beneficiary nomination trusts, charities or companies

Transcription

1 beneficiary nomination trusts, charities or companies This document may be used in relation to both Life Account and Life Account 2 Contracts. Before completing the Beneficiary Nomination you should seek professional financial advice. Only use this form where you are nominating a trust, charity or company. If you wish to appoint an individual person, please complete a Beneficiary Nomination Individuals form available from our website or refer to your local Old Mutual Guernsey office. You can nominate up to a maximum of two trusts, charities or companies to receive the benefits payable under the Contract, subject to any succession restrictions. Any benefits payable will be in equal shares. This Beneficiary Nomination will take effect on the death of all the Relevant Lives Assured and Contract Holders only. As Life Account is issued as multiple Contracts, this Beneficiary Nomination will apply to all Contracts within the Plan. This form must be signed by all Contract Holders. Any future change of Nominated Beneficiaries must be confirmed in writing to us and an endorsement will be issued to confirm our acceptance of the change. International anti-money laundering regulations require Old Mutual Guernsey to identify parties to each transaction. In the case of some registered charities, recognised trusts (such as the National Trust) and certain Government recognised retirement funds, these requirements may be relaxed. Private trust and/or non-registered charities may require significant verification of trustees and/or beneficiaries. In any case, please contact Old Mutual Guernsey office to ascertain the extent of these requirements. Please note if you nominate a beneficiary who is resident in South Africa, they will have an obligation to declare this to the Reserve Bank. Old Mutual Guernsey will not be responsible for any legal or taxation consequences arising from the use of this form. Beneficiary Nomination in respect of Contract number from to Contract Holder(s) name(s) SECTION C MUST BE COMPLETED. IF IT IS NOT, OLD MUTUAL GUERNSEY WILL NOT BE ABLE TO PROCESS THIS REQUEST. page 1 of 5

2 A. Trusts nomination Nomination 1 Trust name Created on (please enter date) Name(s) of Trustee(s) D D M M Y Y Y Y Please state jurisdiction of trust Contact details for nomination 1 (Trustee(s)) s Miss Ms Other Nomination 2 Trust name Created on (please enter date) Name(s) of Trustee(s) D D M M Y Y Y Y Please state jurisdiction of trust Contact details for nomination 2 (Trustee(s)) s Miss Ms Other page 2 of 5

3 B. Charity or company nomination Nomination 1 Charity/Company name Registered office Charity/Business Charity fundraising number Ownership details I confirm that company shares are not held in bearer form. Note: applications from companies issuing bearer shares will not be accepted. Please complete either i) or ii) i) The company is quoted on a recognised stock exchange, either directly or as a subsidiary. a) Stock exchange b) Listed name c) If a subsidiary, please confirm relevant details ii) The company is NOT quoted on a recognised stock exchange, either directly or as a subsidiary. Please confirm ownership details, including, but not limited to, number of shares and names of holders with more than 5%. Contact details for the charity or company s Miss Ms Other page 3 of 5

4 B. Charity or company nomination (continued) Nomination 2 Charity/Company name Registered office Charity/Business Charity fundraising number Ownership details I confirm that company shares are not held in bearer form. Note: applications from companies issuing bearer shares will not be accepted. Please complete either i) or ii) i) The company is quoted on a recognised stock exchange, either directly or as a subsidiary. a) Stock exchange b) Listed name c) If a subsidiary, please confirm relevant details ii) The company is NOT quoted on a recognised stock exchange, either directly or as a subsidiary. Please confirm ownership details, including, but not limited to, number of shares and names of holders with more than 5%. Contact details for the charity or company s Miss Ms Other page 4 of 5

5 C. Declaration I/We acknowledge that: any Beneficiary Nomination will be effective only insofar as the claims of a valid security cessionary have already been met; any absolute assignment negates/cancels any Nominated Beneficiary selections immediately the assignment takes place, and; this Beneficiary Nomination will be effected in accordance with the Life Account General Conditions prevailing at the time. Signature(s) of Contract Holder(s) This date cannot be more than three months prior to our receipt of the form Please note that if the Contract(s) is/are jointly owned, this/they must be signed by all authorised signatories. If this form is not signed and dated, Old Mutual Guernsey will not be able to process the request. Old Mutual Guernsey, whose principal place of business is Albert House, South Esplanade, St Peter Port, Guernsey, GY1 1AW, Channel Islands, is a branch of Old Mutual Life Assurance Company (South Africa) Limited which is incorporated in South Africa Registered office: Mutualpark, Jan Smuts Drive, Pinelands, Cape Town, South Africa. Registered number: 1999/04643/06 IINT10-145/June 2010 FP0017 page 5 of 5