Change of Details
Investment Growth Bond
Section 1 – New personal or company details (applicant)
Please complete the banking details to enable funds to be deposited into an account.
Note: we will not pay automatic regular withdrawals by cheque.
Section 2 – New automatic withdrawal facility details (available to investment of at least $10,000)
Half-yearlyMonthly Quarterly Yearly
Name of financial institution
Account name (must be in the name of the Bond Owner(s))
BSB (Branch Number) Account Number
Rate of increase in payments
Nil or
%
each year
/ /
First withdrawal date
/ /
Last withdrawal date (if required)
Frequency (please indicate ())
$
Amount of each payment (minimum $500)
THIS FORM SHOULD BE USED FOR POLICIES OPENED PRIOR TO 18 MARCH 2013.
Please write in BLOCK letters and use a black ballpoint pen.
Policy Number
Bond Owner 1
Title
Mr Mrs Miss Ms Other Date of birth
/ /
Given name(s) Surname
Other names known by (if any) or Full Company/Business Trust name
Residential/Business address (PO Box is not acceptable)
State Postcode Country
Home number Business number Mobile Facsimile
( ) ( ) ( )
Bond Owner 2
Title
Mr Mrs Miss Ms Other Date of birth
/ /
Given name(s) Surname
Other names known by (if any) or Full Company/Business Trust name
Residential/Business address (PO Box is not acceptable)
State Postcode Country
Home number Business number Mobile Facsimile
( ) ( ) ( )
CommInsure is a registered business name of The Colonial Mutual Life Assurance Society Limited ABN 12 004 021 809 AFSL 235035 (CMLA)005-227 010813
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Bond Owner’s Signature
Date
/ /
Joint Bond Owner’s Signature (if any)
Date
/ /
• I believe that I have obtained all information sufficient to explain the investment objectives, the risk and effect of each investment
option chosen.
• I declare that if this Change of Details form is signed under a Power of Attorney, the Attorney declares that they have not received
notice of revocation of that power (a certified copy of the Power of Attorney should be submitted with the Change of Details form).
If investor is a company, then this must be signed by an authorised officer (e.g. Director, Company Secretary).
Please mail this application to
Investment Growth Bond – Alterations
PO Box 320
Silverwater NSW 2128
Section 4 – Additional contributions
Minimum is $200 per Fund. The minimum initial investment is $1,000. Cash deposits will not be accepted.
This section must be completed in all circumstances.
Cheque (Please attach with this form)
Bpay
®
(Important: please refer to page 30 of the PDS before using Bpay
®
)
® Registered to Bpay Pty Ltd ABN 69 079 137 518
Investment option Amount
Stable fund (3STB) $
Managed fund (3MGD) $
Capital Guaranteed Cash fund (3CSH) $
Fixed Interest fund (3FIX) $
Property fund (3PRP) $
Australian Equities fund (3EQY) $
International Equities fund (3INT) $
Please indicate () how will you be paying
Section 5 – Investor’s declaration
Section 3 – Switching Investment Options (funds)
Investment option Switch from Switch to
Stable fund (3STB) $ $
Managed fund (3MGD) $ $
Capital Guaranteed Cash fund (3CSH) $ $
Fixed Interest fund (3FIX) $ $
Property fund (3PRP) $ $
Australian Equities fund (3EQY) $ $
International Equities fund (3INT) $ $
Total $ $
Please complete the amount you wish to switch in the ‘Switch from’ and ‘Switch to’ columns.
Ensure the totals of each column are equal. The minimum switch is $200 per Fund.
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