Lost policy declaration form

The Hibernians withdrew from the insurance business on 31 March 2013.

Our actuary is in the process of calculating a closure value for each insurance policy, and we will advise individual policy holders during June 2013 of the amount owing under each policy.

In preparation for this, the Hibernians have written to each individual life assurance policy holder requesting their original policy document(s).

(Please note that this request does not apply to funeral benefit members – only to life assurance policy holders)

If you cannot find your original policy document(s), please complete and return the form provided below:

HCBS Lost Policy Declaration Form

This form must be witnessed by a Justice of the Peace or Solicitor of the High Court.