MetLife Retirement Portfolio Beneficiary Nomination Form
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1 For the payment of death benefits Beacon House, 27 Clarendon Road, Belfast BT1 3BG Before you start This form can be used to provide a new nomination in respect of any death benefits payable from your Retirement Portfolio, or to replace an existing nomination. 1 About you National Insurance Number MetLife policy number L Marital status Single Married Civil Partnered Widowed Divorced Dissolved Civil Partnership Would you nominate: one or more individuals - go to section 2 a Trust - go to section 3 a charity - go to section 4 Page 1 of 5
2 2 Your nominated beneficiary / beneficiaries First beneficiary Second beneficiary Third beneficiary Page 2 of 5
3 Your nominated beneficiary / beneficiaries continued... Fourth beneficiary *Total shares for all beneficiaries must equal 100 Page 3 of 5
4 3 Nominating a Trust Name of Trust Date Trust established First Trustee Second Trustee Third Trustee Fourth Trustee Page 4 of 5
5 4 Nominating a charity/charities Where you have no dependants you may like to nominate one or more charities to receive a lump sum death benefit on your death. First charity Name of charity Percentage share Second charity Name of charity Percentage share 5 Your declaration Changing your nomination The Scheme Trustee will refer to your latest nomination when they are notified of your death. We recommend you review your nomination from time to time especially if your circumstances change. You can let us know about any changes to your chosen beneficiaries by writing to us or filling in a new Nomination form. Declaration If I still have assets in my when the Scheme Administrator is notified of my death, I understand they will, acting on the instructions of the Scheme Trustee and subject to any relevant taxes, pay a lump sum and/or income benefits. I understand the Trustee s discretion is absolute, but I wish the Trustee to consider making payment in line with my wishes as indicated in this form. Member signature Date MetLife Sales Desk (Pre-sale information for Financial Advisers) One Canada Square, London E14 5AA Tel: salesresource@metlife.com MetLife Customer Service Centre (Post-sale information for Financial Advisers and policy holders) Beacon House, 27 Clarendon Road, Belfast BT1 3BG Tel: Fax: customerservice@metlife.co.uk Products and services are offered by MetLife Europe d.a.c. which is an affiliate of MetLife, Inc. and operates under the MetLife brand. MetLife Europe d.a.c. is a private company limited by shares and is registered in Ireland under company number Registered office at 20 on Hatch, Lower Hatch Street, Dublin 2, Ireland. UK branch office at One Canada Square, Canary Wharf, London E14 5AA. Branch registration number: BR MetLife Europe d.a.c. (trading as MetLife) is authorised by the Central Bank of Ireland and subject to limited regulation by the Financial Conduct Authority (FCA) and Prudential Regulation Authority (PRA). Details about the extent of our regulation by the FCA and PRA are available from us on request. WM l AUG 2016
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