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Group Life Assurance

A benefit is paid if you were to die while you’re included in the Group Life Mastertrust scheme. The trustees will decide who to pay your benefit to. When they decide they’ll consider your circumstances at the time of your death and your wishes recorded on this form.

Please fill in this form to tell the trustees who you’d like to receive your benefit. You will need to submit this form to be stored by MCR Pathways for safekeeping.

If you want to update your expression of wish, please fill in a new form and submit again.

"*" indicates required fields

About You


Name*
DD slash MM slash YYYY

Who would you like the trustees to pay benefit to?


Person 1


Name*
Address*
DD slash MM slash YYYY
Please enter a number from 0 to 100.
Please do not add the % sign. If you want the benefit to be paid to more than one person, please make sure the percentages total 100%.

Person 2


Name
Address
DD slash MM slash YYYY
Please enter a number from 0 to 100.
Please do not add the % sign. If you want the benefit to be paid to more than one person, please make sure the percentages total 100%.

Person 3


Name
Address
DD slash MM slash YYYY
Please enter a number from 0 to 100.
Please do not add the % sign. If you want the benefit to be paid to more than one person, please make sure the percentages total 100%.