Deed of Assignment of a life assurance policy

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1 Deed Assignment Deed Assignment a life assurance policy Do not use this form if the policy is in trust. This deed may be used for policies issued by: Canada Life Limited Canada Life International Limited CLI Institutional Limited Canada Life International Assurance Limited The purpose this deed is to absolutely transfer ownership a policy. This deed is provided as a draft to be considered by you and your pressional adviser. We can accept no responsibility for the tax or any other consequences arising out you executing this deed, or for ensuring that the deed meets with your requirements. Please note: For Canada Life Limited policies you must ensure that you also complete the relevant self-certification form. For Canada Life International Limited, CLI Institutional Limited and Canada Life International Assurance Limited policies you must complete the relevant data capture form. These forms are available from our website Notes The assignment a policy does not change the life (or lives) assured. Therefore, if a policy on the life X is assigned to Y, the policy proceeds will still be payable on the death X, not Y. Assignor(s) the current owner(s) the policy(ies) being assigned. Assignee(s) the new owner(s) the policy(ies) being assigned. Where the policy is held in joint names X and Y and is being assigned into the sole name X, X must sign the deed as both an assignor and the assignee. Y only signs as an assignor. Where the policy is subject to a prior charge (that is) previously assigned to a bank or building society, the previous assignment will take priority over this assignment.

2 Please complete in BLOCK CAPITALS and tick small boxes where appropriate In this deed the singular includes the plural and the masculine includes the feminine (and vice versa) where the context so admits. Deed Assignment This Deed is made on the D D / M M / Y Y Y Y You must date this deed using the date that the last person signs BY The Assignor(s) named below in Part 1 and the Assignee(s) named below in Part 2. WHEREAS 1. The Assignor(s) is/are the owner(s) the policy ( the Policy ) shown in the schedule below. 2. The Assignor(s) would like to assign the benefits the Policy to the Assignee(s). NOW THIS DEED WITNESSES 1. The Assignor(s) assigns all monies payable and all benefits under the Policy to the Assignee(s) absolutely. Schedule Canada Life Limited Please tick as appropriate Canada Life International Limited CLI Institutional Limited Canada Life International Assurance Limited Policy number Policy date D D / M M / Y Y Y Y Segment numbers Part 1 The Assignor(s) between (full name Assignor(s)) (address) Part 2 The Assignee(s) between Nationality Nationality (full name Assignee(s)) Date birth D D / M M / Y Y Y Y Date birth D D / M M / Y Y Y Y (address) 2

3 Please complete in BLOCK CAPITALS We certify that: This instrument falls within Category L in the Schedule to the Stamp Duty (Exempt Instruments) Regulations Data protection notice All parties confirm that they have read the Data Protection Notice on page 5 and are satisfied that their personal information will be handled appropriately in accordance with this statement. Signatures In witness the parties have executed this deed on the day and year mentioned above. Signed and delivered as a deed by the Assignor Print name Assignor Signature Assignor In the presence Address witness Signed and delivered as a deed by the Assignor Print name Assignor Signature Assignor In the presence Address witness 3

4 Please complete in BLOCK CAPITALS Signed and delivered as a deed by the Assignee Print name Assignee Signature Assignee In the presence Address witness Signed and delivered as a deed by the Assignee Print name Assignee Signature Assignee In the presence Address witness To protect you and us from financial crime, we need to verify the identity all owners, including newly appointed trustees. To assist us, we will require documents sufficient to verify the identity and address all owners and appointed trustees. In the absence such documents, we may use credit reference agency searches to verify the identity and address. Please note this will not affect anyone s credit rating. We reserve the right to ask for further documents to confirm your identity. 4

5 Data Protection Notice Any personal information you may provide to Canada Life International Limited (CLI) or CLI Institutional Limited (CLII) as data controller will be treated in accordance with the Isle Man Data Protection Act Any personal information that you may provide to Canada Life International Assurance Limited (CLIA) as data controller will be treated in accordance with the Data Protection Acts 1998 and Any personal information that you may provide to Canada Life Limited (CLL) as data controller will be treated in accordance with the Data Protection Act (CLL, CLI, CLII & CLIA together will be defined as the Company in the remainder this statement). By signing this form you consent to the Company using and sharing your personal information as set out in this notice including, without limitation, the processing personal sensitive data. If submitting personal information about another person, by signing this form you confirm that you have their consent to provide such information to the Company and for their information to be used as set out in this notice. Using personal information The Company uses personal information to undertake any activity relating to its policies, products and services and, where relevant, to process applications, set-up and administer policies, products and services and handle any claims. Sharing personal information The Company may share personal information: with other Canada Life companies including those outside the European Economic Area; its relevant reassurers; with other companies, organisations and associations and/or credit reference agencies in order to prevent, detect or investigate financial crime or fraud; with approved service providers including providers medical services and opinions; with any regulators with competent jurisdiction; with credit reference agencies; with relevant industry bodies such as the Association International Life Offices, if applicable; with any applicable Financial Services Ombudsman Scheme or Supervisor; and in any circumstances if permitted or required to do so by law or if the Company has consent to do so. Where the information is being released to any the above, the Company may use electronic communications. Relevant industry bodies may share information about you collected by other insurances companies with the Company. The Company will not use your information to advise you other products and services fered by third parties or companies within the Canada Life marketing group. Accessing personal information A person whose personal information is held by the Company has various rights including the right to: have any incorrect personal information corrected; and/or access the personal information the Company holds for which a fee may be charged. To do so and/or if you need more information, please contact the Company. Requests and queries should be addressed to each company as appropriate: Canada Life International Limited Canada Life House Isle Man Business Park Douglas Isle Man IM2 2QJ CLI Institutional Limited Canada Life House Isle Man Business Park Douglas Isle Man IM2 2QJ Canada Life International Assurance Limited Irish Life Centre Lower Abbey Street Dublin 1 Canada Life Limited Canada Life Place Potters Bar Hertfordshire EN6 5BA 5

6 Canada Life Limited, registered in England no Registered fice: Canada Life Place, Potters Bar, Hertfordshire EN6 5BA. Telephone: Fax: Member the Association British Insurers. Canada Life International Limited, registered in the Isle Man no Registered fice: Canada Life House, Isle Man Business Park, Douglas, Isle Man IM2 2QJ. Telephone: +44 (0) Fax: +44 (0) Member the Association International Life Offices. CLI Institutional Limited, registered in the Isle Man no C. Registered fice: Canada Life House, Isle Man Business Park, Douglas, Isle Man IM2 2QJ. Telephone: +44 (0) Fax: +44 (0) Member the Association International Life Offices. Canada Life International Assurance Limited, registered in Ireland no Registered fice: Irish Life Centre, Lower Abbey Street, Dublin 1. Telephone: Member the Association International Life Offices. Canada Life Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Canada Life International Limited and CLI Institutional Limited are Isle Man registered companies authorised and regulated by the Isle Man Insurance and Pensions Authority. Canada Life International Assurance Limited is authorised and regulated by the Central Bank Ireland. CTU9 614R(C)

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