I hereby indemnify Royal Financial Services against all claims by any party for any benefits or monies, loss or damages incurred or suffered, in respect of, or caused by, any representation made by me to Royal Financial Services and/or the payment by Royal Financial Services to the above-named beneficiary of any claim in respect of the deceased's death.

I further confirm that I am the authorised person to claim any policy benefits due under the above-mentioned policy.

Royal Funerals will conduct background checks to confirm whether the information provided by me during the claim stage is correct. These checks will include, but are not limited to, identity verification checks against the database of the Department of Home Affairs. If we find any material differences or misrepresentation of any information provided by you, we have the right to repudiate the claim.

Before a claim is paid out, the beneficiaries will be screened against Royal Financial Services (PTY) Ltd Specified Sanctions Lists. Should the beneficiary be found on the sanctions list, the pay-out will not be concluded. The related family will be required to obtain a letter of appointment from the Magistrate Court for nomination of an alternative person to receive the funds. This may lead to the claim payment being delayed.

By submitting this form, I electronically sign and acknowledge this declaration. I understand that this electronic submission has the same legal effect as a handwritten signature.