Trust Form FTF

Trust Deed Form

Policy Holder Details

For Joint policy holders: Please note you must choose at least one Trustee not already named on the policy.

Name *

First

Last

Insurance Provider *

Policy Number *

Does the policy include Critical Illness cover?*

Yes
No

In the case of a Critical Illness claim, do you want your payout to go to yourself or your beneficiaries?

Myself
My Beneficiaries

Email *

Phone Number

Date of Birth *//

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Trustee Details - the person (s) that will manage the monies when you are not here. Note: You will automatically become a Trustee

How many additional trustees do you want?

Trustee 1 Name *

First

Last

Same address as policyholder?

Yes
No

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Country of Residence

Country of Tax Resident

Nationality

Country of Birth

City of Birth

Occupation

TIN (if known)

Phone Number

Date or Birth *//

Percentage Shares

Trustee 2 Name

First

Last

Same address as policyholder?

Yes
No

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Country of Residence

Country of Tax Resident

Nationality

Country of Birth

City of Birth

Occupation

TIN (if known)

Phone Number

Date or Birth//

Percentage Shares

Trustee 3 Name

First

Last

Same address as policyholder?

Yes
No

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Country of Residence

Country of Tax Resident

Nationality

Country of Birth

City of Birth

Occupation

TIN (if known)

Phone Number

Date or Birth//

Percentage Shares

Trustee 4 Name

First

Last

Same address as policyholder?

Yes
No

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Country of Residence

Country of Tax Resident

Nationality

Country of Birth

City of Birth

Occupation

TIN (if known)

Phone Number

Date or Birth//

Percentage Shares

Beneficiary Details - (the person(s) that will benefit from the policy pay out)

How many beneficiaries do you want to add?

Beneficiary 1 Name *

First

Last

Same address as policyholder?

Yes
No

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Phone Number

Date of Birth//

Percentage Shares

Beneficiary 2 Name

First

Last

Same address as policyholder?

Yes
No

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Phone Number

Date of Birth//

Percentage Shares

Beneficiary 3 Name

First

Last

Same address as policyholder?

Yes
No

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Phone Number

Date of Birth//

Percentage Shares

Beneficiary 4 Name

First

Last

Same address as policyholder?

Yes
No

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Phone Number

Date of Birth//

Percentage Shares

Witness Details - Witness must over 18 and not already named in the trust. They can be a witness for all parties of the trust

Witness Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Date of Birth *//

Occupation of Witness

We will send you an electronic version of your Trust Deed by default - if you wish to receive a printed copy in the post please select below. *

Electronic Only
Send in Post