MetLife Single Life Relevant Life Policy Proposal Form

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "MetLife Single Life Relevant Life Policy Proposal Form"

Transcription

1 Invicta House, Trafalgar Place, Brighton BN1 4FR The MetLife Single Life Relevant Life policy is provided and underwritten by MetLife Europe Limited, which trades as MetLife. The proposal form must be completed by the policyholder. Please write clearly, sign, date and return the proposal form to your financial intermediary. The proposal form must be returned to MetLife by the financial intermediary within 30 days of MetLife assuming risk. If you have any questions or require help in completing the proposal form please contact your financial intermediary. Please read this warning carefully. The insurance policy will be set up based on the information you give us. You must disclose all facts that are material to the insurance and provide true, accurate and complete information. Material facts are facts which would influence us in our decision on the terms and conditions (if any) of the insurance we offer you and are not restricted to the answers to the questions below. If you are uncertain as to whether a fact is material, you should disclose the full details to us. Before the policy commences, you must immediately report to us any change from the answers in this form or to any other information you have provided. The information you provide will form the basis of the contract of insurance between you and us. If you provide misleading information or you fail to disclose material facts before the insurance cover commences, the insurance cover provided under the policy may be void and it may result in a claim for benefit being rejected or any benefit payable being reduced. Page 1 of 10

2 1 Applicant s details Please complete in block capitals Employer details Organisation name(s) Registered address City Country Postcode Trading address City Country Postcode Scheme name (leave blank if same as employer) Company registration number (if applicable) Type of organisation (e.g. limited company, partnership, charity etc.) Full name and date of birth of the individual, employee or partner to be insured Nature of trade or business carried out by the individual (please describe the activities of the individual) Page 2 of 10

3 2 Policy details This section must be completed even if there is no existing policy. Please tick one of the following statements as appropriate: The policy benefit is currently insured with 1 or more insurers or self-insured on an identical benefit basis (Please complete all questions). The policy benefit is currently insured with 1 or more insurers or self-insured on a non-identical benefit basis (Please complete all questions). The benefits under this policy are not currently provided to the employee or partner (Please complete all questions c. and d.). a. Current insurer b. Has the employee s or partner s benefits been rated, declined, limited to a free salary level or free cover limit under a previous employer-sponsored single life relevant life policy? Yes No (If Yes please complete table below) Benefit Underwriting decision Reason for decision Date of decision Subject to any temporary cover provided during the underwriting process, please note that the employee or partner will not be granted cover under the policy until satisfactory evidence of health is received and the risk is accepted by MetLife. c. Is there a current or pending income protection / permanent health insurance claim in respect of the employee or partner? Has the employee or partner been absent from work for more than 90 continuous days at the commencement date? Yes No (If Yes please complete table below) Dates of absence from / to Cause Lump sum benefit d. Is the employee or partner based overseas or do they travel overseas for business purposes? Yes No (If Yes please complete table below) Occupation Country Frequency and duration of visits Page 3 of 10

4 3 Basis of Benefits Please select the benefit basis required. A maximum Life benefit of up to 10 x salary or earnings can be selected. X Salary or Lump sum (e.g. 100,000) Definition of salary or earnings (if multiple of salary chosen) Examples: 1. Basic annual salary at review date coinciding with or preceding the date of claim 2. Basic annual salary at the date of claim 3. P60 earnings 4. Another definition previously agreed with the insurer MetLife. If left blank example 1 will be used. Page 4 of 10

5 4 Eligibility Termination Age Were any of the following coverages quoted? Redundancy cover Redundancy cover period (in months) Early retirement cover Late retirement cover Late retiree termination age Are the above currently insured? (If Yes please provide details) Yes No Extensions to cover are optional and must be requested. Page 5 of 10

6 5 Actively at Work Declaration This applies to both currently insured and new policies and refers to this Single Life Relevant Life proposal. Unless specified by MetLife in writing, this Actively at Work declaration must be completed. On the last working day before the commencement date of the single life relevant life policy, did the employee or partner not meet the Actively at Work definition (as set out below) on the last working day before the commencement date due to accident or sickness? Yes No If Yes, please provide details: Cause Dates of absence from/to Benefit In the event they are not actively at work on the last working day before the commencement date due to accident or sickness, the employee or partner will not be granted cover until satisfactory evidence is received and they are accepted for cover by MetLife. Definition: Actively at work means, in relation to the employee employed by the employer or the partner of the employer at any relevant date, that they have not received medical advice to refrain from and are actively engaged in or are otherwise following their normal occupation on that date. Actively means the employee or partner is, in the opinion of the insurer, mentally and physically capable of working their normal contracted number of hours, either at their usual place of business or at the location to which business requires them to travel. Absence from work does not include holidays, maternity, paternity and adoption leave, or any other authorised leave to be approved by the insurer. Page 6 of 10

7 6 Commencement and declaration We hereby request that MetLife assume cover for the above named Single life Relevant Life Policy in accordance with the standard policy terms and conditions provided with: Quotation No. Dated We understand that the above quotation is subject to the information supplied by us in response to MetLife s underwriting questions. We understand that if any material facts supplied by us in this affect the premium rate detailed in the quotation above, a new quotation will be issued. We also understand that MetLife will not assume risk, until we have received written confirmation that their underwriting criteria have been satisfied. Commencement date and payment frequency Requested commencement date Requested review date (assumed 1 year after the commencement unless stated) MetLife will confirm in writing the date cover has commenced. This date cannot be backdated. Frequency with which premiums will be paid Annual Bi-annually Quarterly Monthly Declaration We declare that we have disclosed all facts material to the insurance cover and that the answers to the questions or to MetLife s underwriting questions in this form are true, accurate and complete. We agree that the application, together with statements made and information supplied by us in connection with the application, shall form the basis of the policy cover(s) granted by MetLife. We have read the data protection and confidentiality notice below and we note and understand the purposes for which personal data and sensitive personal data will be stored and processed by MetLife and with whom the data may be shared or transferred. We warrant that personal data provided to MetLife for the purposes of the Single Life Relevant Life Policy is provided in accordance with the rights of the data subject under the Data Protection Act We consent to MetLife seeking information from any insurance company to which a proposal for single life relevant life cover has been made and we authorise the giving of such information. We understand that we must notify MetLife of any change in the answers to the above questions and information supplied before the insurance cover commences. We acknowledge and understand that it is not MetLife s responsibility to advise on and confirm the way in which any policy operates, in particular regards to the tax treatment of a policy and whether it meets the relevant criteria of HM Revenue and Customs. We agree to furnish such medical evidence and confirmation of age satisfactory to MetLife as may be requested from time to time. Please ensure one of the authorised signatories as identified overleaf signs this declaration. We confirm that an electronic copy of this proposal form shall have the same validity as the original. Signature Position Name Date For and on behalf of Page 7 of 10

8 7 Authorised signatories For completion of claims and policy documentation please provide a minimum of 2 authorised persons. Name Signature Date Position Name Signature Date Position Name Signature Date Position Name Signature Date Position Page 8 of 10

9 Data protection and confidentiality notice Information relating to an individual (the data subject), or personal data or sensitive personal data (for example their medical notes and records) as defined by the Data Protection Act 1998, whether included in this application or otherwise, is private and confidential. We comply with all legislation relating to Data Protection. We hold or process personal data or sensitive personal data for the purposes set out below. We will store and process data for underwriting and claims, fraud and crime prevention and detection, marketing purposes, to carry out research and analysis, to set up and administer, and provide information about the policy or the linked policy in connection with any reinsurance and in connection with any subsequent application(s). We may share with or transfer data relating to an individual for the above purposes to our parent company and other companies within the company group, to our successors or assigns, to other insurers, to insurance intermediaries, to our service providers, to our reinsurers or to third party companies to process or manage information on our behalf. These companies may operate outside the European Economic Area. Data will be processed as securely as if we were processing it, under a strict code of privacy and security. We may process or share personal data or sensitive personal data with other insurers, reinsurers, law enforcement agencies and other third parties for the purposes of fraud and crime prevention and detection and to comply with our statutory obligations. Page 9 of 10

10 Products and services are offered by MetLife Europe Limited which is an affiliate of MetLife, Inc. and operates under the MetLife brand. MetLife Europe Limited is authorised by the Central Bank of Ireland and subject to limited regulation by the Financial Conduct Authority. Details about the extent of our regulation by the Financial Conduct Authority are available from us on request. Registered address: 20 on Hatch, Lower Hatch Street, Dublin 2, Ireland. Registration number UK branch address: One Canada Square, Canary Wharf, London E14 5AA. Branch registration number BR EB l SEP 2015

GROUP INCOME PROTECTION

GROUP INCOME PROTECTION GROUP INCOME PROTECTION PROACTIVE PROTECTION PROVIDED BY METLIFE POLICY PROPOSAL FORM This policy is provided and underwritten by MetLife Europe Limited, which trades as MetLife. This form must be completed

More information

METLIFE SINGLE LIFE RELEVANT LIFE POLICY TERMS AND CONDITIONS

METLIFE SINGLE LIFE RELEVANT LIFE POLICY TERMS AND CONDITIONS METLIFE SINGLE LIFE RELEVANT LIFE POLICY TERMS AND CONDITIONS Contents 1 The MetLife Single Life Relevant Life policy 4 2 Definitions 4 3 Minimum requirements for the MetLife Single Life Relevant Life

More information

GROUP INCOME PROTECTION PROACTIVE PROTECTION PROVIDED BY METLIFE POLICY TERMS & CONDITIONS

GROUP INCOME PROTECTION PROACTIVE PROTECTION PROVIDED BY METLIFE POLICY TERMS & CONDITIONS GROUP INCOME PROTECTION PROACTIVE PROTECTION PROVIDED BY METLIFE POLICY TERMS & CONDITIONS 1 CONTENTS 1. The policy 2 2. Definitions 3 3. Minimum requirements for the policy 7 4. Eligible employees and

More information

METLIFE EXCEPTED GROUP LIFE POLICY TECHNICAL GUIDE

METLIFE EXCEPTED GROUP LIFE POLICY TECHNICAL GUIDE METLIFE EXCEPTED GROUP LIFE POLICY TECHNICAL GUIDE This document is a guide to the features, benefits, risks and limitations of the MetLife Excepted Group Life policy, including how the policy works and

More information

Group Life Policy for Registered Schemes Technical Guide

Group Life Policy for Registered Schemes Technical Guide For commercial customers and their advisers only Group Life Policy for Registered Schemes Technical Guide Reference BGR/4507/FEB10-P Contents Page Its aims 3 Employers your commitment Risk factors How

More information

Online Group Life Policy for Registered Schemes Technical Guide

Online Group Life Policy for Registered Schemes Technical Guide For commercial customers and their advisers only Online Group Life Policy for Registered Schemes Technical Guide Reference BGR/5576/SEP13 Contents Page Its aims Employers your commitment Risk factors How

More information

LEGISLATION UPDATE THE LIFETIME ALLOWANCE, FIXED PROTECTION 2014 AND METLIFE REGISTERED GROUP LIFE POLICIES

LEGISLATION UPDATE THE LIFETIME ALLOWANCE, FIXED PROTECTION 2014 AND METLIFE REGISTERED GROUP LIFE POLICIES FOR INTERMEDIARY USE ONLY FEBRUARY 2014 LEGISLATION UPDATE THE LIFETIME ALLOWANCE, FIXED PROTECTION 2014 AND METLIFE REGISTERED GROUP LIFE POLICIES This update is a summary of MetLife s interpretation

More information

Group Income Protection Technical Guide

Group Income Protection Technical Guide For commercial customers and their advisers only Group Income Protection Technical Guide Reference BGR/4019/OCT12 Contents Page Its aims Employers your commitment Risk factors How does the policy work?

More information

METLIFE Group Life (INCLUDING FLEXIBLE BENEFITS) Technical Guide

METLIFE Group Life (INCLUDING FLEXIBLE BENEFITS) Technical Guide METLIFE Group Life (INCLUDING FLEXIBLE BENEFITS) Technical Guide 1 MetLife Group Life Policies Technical Guide MetLife has a range of policies aimed to meet your life cover needs in respect of your employees

More information

PSEU INCOME PROTECTION PLAN APPLICATION FORM

PSEU INCOME PROTECTION PLAN APPLICATION FORM PSEU INCOME PROTECTION PLAN APPLICATION FORM Personal Details Full name: Title: Mr Mrs Miss Ms Date of birth: D D M M Y Y Y Y Address: PPS number: Phone number: Email address: Employment Details Employer:

More information

GROUP INCOME PROTECTION

GROUP INCOME PROTECTION GROUP INCOME PROTECTION PROACTIVE PROTECTION PROVIDED BY METLIFE POLICY technical guide This document is a guide to the features, benefits, risks and limitations of the policy, including how the policy

More information

UltraCare International Schools plan Individual application Moratorium

UltraCare International Schools plan Individual application Moratorium UltraCare International Schools plan Individual application Moratorium Need help completing this application? Please contact either your advisor or us directly. You can find our contact details on our

More information

Excepted Group Life Assurance for Police Federations

Excepted Group Life Assurance for Police Federations Group Life Assurance Excepted Group Life Assurance for Police Federations Policy Conditions Retired Officers The nature of the Policy The Policy is an excepted group life Policy as defined in section 482(2)

More information

Technical Guide GROUP LIFE ASSURANCE TECHNICAL GUIDE DEATH-IN-SERVICE BENEFITS INSURED UNDER AN EXCEPTED GROUP LIFE ASSURANCE TRUST

Technical Guide GROUP LIFE ASSURANCE TECHNICAL GUIDE DEATH-IN-SERVICE BENEFITS INSURED UNDER AN EXCEPTED GROUP LIFE ASSURANCE TRUST Technical Guide GROUP LIFE ASSURANCE TECHNICAL GUIDE DEATH-IN-SERVICE BENEFITS INSURED UNDER AN EXCEPTED GROUP LIFE ASSURANCE TRUST People you can trust- A company you can rely on Who are Omnilife? Omnilife

More information

Group Life Assurance. Technical Guide. Group Life Assurance for Death in Service Benefits under Registered Occupational Pension Schemes

Group Life Assurance. Technical Guide. Group Life Assurance for Death in Service Benefits under Registered Occupational Pension Schemes Group Life Assurance Group Life Assurance for Death in Service Benefits under Registered Occupational Pension Schemes Technical Guide This Technical Guide does not constitute contractual Terms Registered

More information

Online Group Income Protection Technical Guide

Online Group Income Protection Technical Guide For commercial customers and their advisers only Online Group Income Protection Technical Guide Reference BGR/5575/SEP13 Contents Page Its aims Employers your commitment Risk factors How does the policy

More information

Technical Guide GROUP LIFE ASSURANCE TECHNICAL GUIDE DEATH-IN-SERVICE BENEFITS FOR REGISTERED OCCUPATIONAL PENSION SCHEMES

Technical Guide GROUP LIFE ASSURANCE TECHNICAL GUIDE DEATH-IN-SERVICE BENEFITS FOR REGISTERED OCCUPATIONAL PENSION SCHEMES Technical Guide GROUP LIFE ASSURANCE TECHNICAL GUIDE DEATH-IN-SERVICE BENEFITS FOR REGISTERED OCCUPATIONAL PENSION SCHEMES People you can trust- A company you can rely on Who are Omnilife? Omnilife is

More information

SINGLE RELEVANT LIFE ASSURANCE POLICY

SINGLE RELEVANT LIFE ASSURANCE POLICY SINGLE RELEVANT LIFE ASSURANCE POLICY --------------------------------------------------------------------------------------------------------------------------- TERMS AND CONDITIONS In consideration of

More information

Havensrock Trustees Registered Group Life Assurance

Havensrock Trustees Registered Group Life Assurance Havensrock Trustees Registered Group Life Assurance Technical Guide 30 th July 2015 - vs1.5 Havensrock Trustee Registered Group Life Assurance - Technical Guide 1 Havensrock Technical Guide Welcome to

More information

COMMERCIAL INSURANCE PROPOSAL FORM COVER DESIGNED FOR YOUR BUSINESS

COMMERCIAL INSURANCE PROPOSAL FORM COVER DESIGNED FOR YOUR BUSINESS COMMERCIAL INSURANCE PROPOSAL FORM COVER DESIGNED FOR YOUR BUSINESS This Proposal is for use by special agreement with NIG in connection with their range of Commercial Non-motor Policies other than Motor

More information

Excepted Group Life Assurance for Police Federations

Excepted Group Life Assurance for Police Federations Group Life Assurance Excepted Group Life Assurance for Police Federations Policy Conditions Serving Officers The nature of the Policy The Policy is an excepted group life Policy as defined in section 482(2)

More information

MOTOR TRADE ROAD RISKS ANNUAL DECLARATION COVER ENGINEERED FOR THE MOTOR TRADE

MOTOR TRADE ROAD RISKS ANNUAL DECLARATION COVER ENGINEERED FOR THE MOTOR TRADE MOTOR TRADE ROAD RISKS ANNUAL DECLARATION COVER ENGINEERED FOR THE MOTOR TRADE Motor Trade Road Risks Important Note You (or the broker or agent completing the form on your behalf) must provide all material

More information

Individual insurance transfer

Individual insurance transfer AON MASTER TRUST Individual insurance transfer Use this form if you are a current member or joining the Aon Master Trust as a new member and you wish to transfer your current insurance cover with another

More information

Flexible Benefits Technical summary

Flexible Benefits Technical summary Flexible Benefits Technical summary An excellent choice Canada Life Limited aims to satisfy your specific requirements for Group Life, Group Income Protection or Group Critical Illness cover. With us you

More information

Generali PanEurope Group Income Protection

Generali PanEurope Group Income Protection Generali PanEurope Group Income Protection EmployeE CLAIM FORM AND GUIDE TO THE Claims Process 2 Group Income Protection Employee Guide to the Claims Process Group Income Protection is designed to provide

More information

APPLICATION FORM. / / / PENSION ANNUITY. Once you ve completed this form, please return it to: Legal & General Annuities PO Box 809 Cardiff CF24 0YL

APPLICATION FORM. / / / PENSION ANNUITY. Once you ve completed this form, please return it to: Legal & General Annuities PO Box 809 Cardiff CF24 0YL PENSION ANNUITY APPLICATION FORM. Once you ve completed this form, please return it to: Legal & General Annuities PO Box 809 Cardiff CF24 0YL We will already have sent you a quote(s), illustrating the

More information

Group Critical Illness Insurance Policy UGCIPOL/08/2008

Group Critical Illness Insurance Policy UGCIPOL/08/2008 Group Critical Illness Insurance Policy UGCIPOL/08/2008 GROUP CRITICAL ILLNESS INSURANCE POLICY This policy is issued by Unum Limited (called Unum in this policy) to the policyholder named in the schedule.

More information

Group Personal Pension

Group Personal Pension Application Form (For employed or self-employed individuals) Who this form is for When we refer to Standard Life we mean Standard Life Assurance Limited This form is for employees, or self-employed individuals

More information

Private medical insurance employer application form.

Private medical insurance employer application form. Private medical insurance employer application form. Fully insured corporate Notes to help you Please use black ink and write in CAPITAL LETTERS or tick as appropriate. All questions to be answered. Any

More information

Technical Guide GROUP INCOME PROTECTION TECHNICAL GUIDE. People you can trust- A company you can rely on

Technical Guide GROUP INCOME PROTECTION TECHNICAL GUIDE. People you can trust- A company you can rely on Technical Guide GROUP INCOME PROTECTION TECHNICAL GUIDE People you can trust- A company you can rely on Who are Omnilife? Omnilife is a specialist insurer providing Group Risk benefits for employers that

More information

SINGLE RELEVANT LIFE ASSURANCE POLICY

SINGLE RELEVANT LIFE ASSURANCE POLICY SINGLE RELEVANT LIFE ASSURANCE POLICY --------------------------------------------------------------------------------------------------------------------------- TERMS AND CONDITIONS In consideration of

More information

Group Life Assurance. Registered Policy Terms and Conditions. GLA Policy Conditions and Definitions/06.11(4)

Group Life Assurance. Registered Policy Terms and Conditions. GLA Policy Conditions and Definitions/06.11(4) Group Life Assurance Registered Policy Terms and Conditions GLA Policy Conditions and Definitions/06.11(4) GENERAL CONDITIONS 1. PERIOD OF POLICY Subject to the provisions of these General Conditions this

More information

Sippchoice Bespoke SIPP

Sippchoice Bespoke SIPP Sippchoice Bespoke SIPP Application Form (from 1 October 2015) Please indicate the unique reference number shown on the Key Features Illustration that you received with this application. Failure to complete

More information

Generali PanEurope Group Income Protection. GUIDE TO THE Claims Process

Generali PanEurope Group Income Protection. GUIDE TO THE Claims Process Generali PanEurope Group Income Protection Employer CLAIM FORM AND GUIDE TO THE Claims Process 2 Group Income Protection Employer s Guide to the Claims Process Group Income Protection is designed to provide

More information

Underwritten by. Home Contents Insurance Application Form

Underwritten by. Home Contents Insurance Application Form Underwritten by Home Contents Insurance Application Form Tenants Home Contents Insurance Scheme Application Form Subject to the terms, exclusions and conditions of the policy, a specimen of which is available

More information

IMPORTANT NOTICE TO THE APPLICANT

IMPORTANT NOTICE TO THE APPLICANT Proposal Form Directors and Officers Liability Insurance ALL COMPANIES IMPORTANT NOTICE TO THE APPLICANT Please fully complete this Proposal Form. It is very important that the person completing the Proposal

More information

Group Life Assurance. Change of Policyholder Introduction. Trust and policy details

Group Life Assurance. Change of Policyholder Introduction. Trust and policy details Change of Policyholder Introduction This form allows you to change the policyholder(s)/trustee(s) for a Group Life Assurance Policy for death in service benefits where the scheme only provides death in

More information

ACCIDENT CASH PLAN- HOSPITALISATION CLAIM FORM

ACCIDENT CASH PLAN- HOSPITALISATION CLAIM FORM ACCIDENT CASH PLAN- HOSPITALISATION CLAIM FORM Please provide as much information as possible when completing this form. If you are unable to fit your answers into the spaces below, please continue on

More information

COMMERCIAL VEHICLE PROPOSAL FORM YOU LL ONLY NEED TO WORRY ABOUT THE TRAFFIC

COMMERCIAL VEHICLE PROPOSAL FORM YOU LL ONLY NEED TO WORRY ABOUT THE TRAFFIC COMMERCIAL VEHICLE PROPOSAL FORM YOU LL ONLY NEED TO WORRY ABOUT THE TRAFFIC Introduction Choice of Cover Third Party Fire and Theft You are covered for liability to third parties (including passengers)

More information

Registered Group Life Policies

Registered Group Life Policies Registered Group Life Policies Technical Guide (inc. Flexible Benefit Policies) 1 1 Its aims 1.1 How does the Policy work? 1.2 Your commitment 1.3 Risk factors 2 What factors should be considered in deciding

More information

a) Are its shares traded or expected to be traded on the London Stock Exchange or any other Exchange where its shares may be bought or sold?

a) Are its shares traded or expected to be traded on the London Stock Exchange or any other Exchange where its shares may be bought or sold? DIRECTORS AND OFFICERS AND CORPORATE LIABILITY INSURANCE APPLICATION FORM ALL COMPANIES IMPORTANT NOTICE TO THE APPLICANT To apply for Directors and Officers Liability, Corporate Liability or Employment

More information

Group Income Protection Policies

Group Income Protection Policies Group Income Protection Policies Technical Guide (inc. Flexible Benefit Policies) 1 1 Its aims 1.1 How does the Policy work? 1.2 Your commitment 1.3 Risk factors 2 What factors should be considered in

More information

Group Income Protection Insurance Policy GIPPOL(EMPLOYEE)/04/2008

Group Income Protection Insurance Policy GIPPOL(EMPLOYEE)/04/2008 Group Income Protection Insurance Policy GIPPOL(EMPLOYEE)/04/2008 GROUP INCOME PROTECTION INSURANCE POLICY This policy is issued by Unum Limited (called Unum in this policy) to the policyholder named in

More information

Compulsory Purchase Annuity

Compulsory Purchase Annuity Application form Who this form is for 0615 This form is for people who want to purchase a pension from Standard Life Filling in this form Before completing this form read the Key Features Document (CPA17)

More information

Select & Protect MPPI

Select & Protect MPPI Start of Policy Summary 1. Policy Summary This is a summary of the policy cover for Mortgage Payment Protection insurance, and does not include the full terms and conditions of the contract, which can

More information

Elite Retirement Account

Elite Retirement Account Elite Retirement Account Application Form and Mandate for a Self Invested Personal Pension Plan Member Bank Account Self Invested Personal Pension Scheme Account Opening Request To: The Manager, Partnerships

More information

Group Income Protection. Policy Conditions

Group Income Protection. Policy Conditions Group Income Protection Policy Conditions These Policy Conditions are introduced from 16 September 2015 Your Policy The contractual terms of the Policy are set out in: these Policy Conditions and any

More information

Group Life Assurance Technical Guide

Group Life Assurance Technical Guide Group Life Assurance Technical Guide Page 1 of 10 1. AMTRUST LIFE AIMS The information contained in this guide gives an outline of our approach to insuring Group Life business and our Standard Terms and

More information

Just Retirement Fixed Term Annuity Application Form

Just Retirement Fixed Term Annuity Application Form Just Retirement Fixed Term Annuity Application Form You should make sure you ve read the Key Features Document and the Conditions of the Just Retirement Fixed Term Annuity before you apply. About this

More information

PRIVATE MEDICAL INSURANCE BUSINESS HEALTHCARE WITH HEALTHY BUSINESS DISCOUNT

PRIVATE MEDICAL INSURANCE BUSINESS HEALTHCARE WITH HEALTHY BUSINESS DISCOUNT EMPLOYER APPLICATION FORM PRIVATE MEDICAL INSURANCE BUSINESS HEALTHCARE WITH HEALTHY BUSINESS DISCOUNT To be used for new business plans with 2 9 employees who are eligible for a Healthy Business Discount

More information

Application for a. Single Premium Immediate Annuity

Application for a. Single Premium Immediate Annuity Application for a Single Premium Immediate Annuity BMO Life Assurance Company 60 Yonge Street, Toronto, Ontario, Canada M5E 1H5 Tel 416-596-3900 Fax 416-596-4143 Toll Free 1-877-742-5244 348E (2010/11/18)

More information

Tenants and Leaseholders Home Contents Insurance Scheme Application Form

Tenants and Leaseholders Home Contents Insurance Scheme Application Form Tenants and Leaseholders Home Contents Insurance Scheme Application Form (Subject to the terms, exclusions and conditions of the policy, a specimen of which is available on request). Before you fill in

More information

Copy of the Life Insured s/payor s (for Payor Benefit)/ Child (For Serious Illness of a Child Benefit)) Identity Card/Birth Certificate/ Passport

Copy of the Life Insured s/payor s (for Payor Benefit)/ Child (For Serious Illness of a Child Benefit)) Identity Card/Birth Certificate/ Passport Dear Claimant We are sorry to learn of your illness/ injury. In order for us to process the claim, we require the following: 1. Critical Illness Form 2. Attending Physician s Statement 3. Copy of the Life

More information

Terms of Business FBD Insurance plc

Terms of Business FBD Insurance plc Terms of Business FBD Insurance plc Why have terms of business? This document protects you. It is required by the Central Bank of Ireland. It is important that you read it in full. If there is anything

More information

1. Understand the nature of the group risk market 2. 2. Understand the nature and purpose of the different types of employee benefits 3

1. Understand the nature of the group risk market 2. 2. Understand the nature and purpose of the different types of employee benefits 3 Group risk At the end of this unit, candidates should understand the: nature and purpose of employee benefits; main elements of the State benefits system in the UK; legislative and regulatory context in

More information

NEXT HEALTHCASHPLAN HEALTHSCHEME DENTAL THERAPY +CARE4 USING YOUR HEALTH CASH PLAN

NEXT HEALTHCASHPLAN HEALTHSCHEME DENTAL THERAPY +CARE4 USING YOUR HEALTH CASH PLAN HELP US TO HELP YOU To request further information on any of the products below - tick the box(es) of your choice... PLAN4LIFE CANCER INSURANCE TRAVEL INSURANCE Financial help when you need it most. With

More information

Havensrock Registered Group Life Assurance

Havensrock Registered Group Life Assurance Havensrock Registered Group Life Assurance Technical Guide 30 th July 2015 vs2.2 Havensrock Registered Group Life Assurance - Technical Guide 1 Havensrock Technical Guide Welcome to our Technical Guide.

More information

Spouse s and Partner s Group Life Assurance

Spouse s and Partner s Group Life Assurance TECHNICAL GUIDE Spouse s and Partner s Group Life Assurance Because everyone needs a back-up plan unum.co.uk Technical Summary Technical Guide for Commercial customers and their advisers. This product

More information

Registered Group Life Assurance Technical Guide

Registered Group Life Assurance Technical Guide Registered Group Life Assurance Technical Guide Thank you for choosing Optimal. By selecting Optimal you have chosen to insure your Group Life benefits with one of the newest and fastest growing Group

More information

Please use BLOCK CAPITALS only and blue or black ink, ticking boxes where appropriate.

Please use BLOCK CAPITALS only and blue or black ink, ticking boxes where appropriate. TD Direct Investing SIPP benefit form - annuity purchase discharge form SIPP benefit form - annuity purchase discharge form This benefit form must be completed if you wish to purchase a lifetime annuity

More information

Excepted Life Assurance

Excepted Life Assurance Excepted Life Assurance On Risk Form for Excepted Life Assurance Policy 1 This form may only be completed by an individual authorised to act for and on behalf of the Trustees of the Excepted Life Assurance

More information

Key Features of the MetLife Income for Life Bond (UK and International)

Key Features of the MetLife Income for Life Bond (UK and International) Key Features of the MetLife Income for Life Bond (UK and International) 1 Key Features of the MetLife Income for Life Bond (UK and International) Key Features of the MetLife Income for Life Bond (UK and

More information

Supplementary Group Life Policy Application Form

Supplementary Group Life Policy Application Form Supplementary Group Life Policy Application Form Please ensure that you complete all items in each section. Please answer all questions in BLOCK CAPITALS, ticking boxes or circle were appropriate. If you

More information

PART 2 - DETAILS OF THE CLAIM

PART 2 - DETAILS OF THE CLAIM Lifeline Plus Group Personal Accident & Travel Insurance Personal Accident and Sickness Claim Form The claimant should complete and sign this form. If the claimant is under 18 years of age, this form should

More information

E-ISA. Power of Attorney application form. Personal details. Donor. 1st Attorney Title: Mr, Mrs, Ms, Miss Other (please specify) Surname.

E-ISA. Power of Attorney application form. Personal details. Donor. 1st Attorney Title: Mr, Mrs, Ms, Miss Other (please specify) Surname. E-ISA Power of Attorney application form Please read these notes before you fill in this form The account will be operated strictly in accordance with the instructions confirmed within the Power of Attorney

More information

Selected Investment Funds (SIF) Plan and SIF Individual Savings Account (ISA) Additional Investment Form and Switch Form

Selected Investment Funds (SIF) Plan and SIF Individual Savings Account (ISA) Additional Investment Form and Switch Form HNBPST Selected Investment Funds (SIF) Plan and SIF Individual Savings Account (ISA) Additional Investment Form and Switch Form Notes on completing this form Please read the Selected Investment Funds Key

More information

Accident, Sickness & Critical Illness Claim Form

Accident, Sickness & Critical Illness Claim Form Republic of Ireland Accident, Sickness & Critical Illness Claim Form Information Before you return your claim form, please ensure that you have me the required waiting period: Waiting period (after initial

More information

SHORT TERM THEATRE INSURANCE PROPOSAL

SHORT TERM THEATRE INSURANCE PROPOSAL *A FULL POLICY WORDING IS AVAILABLE ON REQUEST* Please complete in full selecting the covers you require or have been quoted. Name of Proposer in full: SHORT TERM THEATRE INSURANCE PROPOSAL. Limited Company

More information

MetLife Discretionary Gift Trust

MetLife Discretionary Gift Trust R MetLife Discretionary Gift Trust Important Information This document is provided on the strict understanding that it is presented as a draft to be considered by the Settlor and his/her legal advisers.

More information

First Notice of Claim for Unemployment Benefits

First Notice of Claim for Unemployment Benefits How to help us process your claim Checklist Before submitting your claim form, make sure you can tick all the boxes below: Involuntary unemployment claims - documents required Section A: Statement of claimant

More information

INTERNATIONAL SICKNESS REPORTING FORM FOR LOSS OF COMMERCIAL FLYING LICENCE INSURANCE

INTERNATIONAL SICKNESS REPORTING FORM FOR LOSS OF COMMERCIAL FLYING LICENCE INSURANCE INTERNATIONAL SICKNESS REPORTING FORM FOR LOSS OF COMMERCIAL FLYING LICENCE INSURANCE PART 1 - INSTRUCTIONS AND UNDERTAKINGS: Please read the following notes carefully before completing this form. BACKGROUND:

More information

Public Limited Company, Limited Company or Limited Liability Partnership

Public Limited Company, Limited Company or Limited Liability Partnership Public Limited Company, Limited Company or Limited Liability Partnership Mandate for transacting with Bank of Ireland Global Markets in the United Kingdom (UK) Global Markets Your Business Details Business/Trading

More information

When we receive your claim submission, we will assess it and correspond with you further in due course.

When we receive your claim submission, we will assess it and correspond with you further in due course. Travel Insurance Boots Travel Claims PO Box 60108 London SW20 8US Tel: 0845 125 3820 Fax: 0870 130 1950 Dear Sir / Madam, So that we may process your claim as quickly as possible please ensure that you

More information

The Charity Bank Savings Account

The Charity Bank Savings Account The Charity Bank Savings Account Application form for corporates Please complete in block capitals and return this form to: Charity Bank, Fosse House, 182 High Street, Tonbridge, Kent TN9 1BE FoR office

More information

ANZ Superannuation Savings Account Life Insurance Application Form

ANZ Superannuation Savings Account Life Insurance Application Form 12 March 2014 Customer Services Phone 13 38 63 Fax 02 9234 6668 Email customer@onepath.com.au Website anz.com Note: Please ensure you complete all details on this form. Any missing details will delay your

More information

Family Funeral Cover Policy Document

Family Funeral Cover Policy Document Instant Life Family Funeral Cover Policy Document Be Assured. Prosper Family Funeral Cover Welcome to Instant Life. We are a predominantly online insurance administrator operating from offices in Johannesburg,

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES Howden Insurance Brokers Limited is an official scheme provider of Professional Indemnity for BIBA members Please complete this

More information

Retirement instruction for company pension and buy out bond

Retirement instruction for company pension and buy out bond Retirement instruction for company pension and buy out bond Filling in this form OPSBRET V14 0615 Complete this form if the member is retiring now and have their policy proceeds paid according to these

More information

Employer s Liability. Accident report form. Policyholder details. Injured employee. Please return this form to:

Employer s Liability. Accident report form. Policyholder details. Injured employee. Please return this form to: Employer s Liability Accident report form Please return this form to: Please: Read this form fully before filling it in and where possible answer all questions in CAPITALS. Do not take any action in connection

More information

Complete Solutions Personal Retirement Savings Account

Complete Solutions Personal Retirement Savings Account Complete Solutions Personal Retirement Savings Account Customer Application Booklet Please ensure you read all declarations carefully before signing Product Selection Personal Retirement Savings Account

More information

Pension Trader Account for SIPP application

Pension Trader Account for SIPP application Pension Trader Account for SIPP application This is an application form to open a Pension Trader Account for SIPP. Please read this application form in conjunction with your Pension Trader Account for

More information

Community Underwriting Personal Accident Claim Form

Community Underwriting Personal Accident Claim Form Community Underwriting Personal Accident Claim Form About the Insurer Calliden Insurance Limited (us/we/our) (Calliden) (ABN 47 004 125 268, AFSL 234438) is the insurer and issuer of this Policy and this

More information

Proposal Form. BusinessGuard Insurance Brokers Professional Liability Insurance

Proposal Form. BusinessGuard Insurance Brokers Professional Liability Insurance BusinessGuard Insurance Brokers Professional Liability Insurance BusinessGuard Insurance Brokers Professional Liability Insurance This policy is issued by AIG Australia Limited on a claims-made and notified

More information

Savings Account Application Form

Savings Account Application Form Your Information i) We may send your details to credit reference agencies and/or fraud prevention agencies who will supply us with information for the purpose of verifying your identity, including information

More information

Policy. Conditions. Protection Policy Conditions. Protection

Policy. Conditions. Protection Policy Conditions. Protection Protection Policy Conditions Policy Conditions Protection IMPORTANT Please keep these documents safely The utmost care should be taken of this policy as duplicates of lost policies can not generally be

More information

PERSONAL DETAILS PERSONAL DETAI. Which applicant do these details relate to? Applicant 1 Applicant 2. 1 Forename(s) 2 Middle Name(s) 3 Surname(s)

PERSONAL DETAILS PERSONAL DETAI. Which applicant do these details relate to? Applicant 1 Applicant 2. 1 Forename(s) 2 Middle Name(s) 3 Surname(s) PERSONAL DETAILS Which applicant do these details relate to? Applicant 1 Applicant 2 PERSONAL DETAI 1 Forename(s) 2 Middle Name(s) 3 Surname(s) 4 Title (Mr / Mrs / Miss / Ms / other) 5 Gender Male Female

More information

Cash ISA Application Form

Cash ISA Application Form Your Information i) We may send your details to credit reference agencies and/or fraud prevention agencies who will supply us with information for the purpose of verifying your identity, including information

More information

Havensrock Excepted Group Life Assurance

Havensrock Excepted Group Life Assurance Havensrock Excepted Group Life Assurance Technical Guide 30 th July 2015 vs2.2 Havensrock Excepted Group Life Assurance - Technical Guide 1 Havensrock Technical Guide Welcome to our Technical Guide. This

More information

This policy is provided by i:protect and administered by Wessex Group on behalf of AmTrust International Underwriters Limited.

This policy is provided by i:protect and administered by Wessex Group on behalf of AmTrust International Underwriters Limited. i:protect insurance Policy Summary This policy summary brings some important points to your attention. It does not contain the full terms and conditions of this insurance. Full terms and conditions can

More information

SIPP benefit form drawdown and lump sum payments

SIPP benefit form drawdown and lump sum payments TD Direct Investing SIPP benefit form drawdown and lump sum payments SIPP benefit form drawdown and lump sum payments Please complete this form if you want to access your pension and take benefits as a

More information

Drawdown Pensions: A technical guide

Drawdown Pensions: A technical guide For Financial Adviser use only Drawdown Pensions: A technical guide March 2013 News and information from MetLife s Technical Team In this bulletin: Drawdown has been an alternative to annuity purchase

More information

Professional Indemnity Insurance for Miscellaneous Professions Proposal Form

Professional Indemnity Insurance for Miscellaneous Professions Proposal Form Professional Indemnity Insurance for Miscellaneous Professions Proposal Form Important Notice 1. This is a proposal for a contract of insurance, in which Proposer or you / your means the individual, company,

More information

Multi-Platform Open Annuity

Multi-Platform Open Annuity Multi-Platform Open Annuity Application Form Powered by the London & Colonial... Upgradable, Capable, Flexible www.londoncolonial.com Multi-Platform Open Annuity Form To London & Colonial Assurance PLC:

More information

WHAT YOU NEED TO KNOW ABOUT ISAs

WHAT YOU NEED TO KNOW ABOUT ISAs WHAT YOU NEED TO KNOW ABOUT ISAs How to protect and grow your ISA savings, or use them to generate income ISA Portfolio About MetLife As the UK market leaders in guaranteed retirement solutions, we understand

More information

EXCEPTED LIFE ASSURANCE

EXCEPTED LIFE ASSURANCE Policy No: PL05080(2014) EXCEPTED LIFE ASSURANCE This is to Certify that in accordance with the authorisation granted under the Binding Authority Contract No. B0328F6101471307U to the undersigned by Certain

More information

Online Accounts. Power of Attorney application form. Personal details. Donor. 1st Attorney. 3rd Attorney. 2nd Attorney

Online Accounts. Power of Attorney application form. Personal details. Donor. 1st Attorney. 3rd Attorney. 2nd Attorney Online Accounts Power of Attorney application form Please read these notes before you fill in this form The account will be operated strictly in accordance with the instructions confirmed within the Power

More information

LIABILITY PROPOSAL FORM BUSINESS LIABILITY COVER

LIABILITY PROPOSAL FORM BUSINESS LIABILITY COVER LIABILITY PROPOSAL FORM BUSINESS LIABILITY COVER FOR INTERNAL USE ONLY Agent Name Agency Code When completing this form, please tick the appropriate boxes and answer all questions in BLOCK CAPITALS IMPORTANT

More information

Foundation dentists application form

Foundation dentists application form Foundation dentists application form For all UK applications Important notes: Before completing this application form It is important that you have been given a copy of our key features document and your

More information

Initial Charge waived ISA. Class R GBP Application forms 2015/2016 Terms and conditions

Initial Charge waived ISA. Class R GBP Application forms 2015/2016 Terms and conditions Initial Charge waived 0% ISA Class R GBP Application forms 2015/2016 Terms and conditions ISA terms and conditions Definitions Account Account holding your Investments in an ISA. Additional Permitted Subscription

More information