Burial Reimbursement Form. Funeral Advantage is a life insurance policy underwritten by

Funeral Advantage is a life insurance policy underwritten by Lincoln Heritage Life Insurance Company® on form ICC13FEAPPR. Burial Assistance HRA’s Office of Burial Services (OBS) can provide financial assistance to help you meet the funeral expenses for a deceased low-income New York City resident. Please refer to OMB Control No. In the case of reimbursement to an individual, to receive a payment you will need a form of identification to verify the name and address of the person receiving the payment from HRA. FUNERAL CLAIM FORM One form per claim Call Centre 0861 001 788 E-mail: info@nhb. The funeral claim form (CLAIM009) open_in_new completed and signed by the claimant or authorised representative of the claimant. That individual should bring any documentation to the initial interview and may submit the remainder of documentation needed by US Mail. Please wait while we load the application for you. When two or more persons have been party to the arrangements, one must be designated to file the claim for reimbursement since only one claim will be accepted. In cases where the name appearing in the receipt being submitted as proof of payment of funeral expense is different from that of the claimant (as indicated in SSS Form BPN-103), the claimant must submit a signed authority or conformity of payment in favor of the claimant.

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