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Add or Remove Assignee
Add/Remove/Change Beneficiary
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Add/Remove/Change Beneficiary

Policy No. (If unknown please tick box on the side)
Salutation
First Name*
Middle Name
Last Name*
Contact No.
Email
Address 1
Address 2
Town/City*
Country*
Please select the change that you would like to make
- Add Beneficiary
ADD BENEFICIARY
Is there a current Beneficiary on the policy?
- Yes
- No
How many beneficiaries are currently stated on the policy?
Were any of the beneficiaries added from inception?
- Yes
- No
Please select relationship of Beneficiaries
Is Beneficiary still a minor?
- Yes
- No
Please provide New Beneficiary Details
Salutation
First Name*
Middle Name
Last Name*
Date Of Birth
Date Format: MM slash DD slash YYYY
Address 1
Address 2
Town/City*
Country*
Email
Contact No.
Relationship of Beneficiary
Other
- Change Beneficiary Details
Change Beneficiary Details
Please select the change that you would like to make
From
To
Salutation
First Name*
Middle Name
Last Name*
Address 1
Address 2
Town/City*
Country*
Email
Contact No.
Relationship to policyholder
Allocation
How many beneficiaries are currently stated on the policy?
Were any of the beneficiaries added from inception?
- Yes
- No
Please select relationship of Beneficiaries
Is Beneficiary still a minor?
- Yes
- No
Will the Minor's allocation be reduced?
- Yes
- No
Please give allocation details including percentage changes
- Remove Beneficiary
REMOVE BENEFICIARY
Was the Beneficiary added from inception?
- Yes
- No
Please select relationship of Beneficiaries
Is Beneficiary still a minor?
- Yes
- No
Please provide Details of Beneficiary to be removed
Salutation
First Name*
Middle Name
Last Name*
Address 1
Address 2
Town/City*
Country*
Email
Contact No.
Relationship to policyholder
Other
Signature of Policyholder
- Type-in Signature
- Digital Signature
Signature*
Signature*
Date
Date Format: MM slash DD slash YYYY
Signature of Beneficiary
- Type-in Signature
- Digital Signature
Signature*
Signature*
Date
Date Format: MM slash DD slash YYYY

Add/Remove/Change Beneficiary

ADD BENEFICIARY

Please provide New Beneficiary Details

Change Beneficiary Details

Allocation

REMOVE BENEFICIARY

Please provide Details of Beneficiary to be removed