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THE FAMILY INDEMNITY PLAN

DESIGNATION OF BENEFICIARY FORM

This designation shall be effective only when delivered to the organisation duly executed by the Insured Member and during the lifetime of the designated beneficiary.

Organisation: *


Certicate Number *

Membership Number *


Member Full Name: *


Name of Beneficiary: *


Date of Birth: *

Relationship to Member:


Please note that if Beneficiary is a minor (under the age of 16) you are required to name a Legal Guardian.

Name of Legal Guardian:


Please note that upon Minors reaching the Age of Maturity (16 Years), the above named Guardian would be considered null and void under this certificate.

I hereby designate the above mentioned as my beneficiary, if living, to receive any and all sums of money, herein called the ‘BENEFIT’, paid under and by virtue of the terms and conditions of the Family Indemnity Plan Group Insurance Policy, of the CUNA Caribbean Insurance Society to the said Organization.

This designation takes precedence over any earlier designated wherever and however made. I hereby reserve the right to change the beneficiary herein designated.

If the designated beneficiary precedes me in death, the Benefit will be paid to my Estate if a new beneficiary has not been nominated. In the case where the Legal Guardian precedes the minor death, the benefit will be paid to the minor’s Estate if the new Legal Guardian has not been nominated.


(Witness)

(Signature of Member)

(Date)

(Date)