Beneficiary designation
1 General information
The Manufacturers Life Insurance Company NN0283E (01/2020)Page 1 of 2
Policy number(s)
Address of owner (number, street, apartment)
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City or town Province Postal code
Beneficiary name(s) (first, middle initial, last)
Beneficiary name(s) (first, middle initial, last)
Secondary beneficiary (subrogated in Quebec) name(s)
(first, middle initial, last)
Relationship*
Trustee name(s) (first, middle initial, last)
Relationship*
Share
(total 100%)
Relationship
of trustee to
beneficiary
Share
(total 100%)
For policies issued in Quebec only: If you named your married or civil union spouse as
a beneficiary, the designation is irrevocable unless you select revocable.
2 Beneficiary designation
Beneficiaries (other than a spouse
under a Quebec policy) are revocable
unless you write the word “irrevocable”
after that beneficiary’s name.
* In Quebec, tell us the beneficiary’s
relationship to the owner.
In all provinces except Quebec, tell
us the beneficiary’s relationship to the
insured person.
If you have an irrevocable beneficiary,
your rights in the policy will be limited.
The beneficiary must give written
consent before you can:
Note: Minor children cannot give
written consent to these changes.
• change this designation;
• withdraw funds;
• assign the contract;
• transfer ownership; or
• otherwise change your policy
(e.g. decrease coverage).
Name of insured person/annuitant (first, middle initial, last)
Restate the beneficiary designations or trustee appointments you want to make or maintain.
Name of owner (first, middle initial, last or full name of legal entity)
Revocable
By completing this form, you are asking
us to change the information you
previously provided. Any previous
beneficiary designation or trustee
appointment is revoked.
Life policies (except Synergy): Use this form to name a beneficiary as described in your contract
and permitted by law.
Accident and sickness insurance policies, and combination insurance (including
Lifecheque, LivingCare and Synergy): You must use different forms. See Related forms, page 2.
•
We
,
us
and
our
mean the insurer of the policy identified below.
You
and
your
mean the policy owner.
• An insured person is a person who is insured under the policy or any rider.
For annuity/investment contracts, the insured person is the annuitant.
• See page 2 of this form for instructions on how to complete it.
• A copy, fax, scan or image of this beneficiary designation is as valid as the original.
• If you have any questions about completing this form, contact your advisor or call our customer
service centre at 1-888-626-8543 in all provinces except Quebec or 1-888-626-8843 in Quebec.
If you are calling from outside of North America, call us collect at 519-747-6600.
Send this completed form to
Manulife, Individual Insurance at:
All provinces except Quebec
500 King Street North
PO BOX 1669
WATERLOO ON N2J 4Z6
Fax: 1-877-763-8834
manulife.ca
In Quebec
2000, rue Mansfield
bureau 1310
MONTREAL QC H3A 3A1
Fax: 1-877-271-5494
Advisor name Advisor code
3 Trustee for minor
beneficiaries
(not applicable in Quebec)
Complete this section if a beneficiary named on this form is a minor. If so, you agree that any benefit that becomes
payable to a minor child will be paid to the trustee to hold in trust for the child until the child comes of age.
• two signing officers’ signatures
and titles
or
• one signing officer’s signature, title
and the corporate seal;
if the corporation does not have
a seal and you are the only
person authorized to sign on
behalf of the corporation, in
addition to signing, insert your
initials in the box provided.
Initial here
Write your initials here to confirm that you are the only person authorized to sign on behalf of the
corporation and that it does not have a seal. You must also sign above.
By signing below, you:
• revoke any beneficiary designation or direction of payment that was previously made with respect to the
proceeds payable on the death of the insured person or annuitant under the above policy or policies, and
• direct that those proceeds be paid to the beneficiary or beneficiaries listed on this form.
Signature of owner**
Signature of irrevocable or preferred beneficiary, if applicable
Signature of witness (other than beneficiary)
Signature of witness
Signature of owner** Signature of witness (other than beneficiary)
Signed at (city or town, province) Date (dd/mmm/yyyy)
4 Signatures
** If the owner is a corporation,
we require:
Title (if applicable):
Title (if applicable):
✘
✘
✘
✘
✘ ✘
By signing here, you, the irrevocable beneficiary, consent to the above change in the beneficiary designation listed
on this form for the above policy(ies) and relinquish your rights as a beneficiary.
Date (dd/mmm/yyyy)
Total
Total
