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.
Certicate Number *
Membership Number *
Member Full Name: *
Name of Beneficiary: *
Date of Birth: *
Relationship to Member:
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.
Finally, are you a real person? Enter the value below.*