Disbursements

We are only processing electronic disbursements for New Zealand at this time.

Please select a valid Type of Disbursement.
Please select a valid Claim Type.

Personal Information

Please enter a valid Policyholder Name.
Please enter a valid Policy Number.
Please select a valid Country.
Please enter a valid Address.
Please enter a valid City.
Please select a valid State/Province.
Please enter a valid Zip/Postal code.

Bank Information

Please enter a valid Name of Account.
Please enter a valid Bank Name.
Please select a valid Account Type.
Please enter a valid Routing Number.
Please enter a valid Bank Transit Number.
Please enter a valid Branch Name.
Please enter a valid Account Number.
Account Number must match.
  1. A PDF copy of a voided check
  2. PDF copy of a printed account verification screen signed and stamped with the bank stamp.
  3. A PDF bank statement
  4. A PDF copy of screen shot from a Mobile Bank device
Only PDF files are currently supported.

Your submission has been received and will be processed shortly.

There was an error with your submission, please try again or contact us if problems persist.