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EXPRESSION OF WISH FORM (DOC)

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					EXPRESSION OF WISH FORM In the event of my death, I wish the Trustees of my employers Death in Service Scheme to pay the lump sum benefit arising, to the beneficiary (ies), listed below. I understand that the Trustees will not be bound by this form and that it is only an expression of my wishes. BENEFICIARY 1 Name: Address: -

Relationship: -

Proportion of Benefit:-

%

BENEFICIARY 2 Name: Address: -

Relationship: -

Proportion of Benefit:-

%

BENEFICIARY 3 Name: Address: -

Relationship: -

Proportion of Benefit:-

%

SIGNED: FULL NAME: EMPLOYER:-

DATE: -

In the event of a change in your personal circumstances, a revised Expression of Wish Form should be completed and passed to your Human Resources Department.


				
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posted:1/22/2010
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