SECTION 3 – BENEFICIARY NOMINATION RULES
Your nomination is subject to the following rules:
◆ A nominated beneﬁciary must be a natural person;
◆ Conditional nominations cannot be made;
◆ You may change a nominated beneﬁciary or revoke a previous nomination at any time;
◆ A nominated beneﬁciary has no rights until the policy ownership is transferred upon death of the policy holder;
◆ Reversionary beneﬁciaries may not be altered once the Annuity commences.
SECTION 4 – DECLARATION
1. All answers given on this form are true and correct.
2. I understand that I indemnify The Colonial Mutual Life Assurance Society Limited ABN 12 004 021 809 AFSL 235035 (‘CMLA’)
asawholly owned subsidiary of Commonwealth Bank of Australia ABN 48 123 123 124 against any liabilities whatsoever arising
out of it acting on any of these details provided by me in connection with this form.
3. I understand that this nomination:
a. will apply to my Policy with CMLA until cancelled by me/us in writing; and
b. where indicated replaces any previous nomination made to CMLA.
4. If this form is signed under a Power of Attorney, the attorney certiﬁes that he/she has not received notice of revocation of that
Power. A certiﬁed copy of the Power of Attorney should be submitted with this form unless already sighted by CMLA.
Signature of Policy Owner Date
DD / MM / YYYY
Signature of Joint Policy Owner Date
DD / MM / YYYY
CommInsure Guaranteed Annuities
PO BOX 320
Silverwater NSW 2128
ePost (adviser use only)
Scan and email form to:
Page 2 of 2
commbank.com.au I Phone: 1800 624 100 Monday to Friday (Sydney time) 8.30am to 6.00pm I Fax: 1300 852 094 I Mail: CommInsure Guaranteed Annuities
PO Box 320 Silverwater NSW 2128
Issued by The Colonial Mutual Life Assurance Society Limited ABN 12 004 021 809, AFSL 235035 (CMLA). CommInsure is a registered business name of CMLA.
Thank you for completing this form