request a group life claim form

To request a claim form following the death of a scheme member, please provide the information as below and click the button ‘Click here to produce a claim form’.

This will open a new PDF document, pre-populated with the information you have provided about the scheme member. Please save the PDF to your own computer, complete the remainder of the form, attach it to an email and send it to claims@ellipse.co.uk.

When you ‘Click here to produce a claim form’ this will also trigger an automated email notifying us of the new claim.

Further information regarding the claims process can be found here.

To make a claim under a critical illness, Interact (group income protection) or partner or spouse policy, please email claims@ellipse.co.uk or call 0203 003 6161.

  • Policy Details

  • Deceased Member Details

  • *indicates mandatory field