Canada Life. Group Life Assurance. Claim form. Group Life Assurance. Completion of all relevant fields will ensure prompt assessment of the claim
|
|
- Benjamin Sutton
- 6 years ago
- Views:
Transcription
1 Claim form Completion of all relevant fields will ensure prompt assessment of the claim Life Claims Team Canada Life Limited 3 Rivergate Temple Quay Bristol BS1 6ER Tel: Fax: Grouplifeclaims@canadalife.co.uk
2 Important information please read prior to completion of Claim form When should a trustee/authorised signatory submit a claim form? As soon as possible after a member s death. We will not pay any benefit, or any additional amounts of benefit, if a completed claim form, in respect of the benefit being claimed, has not been received by us within two years of the date of a member s death. How to submit a claim? If you wish to make a claim, we will initially need: a fully completed original claim form signed by the scheme trustees, or other agreed signatories Section 1 Section 2 Section 3 Section 4 Section 5 Section 6 Section 7 Section 8 Lump sum if applicable Pension if applicable evidence of a member s earnings where individual scheme data has not been provided at the commencement of risk or subsequently at the commencement of the current rate guarantee period (evidence can be copies of a member s last three full pay slips, a member s P60 for the last tax year or a P14). a member s original death certificate. where a spouse s/civil partner/dependant s pension is to be claimed, an original birth certificate for the spouse/civil partner and any other dependant and if applicable an original marriage certificate/civil partnership certificate for spouse/ civil partner. If the pension is payable to a person who is not the member s spouse/civil partner or child, we will also require: a copy of the current Scheme rules, a copy of the trustees investigations where they have established financial dependency in accordance with the Scheme rules. Original certificates will be returned to sender by recorded delivery as efficiently as possible. If the policy has been set up under the Canada Life Group Life Master Trust then an additional Master Trust Family Information Form will be required. Contact the life claims team for details. Why does Canada Life require original certificates? Due to HMSO directives relating to copyright, we are unable to accept photocopies. It should also be noted that having sight of the original documentation also reduces the risk of fraud. How long will it take to process my claim? Once we have received all our initial requirements, we will advise you within five working days: of any further information we require to assess the validity of the claim, or if we are unable to admit the claim and the reason(s) why. How will benefits be paid? If your claim is accepted, our settlement of any lump sum benefit will normally be remitted by Electronic Fund Transfer, in the name of the trustees of the scheme, direct into the trustee bank account. Payments will not normally be made to parties other than the trustees of the scheme. If the policy has been set up under the Canada Life Group Life Master Trust, payment will be made via Electronic Transfer direct to the beneficiary(ies). Does Canada Life offer any support services? A confidential 24-hour bereavement counselling and probate helpline is available for family members. 2
3 Section 1 Please ensure this section is fully completed for all claims. If the name on the deed is different to that on our records, please notify us. Principal employer s name Employer s name (if different from above) Group policy number Section 2 Payment details Payment to be made (please select one only) Please record trustee bank account details below in all cases where a lump sum is being claimed. Payment by other means will delay settlement. Canada Life will not make payment to a company trading account. Payment should only be made to a dedicated trustee bank account. If the trustees require payment to other than a trustee account (direct to beneficiaries) please arrange for completion of an authorisation and discharge form. To Trustee s Bank Account Please complete the account details section below. Direct to beneficiary(s). Authorisation and discharge attached/to follow. Via Canada Life Group Life Master Trust An additional Master Trust Family Information Form will be required. Please contact the life claims team as below. Trustee s bank account details Trustees account name Only complete with dedicated trustee bank account details. If in doubt please contact us. (t required for Master Trust) Trustees of Name of bank Branch Bank sort code Account number Authorisation and discharge forms must be completed on the policyholder s headed paper. Up to 3 named beneficiaries (individuals/charities) can be included on an authorisation and discharge form. Payment will not be made direct to the estate of the deceased or to a trust account which is not the trust used for creation of the group life scheme. Wording and full details can be obtained by contacting the life claims team on Section 3 Deceased member s details Member s full name Fully complete for all claims. Date of birth Employment start date If the member did not join the scheme when first eligible, please provide full details / explanation On what date did the member last attend work? Category for cover (eg works, staff, director etc) Scheme salary applicable at date of member s last attendance at work Benefit calculation (eg 3 x scheme salary) Amount of lump sum benefits being claimed Basis upon which the benefit is calculated. Date of death Scheme inclusion date (if different from employment start date) Scheme salary applicable at date of member s death Place of work postcode 3
4 Section 4 Death occurring overseas Particulars of deceased Date of departure from the UK Intended date of return to UK Last UK address Please complete if death occurred overseas. Please ensure that the original death certificate is provided along with an official translation in cases where no UK death certificate has been issued. Country visited Purpose of visit (e.g. business, holiday) Passport number Details of death Address abroad at time of death Exact place of death Exact time of death Exact cause of death Was it an accident? If please complete Accident section. Was it an illness? If please complete Illness section. Accident How did the accident occur? Who witnessed the accident? Please give names and addresses Was a police investigation carried out? Please provide a copy of the report if available. To which hospital was the deceased taken? Name and address of doctor certifying death Was there a post-mortem? Please provide a copy of the report if available. Was there an inquest? Please provide a copy of the report if available. Illness When was the deceased first taken ill? Nature of illness Name and address of medical attendant during last illness Name of doctor certifying death Burial/cremation Was the deceased: Buried? Cremated? Please tick the appropriate box. What documentation was obtained to allow the burial or cremation to take place? Where did the burial/cremation take place? Please provide the name and address of one person, not related to the deceased, who was present at the burial/cremation 4
5 Section 5 Spouse s/ civil partner s/ dependant s details Spouse s/civil partner s/ dependant s full name Date of birth This section only needs to be completed if a spouse/civil partner, dependant s or children s pension needs to be claimed. National Insurance number Basis of calculation of pension Annual amount of pension (payable on the member s death in accordance with the policy) If the spouse s/civil partner s/dependant s pension claimed includes any differing levels of escalation please provide the amounts and the levels of escalation below. Level of escalation e.g. Nil, LPI, 5% Amount of pension (NB: The pension amounts must equal the annual amount of pension shown above.) Post A-Day Pre A-Day HMRC maximum annual pension for the spouse/civil partner/dependant (if applicable) Details of any qualifying children where children s benefits are payable Full name Date of birth Child s annual pension Contingent orphans If the policy provides a contingent orphans benefit on death of the above named beneficiary please advise if there are potential orphans. If a child s pension is to be paid to an adult an additional authority form will need to be completed. Method of payment Payment details for spouse s/civil partner s/dependant s pension Net of tax to spouse/civil partner/dependant Gross to trustees Section 6 Authority for payment of pension for spouse, civil partner or other dependants This section only needs to be completed if you would like the pension to be paid directly to the spouse/ civil partner. We the trustees of the Group Policy mentioned overleaf, hereby request and authorise Canada Life Limited to act as our agents in paying pensions arising under the said policy on the death of the member named overleaf in the manner described below. Full name Home address Name of bank Branch Bank sort code Account number Roll number (if building society account) Account name 5
6 Section 7 Checklist Please ensure that all items on this checklist have been enclosed/completed. Failure to do so may delay the claim. Lump sum Claim form fully completed Payment details provided Original death certificate Evidence of earnings Declaration signed Place of work postcode Amount of lump sum For Master Trust only Expression of wish form Pension Please ensure all lump sum boxes are ticked Spouse/dependant bank details (if applicable) Marriage certificate Birth certificate Declaration signed Annual pension amount HMRC annual pension amount Claims will be withheld if any information relating to any aspect of the scheme that we have asked for is outstanding or the premiums we have asked for have not been paid when due. We will not settle any claims, or any requests for additional amounts of benefit, submitted to us more than 2 years after the date of a member s death. Section 8 Declaration Signature To be completed by the trustees or authorised signatories of the scheme. Please provide a list of authorised signatories if it differs from our records. We hereby apply for payment of the benefit(s) described above. We declare that the deceased member was a member of the Scheme on the date of death and that the particulars set out above are correct to the best of our knowledge and belief. We agree that the payment of a benefit in accordance with our instructions above will constitute a full discharge of the liability of Canada Life under the policy in respect of that benefit. Where the benefits claimed include a dependant s benefit, we confirm that the recipient of that benefit was dependant on the member. Date Print name Capacity of signatory* *This signature must be a Trustee or Authorised Signatory. These should be sent as soon as possible to: Life Claims Team, Canada Life Limited, 3 Rivergate, Temple Quay, Bristol BS1 6ER Our forms are available to download from our website: Canada Life Limited, registered in England no Registered Office: Canada Life Place, Potters Bar, Hertfordshire EN6 5BA. CLFIS (UK) Limited, registered in England no is an associate company of Canada Life Limited. Registered Office: Canada Life Place, Potters Bar, Hertfordshire EN6 5BA. Canada Life Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. GRP70 115R Canada Life Limited 3 Rivergate, Temple Quay, Bristol BS1 6ER Telephone
Canada Life Group Life Assurance
Life Claim Form If you have any questions regarding completion of the form or the submission process, call us on 07 96 60. Please complete in accordance with the Policy. Employer s details POLICYHOLDER
More informationAccepted quote reference
Risk details form In order to place cover with Canada Life, please make sure you: Accepted quote reference scan and email or fax this form to our Bristol office in advance of the commencement of risk.
More informationCanada Life Group Critical Illness
CLAIM FORM Claims procedures Please note that in order to satisfy a claim, the insured person s illness must meet the definition for the relevant critical illness described within the Policy Conditions.
More informationGROUP INSURANCE. Group Target Market GROUP TARGET MARKET GROUP LIFE LUMP SUM GROUP LIFE DEATH IN SERVICE PENSION GROUP INCOME PROTECTION
GROUP INSURANCE Group Target Market GROUP TARGET MARKET GROUP LIFE LUMP SUM GROUP LIFE DEATH IN SERVICE PENSION GROUP INCOME PROTECTION GROUP CRITICAL ILLNESS FLEXIBLE BENEFITS GROUP TARGET MARKET Canada
More informationGroup Life Assurance. Technical Guide. This Technical Guide is introduced from 25th May 2015.
Group Life Assurance Technical Guide This Technical Guide is introduced from 25th May 2015. Overview This product is designed to be a straightforward and convenient way to provide life cover for your employees,
More informationCanada Life Group Life Assurance
Canada Life Group Insurance February 2016 A comparison between registered group life schemes, excepted group life policies and relevant individual life policies This bulletin sets out to provide a comparison
More informationor Telephone Fax
Canada Life Limited, registered in England no. 977. Registered Office: Canada Life Place, Potters Bar, Hertfordshire EN6 BA. Member of the Association of British Insurers. CLFIS (UK) Limited, registered
More informationAccepted quote reference
Risk details form In order to place cover with Canada Life, please make sure you: Accepted quote reference scan and email or fax this form to our Bristol office in advance of the commencement of risk.
More informationMETLIFE GROUP LIFE POLICY DEATH CLAIM FORM METLIFE GROUP LIFE POLICY DEATH CLAIM FORM ALL QUESTIONS REQUIRE COMPLETION IN ORDER TO VALIDATE THE CLAIM
METLIFE GROUP LIFE POLICY DEATH CLAIM FORM METLIFE GROUP LIFE POLICY DEATH CLAIM FORM PLEASE NOTE THAT THE ISSUE OF THIS CLAIM FORM BY METLIFE DOES NOT CONSTITUTE AN ADMISSION OF ANY LIABILITY BY METLIFE
More informationRegistered Pension Schemes Dependant s Benefit Election Form. Form
Registered Pension Schemes Dependant s Benefit Election Form Form Policyholder/Member details (Office use) Policyholder/Member Policy number(s) Scheme name Electing a benefit option Please read the enclosure,
More informationChange of Policyholder
Change of Policyholder This form allows you to change the policyholder for a Group Income Protection Policy. WHEN TO USE THIS FORM This form can be used where a Group Income Protection Policy is being
More informationGROUP LIFE ASSURANCE. Technical Guide. Excepted Group Life Assurance for lump sum benefits for partners of employees
GROUP LIFE ASSURANCE Excepted Group Life Assurance for lump sum benefits for partners of employees Technical Guide Introduced from 26 September 2018. About us We provide support when it s needed most We
More informationGroup Life Assurance Policy Conditions
Group Life Assurance Policy Conditions These Policy Conditions are introduced from 1 January 2017 The content of this document reflect our current terms and conditions. Existing policyholders should be
More informationGroup Insurance. Group Life Assurance for Approved Death in Service Benefits Policy conditions
Group Insurance Group Life Assurance for Approved Death in Service Benefits Policy conditions Introduction Our commitment to plain English This Policy uses everyday language wherever possible and is laid
More informationGroup Life Assurance for death in service benefits under registered schemes
Group Life Assurance for death in service benefits under registered schemes eproduct Policy Conditions These Policy Conditions are introduced from 1 January 2017 The content of this document reflect our
More informationCanada Life Automated Self Service
Canada Life Automated Self Service User Manual How to assume risk cl ss Canada Life Automated Self Service How do I access? can be accessed at www.canadalife.co.uk/class or through the main Canada Life
More informationTechnical Guide. Canada Life. for death in service benefits under registered occupational pension schemes. Group Life Assurance.
Canada Life Group Life Life Assurance Assurance Technical Guide Group Life Assurance for death in service benefits under registered occupational pension schemes Technical Guide This Technical Guide is
More informationGROUP LIFE ASSURANCE
GROUP LIFE ASSURANCE Protection when the worst happens WHAT IS GROUP LIFE ASSURANCE? Group Life Assurance pays out a cash lump-sum upon death; this can provide much needed financial support at a difficult
More informationDEATH CLAIM FORM (DCF) CLAIMS DOCUMENT CHECKLIST (CDCL)
DEATH CLAIM FORM (DCF) CLAIMS DOCUMENT CHECKLIST (CDCL) Life Assured Name: Policy No.: Please submit this form along with the requirements mentioned below at the nearest branch or address mentioned overleaf
More informationRelevant Life Assurance for lump sum death in service benefits
Canada Life Group Life Life Assurance Assurance Technical Guide Relevant Life Assurance for lump sum death in service benefits Technical Guide This Technical Guide is introduced from 1st January 2017.
More informationCanada Life Automated Self Service
Canada Life Automated Self Service User Manual How to renew a policy cl ss Canada Life Automated Self Service How do I access? can be accessed at www.canadalife.co.uk/class or through the main Canada Life
More informationWELCOME TO GROUP CRITICAL ILLNESS
WELCOME TO GROUP CRITICAL ILLNESS THANK YOU Thank you for choosing Canada Life Group Insurance Thank you for choosing us to provide Group Critical Illness cover for you and your employees. We provide more
More informationGroup Life Assurance for death in service benefits under a registered pension scheme
Group Life Assurance for death in service benefits under a registered pension scheme eproduct Technical Guide This Technical Guide is introduced from 1st January 2017. About us We provide support when
More informationCLAIM FORM. B. Details of the person who has died. A. Using this form. C. Policies claimed against. Page 1 of 8
LYNCH WOOD PARK LYNCH WOOD PETERBOROUGH PE2 6FY WWW.NPI.CO.UK CLAIM FORM A. Using this form Some of the terms we use in this form appear in italics. These terms, and some others, are explained in the claim
More informationCanInvest Select Account Application for a new policy
Your Account will be set-up on the basis of your Personal Example reference number quoted here: P O B This reference number is on the bottom left hand corner of the Personal Example. Applications without
More informationApplication. Purchased Life Annuity Annuity Plan IV. An annuity purchased with client s own funds
Purchased Life Annuity Annuity Plan IV Application An annuity purchased with client s own funds In order for your application to be processed as a priority, the following must be completed. Agency no:
More informationINDIVIDUAL DEATH CLAIM FORM
INDIVIDUAL DEATH CLAIM FORM Dear claimant, We are sorry to learn about the death of our policyholder. In order for us to process your claim, we require the following: (1) Claimant s Statement (2) Consent
More informationCanRetire. Application Transfer Out. Pension Investment Plan. Flexible Drawdown Plan. Fixed Term Income Plan (Guaranteed Maturity Value) PIP FDP FTIP
CanRetire Application Transfer Out PIP Pension Investment Plan Flexible Drawdown Plan Fixed Term Income Plan (Guaranteed Maturity Value) Transfer funds out of to another UK registered pension scheme Please
More informationPersonal Pension Plan. Release / Retirement Form
Personal Pension Plan Release / Retirement Form Applicant s Details Surname Forename(s) Mr/Miss/Mrs/Other Marital Status Date of Birth Contact Tel Address Postcode Tax Free Cash Option Under Jersey Income
More informationGROUP LIFE ASSURANCE. Medical Underwriting Guide. How it Works Product Guide Running the Policy. Contents
Medical Underwriting Guide Contents When do we medically underwrite? Individual not currently covered under the policy 2 Individual already covered under the policy 2 How do we know if medical underwriting
More informationNHS Pensions - Claim for a lump sum on death in respect of a Pension Credit (AW11PC)
NHS Pensions - Claim for a lump sum on death in respect of a Pension Credit (AW11PC) Before completing this form please read the the notes below. Notes NHS Pensions may be able to pay a lump sum on death
More informationEQ TRAVEL CLAIM FORM
EQ TRAVEL CLAIM FORM Agency Policy No Please note: Sections 1, 2 and 12 must be completed. Sections 3 to 11 complete only the relevant sections. The acceptance of this form is NOT an admission of liability
More informationNHS Pensions - Claim for payment of children's pension (AW158)
NHS Pensions - Claim for payment of children's pension (AW158) This form only applies to members whose Scheme membership extends to or beyond 1 April 2008. Member's surname Other names Membership number
More informationNHS Pensions - Claim for payment of children's pension (AW158)
NHS Pensions - Claim for payment of children's pension (AW158) This form only applies to member's whose Scheme membership ended before 1 April 2008. Member's surname Other names Membership number SD /
More informationDeath Claim (Individual Policyowner) Instruction Page
HSBC Insurance (Singapore) Pte. Limited. (Reg. No. 195400150N) 21 Collyer Quay #02-01 Singapore 049320, Monday to Friday 9.30 am to 5 pm. www.insurance.hsbc.com.sg Customer Care Hotline: (65) 6225 6111
More informationApplication Form for the Curtis Banks SIPP
Application Form for the Curtis Banks SIPP This application form is a legally binding document between you (the applicant), Curtis Banks Limited and Colston Trustees Limited. Please complete all relevant
More informationNHS Pensions - Claim for Adult Dependant Pension on death of an active member (AW9)
NHS Pensions - Claim for Adult Dependant Pension on death of an active member (AW9) Please read the guidance notes below and the Survivors Guide first which is available on our website at www.nhsbsa.nhs.uk/pensions
More informationEmployee Application Form
The housing sector scheme of choice Social Housing Pension Scheme Employee Application Form Defined Benefit Membership number, to be completed by TPT Retirement Solutions: M PLEASE COMPLETE SECTIONS 1
More informationGROUP INCOME PROTECTION
Medical Underwriting Guide Contents When do we medically underwrite? Individual not currently covered under the policy 2 Individual already covered under the policy 2 How do we know if medical underwriting
More informationDeed of Assignment of a life assurance policy to an absolute beneficiary under a trust Deed of Assignment
This deed may be used for policies issued by: Canada Life Limited Canada Life International Limited CLI Institutional Limited Canada Life International Assurance (Ireland) DAC Deed Assignment a life assurance
More informationNHS Pensions - Claim for a lump sum on death in respect of a Pension Credit (AW11PC)
NHS Pensions - Claim for a lump sum on death in respect of a Pension Credit (AW11PC) Before completing this form please read the the notes below. Notes NHS Pensions may be able to pay a lump sum on death
More informationDeath Claim Form. Information on member. Information on insured person (deceased)
NTUC Gift Death Claim Form Dear Claimant We are sorry to learn of the death of our Life Insured. In order for us to assess your claim, please complete this form in FULL and attach the required documents.
More informationRetirement Options Form. Your Personal Details (Compulsory Information) Missing information could result in your payment being delayed
Retirement Options Form You have a choice of options when converting your pension fund into retirement benefits. Do make sure that you have read the booklet A Guide to Your Retirement Choices before completing
More informationSelf Invested Personal Pension. Benefit Form Uncrystallised Funds Pension Lump Sum (UFPLS)
Self Invested Personal Pension Benefit Form Uncrystallised Funds Pension Lump Sum (UFPLS) Important notes This benefit form must be completed if you wish to: Take a single UFPLS payment from your SIPP.
More informationDeath notification and application for death benefits
Date of receipt: Death notification and application for death benefits Before completing this form, please read the accompanying notes. Please complete this form using black ink and BLOCK CAPITALS. Part
More informationSIPP benefit form flexi-access and capped drawdown
SIPP benefit form flexi-access and capped drawdown This form can be used to: take a pension commencement lump sum (PCLS) take a pension commencement lump sum and set up drawdown payments Alternatively,
More informationPlease indicate below which situation applies to you. Tick one box only. Receiving a pension chargeable to tax
Curtis Banks Ltd, 3 Temple Quay Bristol, BS1 6DZ T 0117 910 7910 F 0117 929 2514 Contribution Form curtisbanks.co.uk This form should be used for contributions to the schemes with Crescent Trustees including:
More informationSmall Self Administered Scheme. Benefit Form Flexi-access and Capped Drawdown
Small Self Administered Scheme Benefit Form Flexi-access and Capped Drawdown Important notes Taking benefits from your pension is an important decision. We recommend that you take advice from a regulated
More informationClaim Guide. G-dec002 web 05_16
Claim Guide When somebody close to you has died and you need to deal with an insurance company, the last thing you need is to be faced with lots of technical jargon. Unfortunately, sometimes we have to
More informationChecklist for Death Claim (Individual and Group Insurance Policies)
Checklist for Death Claim (Individual and Group Insurance Policies) Dear claimant We are sorry to learn of the death of our policyholder/insured. In order for us to process your claim, please complete
More informationClaim Form Freedom Protection Plan Accidental Death Cover
Claim Form Freedom Protection Plan Accidental Death Cover Plan Number: Plan Owner: Life Insured (Deceased): Nominated Beneficiaries: Important information about completing this form This claim form is
More informationThis Trust form is designed for use to hold the lump sum death benefits payable under the following plan types in trust:
GGA1568 FLEXIBLE TRUST FORM This Trust form is designed for use to hold the lump sum death benefits payable under the following plan types in trust: Individual Plan issued in connection with your past
More informationCertified True Copy of Death Certificate (by Client Service Officers, Lawfirm or any Notary Public)
DEATH CLAIM Dear Claimant We are sorry to learn of the death of the Life Insured. In order for us to process the claim, we require the following: 4. 5. 6. 7. 8. Completed Death Claim Form (to be completed
More informationModern Merchant Banking
Modern Merchant Banking Sapphire SIPP fixed term deposit account Application form and guidance notes Applying for the Sapphire SIPP fixed term deposit Please retain pages 1 and 2 for your information.
More informationSmall Self-Administered Scheme SSAS. Takeover Application.
Small Self-Administered Scheme SSAS Takeover Application www.investaccpensions.co.uk Contents Company Information 2 Scheme Information 4 Additional Information 5 Member Information (1) 11 Member Information
More informationApplication and income payment form B.
Annuities Application and income payment form A Below Standard Lifetime Allowance Please use black ink and write in CAPITAL LETTERS or tick 4 as appropriate. Any corrections must be initialled. Please
More informationPART OF MATTIOLI WOODS PLC. Small Self-Administered Scheme (SSAS) Application Form
PART OF MATTIOLI WOODS PLC Small Self-Administered Scheme (SSAS) Application Form Please complete NOTES SECTION TITLE PAGE No. COMPLETED Section A Scheme details Page 3 Section B Personal details Page
More informationNHS Pensions - Claim for a lump sum on death of an active member (AW11)
NHS Pensions - Claim for a lump sum on death of an active member (AW11) Please read the guidance notes below and the Survivor Guide first Notes Membership number SD / Important: Only complete this form
More informationClaim Form Hospitalisation
Claim Form Hospitalisation ACE European Group Limited, A Chubb Company Claims Department PO Box 682 Winchester SO23 5AG T: 0345 841 0059 F: 0141 285 2901 claims@chubb.com Please write in black ink and
More informationRBSelect Critical Illness Scheme
RBSelect Critical Illness Scheme An Employee s Guide to Critical Illness cover This document contains important information about the Canada Life Group Critical Illness Flex Scheme for RBSelect. It should
More informationOne Pension Consultancy. Group Life Assurance. An employer s guide to providing a Group Life Assurance Scheme CG2/12
One Pension Consultancy Group Life Assurance An employer s guide to providing a Group Life Assurance Scheme CG2/12 What is a Group Life Scheme? This is effectively an arrangement established by an employer
More informationGuide to your Statement of Account:
Guide to your Statement of Account: Unit Rated schemes If you ve not seen a group insurance scheme statement of account from before, this guide will help to explain the different sections on a statement
More informationClaim Form Freedom Protection Plan Accidental Death Cover
Claim Form Freedom Protection Plan Accidental Death Cover Plan Number: Plan Owner: Life Insured (Deceased): Nominated Beneficiaries: Important information about completing this form This claim form is
More informationclaiming a superannuation death benefit guide
claiming a superannuation death benefit guide This document explains how to make a claim for a superannuation death benefit and what will happen when a death benefit claim is submitted. HS 1129.9 11/17
More informationDeath Claim Information Form 1 March 2013
Death Claim Information Form 1 March 2013 OnePath MasterFund ABN 53 789 980 697 RSE R1001525 SFN 292916944 OnePath Custodians Pty Limited ABN 12 008 508 496 AFSL 238346 RSE L0000673 347 Kent Street, Sydney
More information1. GENERAL Name of the Insured Group Name of subsidiary (if applicable) Names and Surname of Insured Person Date of birth D D M M Y Y Occupation
GROUP PERSONAL ACCIDENT CLAIM FORM Underwritten/ Administered by Frontline Underwriting Managers (Pty) Ltd Vat No. 4350242386 Reg. No. 2008/005015/07 Authorised Financial Service Provider: FSP No. 40752
More informationIssue address. For Reference
Tax Return 2018 Tax year 6 April 2017 to 5 April 2018 (2017 18) UTR NINO Employer reference Issue address Date HM Revenue and Customs office address Telephone Your tax return This notice requires you,
More informationBare Gift & Loan Trust
This loan agreement may be used for policies issued by: Canada Life Limited Canada Life International Limited CLI Institutional Limited Canada Life International Assurance (Ireland) DAC Bare Gift & Loan
More informationBenefit Form income drawdown and lump sum payments. Bank of Scotland Share Dealing Self Invested Personal Pension
Benefit Form income drawdown and lump sum payments Bank of Scotland Share Dealing Self Invested Personal Pension Benefit Form Important tes Please complete this form if you wish to: a) Take benefits from
More informationNHS Pensions - Claim for Adult dependant's pensions, Children's pensions and Allocated pensions (G60)
NHS Pensions - Claim for Adult dependant's pensions, Children's pensions and Allocated pensions (G60) Notes for Dependants Please read these notes carefully before you complete the claim form. Introduction
More informationClaim form - Travel. This document contains fillable form fields. It is recommended you download the file to fill in your information.
Claim form - Travel Contact us for more information: Chubb European Group Limited Claims Department PO Box 682 Winchester SO23 5AG O +44 345 841 0059 F +44 141 285 2901 uk.claims@chubb.com This document
More informationModern Merchant Banking
Modern Merchant Banking Sapphire SIPP fixed term deposit account Application form and guidance notes Applying for the Sapphire SIPP fixed term deposit Please retain pages 1 and 2 for your information.
More informationWe are writing further to your request for a claim form and are very sorry to note the circumstances described.
PO Box 5775 Southend-on-Sea Essex SS1 2JY Dear Sir/Madam Travel Insurance Claim We are writing further to your request for a claim form and are very sorry to note the circumstances described. In order
More informationThe Transfer Pension Portfolio Application Form
The Transfer Pension Portfolio Application Form You should consult your Financial Adviser when completing this form and for more information on the statements within it. Part A should be completed by the
More information*PPPPEN01* APPLYING TO TRANSFER-IN OR CONTRACT-OUT UNDER YOUR PERSONAL PENSION. This must be completed by your financial adviser.
Financial adviser stamp APPLYING TO TRANSFER-IN OR CONTRACT-OUT UNDER YOUR PERSONAL PENSION Financial adviser agency number Please enter your business postcode Are you enclosing a cheque with this application?
More informationThe Retirement Account Application form
The Retirement Account Application form You can use this application if: You are not entitled to a Guaranteed Minimum Pension (GMP), a Guaranteed Annuity Rate (GAR) or a Section 9 (2b) rights. If you are
More informationScheduled First Departure Date : Flight No : Scheduled Return Date : Flight No :
Asia Specialty Insurance Limited Formerly known as Asia Insurance Limited (Company No: LL08800) 8th Floor, Wisma Genting, Jalan Sultan Ismail, 50250 Kuala Lumpur, Malaysia. Tel: +603 2162 1128 Fax: +603
More informationMedical Emergency and Associated Expenses
TRAVEL INSURANCE CLAIM FORM Medical Emergency and Associated Expenses You must register any claim within 30 days of completion of your travel. Please supply original documents of the evidence you intend
More informationHalifax Share Dealing SIPP
Halifax Share Dealing SIPP Benefit form - income drawdown and lump sum payments Please complete this form if you wish to: a) Take benefits from your SIPP as a tax free lump sum (pension commencement lump
More informationThe purpose of this deed is to change the beneficiary under a power of appointment trust.
This trust deed may be used for policies issued by: Canada Life Limited Canada Life International Limited CLI Institutional Limited Canada Life International Assurance (Ireland) DAC Deed appointment to
More informationShare ownership: A bereavement guide
Share ownership: A bereavement guide Providing help in difficult times A guide on bereavement and shareholdings from Link Asset Services We understand that this is a difficult time, and would like to offer
More informationNHS Pensions - Deferred benefits claim form - (AW8P)
NHS Pensions - Deferred benefits claim form - (AW8P) Before completing this form please read the Retirement Guide and the guidance notes at the back of this form. Please type in the fields below then print
More informationA Guide to Your Retirement Choices
A Guide to Your Retirement Choices As you are approaching retirement, there are a number of choices available to you. The choice you make should reflect your own personal circumstances and other pension
More informationPERSONAL ACCIDENT CLAIM FORM
APPENDIX E Completion Notes PERSONAL ACCIDENT CLAIM FORM 1. If a claimant is unable to claim personally, the claim form may be completed on his/her behalf. 2. A claim must be submitted within a reasonable
More informationPolicy Provisions. CanRetire. Pension Investment Plan
Policy Provisions CanRetire Pension Investment Plan Contents Sections Page number 1. Introduction... 3 2. Interpretation and Definitions... 3 3. Premiums... 4 4. Funds and Units... 4 5. Fund switching...
More informationLIFE INSURANCE CLAIM
LIFE INSURANCE CLAIM Life Insurance Claim - Instructions 1. For a Life Insurance Claim: The beneficiary (claimant) should complete the Beneficiary s (claimant s) Statement and submit the completed claim
More informationThe Sanlam Portal Personal Pension Drawdown Application Form
The Sanlam Portal Personal Pension Drawdown Application Form Application under The Sanlam Portal Please note in this Application, we, us means Sanlam Financial Services UK Limited (SFS). In certain instances
More informationBusiness Application (including Trusts & Pensions)
Business Application (including Trusts & Pensions) Please complete all sections in full Section A Your organisation s details Organisation name: Section B Your nominated bank account (for transferring
More informationApplication for Premature Retirement benefits
Date of receipt: Application for Premature Retirement benefits Please complete this form using black ink and in BLOCK CAPITALS. You may find it useful to visit our retirement centre at www.teacherspensions.co.uk/members/planning-retirement
More informationImportant information to include on your tax return before sending it to us.
Important information to include on your tax return before sending it to us. Please make sure you include your: 10-digit Unique Taxpayer Reference (UTR) National Insurance number (NINO) employer reference
More informationClaim Form Personal Accident / Sickness
ACE European Group Limited, A Chubb Company Claims Department PO Box 682 Winchester SO23 5AG T: 0345 841 0059 F: 0141 285 2901 claims@chubb.com Claim Form Personal Accident / Sickness Please write in black
More informationThe purpose of this deed is to absolutely transfer ownership of a policy.
This deed may be used for policies issued by: Canada Life Limited Canada Life International Limited CLI Institutional Limited Canada Life International Assurance (Ireland) DAC Deed Assignment a life assurance
More informationAny fee charged by the member s GP for providing information for completion of the claim form will not be covered.
TRAVEL COVER CLAIM FORM FILLING IN THIS FORM Please fill in this form if a claim is being made from the Worldwide Travel Cover. Complete this form in black ink and as fully and truthfully as possible.
More informationregistered group life technical guide
registered group life technical guide registered group life technical guide 1 Any reference in this technical guide to employer can include the principal employer and participating employers and is also
More informationPolicy Provisions. CanRetire. Flexible Drawdown Plan
Policy Provisions CanRetire Flexible Drawdown Plan Contents Sections Page number 1. Introduction... 3 2. Interpretation and Definitions... 3 3. Premiums... 4 4. Funds and Units... 4 5. Fund switching...
More informationLocal Government Pension Scheme (LGPS) New Joiner Option Form
Local Government Pension Scheme (LGPS) New Joiner Option Form Surrey Pension Fund MASTER NJO 2016 V1 This form is for you if you are eligible to become a member of the Local Government Pension Scheme (LGPS).
More informationFidelity Personal Pension Top up form (for making a transfer or single/regular payments)
Fidelity Personal Pension Top up form (for making a transfer or single/regular payments) With this form you can: set up a regular payment into an existing plan make a single payment into an existing plan
More informationChanging your name. Complete Section 1. Changing your bank account details. Complete Section 2. Changing your address. Complete Section 3.
Secure Advantage+ Pension Plan Alterations Form Lifetime Income Alterations to your Plan This form should be used to make any of the changes to your Plan listed below. You should only fill out the Sections
More informationDEATH BENEFIT DISTRIBUTION REQUEST For use with the Collective Retirement Account (CRA)
Application reference number For office use only *SFDBD0300F* DEATH BENEFIT DISTRIBUTION REQUEST For use with the Collective Retirement Account (CRA) Form purpose This form can be used by the Legal Personal
More informationDeparting Australia Superannuation Payment Direction Form
Departing Australia Superannuation Payment Direction Form Use this form to request a benefit payment from the Russell Investments Master Trust (the Fund, iq Super), if you worked in Australia on an eligible
More information