(Office use only)
GUARANTEED ANNUITIES
LIFESTREAM GUARANTEED INCOME
CHANGE OF BENEFICIARY FORM
Instructions/information on how to complete this form
Please complete this form using BLACK or BLUE INK in CAPITAL LETTERS. Mark appropriate answer boxes with a tick ().
This form is applicable for annuities purchased with personal savings only. Not applicable for lifetime annuities or annuities
purchased with super.
SECTION 1 – POLICY OWNER DETAILS
Policy number
Policy Owner
Title
Mr Mrs Ms Miss Other
}
Given name(s)
Surname
Address
State Postcode Country
Date of birth
DD / MM / YYYY
Email
Joint Policy Owner
Title
Mr Mrs Ms Miss Other
}
Given name(s)
Surname
Address
State Postcode Country
Date of birth
DD / MM / YYYY
Email
SECTION 2 – AMENDING BENEFICIARY NOMINATION
I wish to: please indicate ()
Cancel all current beneficiary nominations for this policy
To make a new nomination or amend/delete an existing nomination, please complete the table below and ensure that your
newnomination split adds up to 100%.
Nomination
Nominated beneficiary first name and surname Date of birth Gender Existing split % New split %
1.
2.
3.
4.
5.
6.
100% 100%
SAVE FORM
PRINT FORM
Page 1 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
22871_CI/1016 CIL1761 101016
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
I declare:
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’)
asawholly 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
Post
CommInsure Guaranteed Annuities
PO BOX 320
Silverwater NSW 2128
ePost (adviser use only)
Scan and email form to:
newbusinessannuity@cba.com.au
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
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