected]
Fraud hotline 0800 200 160  
Liberty Life Assurance Limited - Reg. No. 75913 Privacy Notice Liberty General Insurance Limited - Reg. No. 264481 Privacy Notice | User Agreement