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Client form

Beneficiary nomination

Tell us who should receive the proceeds of your policy and in what proportions. Percentages should add up to 100%.

Your details

Full name*

Email address*

Date of birth*

Policy provider & number (if known)

Beneficiaries

Add up to four beneficiaries. Percentages should add up to 100.

Beneficiary 1 (required)

Full name

Date of birth

Relationship to you

Share of proceeds (%)

Address

Beneficiary 2 (optional)

Full name

Date of birth

Relationship to you

Share of proceeds (%)

Address

Beneficiary 3 (optional)

Full name

Date of birth

Relationship to you

Share of proceeds (%)

Address

Beneficiary 4 (optional)

Full name

Date of birth

Relationship to you

Share of proceeds (%)

Address

Contingent beneficiary

If a beneficiary above cannot receive proceeds, who should receive their share?

Declaration*I confirm the beneficiaries above are my current wishes. I understand nominations may need to sit alongside a trust or will to be legally binding, and my adviser will confirm the right route for my policy.

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