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Life Assurance: Expression of Wish Form

An expression of wish is a request to the trustees or scheme administrator of a group life scheme, under which you are insured, setting out who you would like to receive any death benefits payable on your death. You don't have to provide an expression of your wishes, but it does help the trustee or scheme administrator if you do.

Employers Name

Your Full Name

In the event of your death the trustees will decide who will receive any benefit payable under the terms of the Scheme. They will take into account your circumstances at the time of your death and your wishes as shown in this form.

This form is not legally binding on the trustees and will be used only as a guide by the trustees when exercising their discretion under the terms of the trust.

Your Beneficiary(ies)

Who would you like the benefit to be paid to?

There is no restriction on the number of beneficiaries that you can nominate but if you would like to nominate more than 6, please get in touch with the Happl team.

Beneficiary 1

Please specify the full name, address, relationship (if any), date of birth, and the desired percentage of benefit payable (%)

Would you like to add another?

Yes

Declaration

By signing this form, you confirm that you:

Agree to the trustees using, processing and sharing the personal information (including special categories of personal data) provided to us for the purposes set out in the Data Protection Statement shown above

Understand that, in exercising any discretion, the trustees will not be bound in any way by my wishes, but I would like the trustees to bear them in mind. This expression of wish replaces any previously made by me.

Signature