Losing a loved one is difficult, so we want to make transferring, cancelling or updating their COTA Insurance as simple as possible. If you are a customer or representative of a deceased customer, you may complete this COTA Bereavement form to inform us of a claim, cancel or change ownership of a policy.
Download the COTA Bereavement form here and send it to us by fax, mail or email and we will contact you to make sure everything is in order.
Return the form to us by:
Fax: 08 8112 8180
Mail: COTA Insurance, Reply Paid 84695, Adelaide, SA 5000
Email: Scan a copy of the completed and signed form, add ‘Bereavement Support’ in the subject line and email to ins[email protected]
This form enables the representative(s) of a deceased customer to cancel or transfer all COTA insurances that are in the name of the deceased.
Please complete all relevant sections in this form to ensure that the required action can be completed for the insurances of the deceased customer. If you require additional information on the insurance that is in the name of the deceased, please contact us on 1300 1300 50.
For each relevant insurance, select if you want to transfer the service into the name of another person or cancel the insurance. By completing and returning this form, you are authorising a COTA representative to follow through with your request and contact you to discuss any further details or requirements such as unoccupancy of a house.
Include copies of the following documents, where applicable;
To prevent fraudulent activity and privacy breaches, only people who are authorised to act on behalf of the deceased customer can access and change that customer’s insurance. Representatives are required to provide a copy of the death certificate, they must state that they’re authorised to act on behalf of the deceased customer. The people with the following relationship to the Deceased Estate will be accepted by us to act as their representative:
Please complete this section by specifying the insurance(s) to be cancelled. Please note that once a policy has been cancelled it cannot be reinstated.
Please complete the transfer section by allocating the insurance(s) to be transferred and completing the details of the new policy holder section of the COTA Bereavement Support Form. If a transfer involves multiple parties, please use a separate transfer form for each service.