Trustee Nomination

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Your Details
Is your policy a*
- Single Policy
- Joint Policy
Provider*
Policy Number/Application Number 1*
The Policy or Application Number of the Plan your placing in Trust.
Policy Number/Application Number 2
The Policy or Application Number of the Plan your placing in Trust.
Policy Number/Application Number 3
The Policy or Application Number of the Plan your placing in Trust.
Policy Number/Application Number 4
The Policy or Application Number of the Plan your placing in Trust.
Policy Number/Application Number 5
The Policy or Application Number of the Plan your placing in Trust.
Policy Number/Application Number 6
The Policy or Application Number of the Plan your placing in Trust.
Applicant 1: Name*
Prefix First Middle Last
Applicant 2: Name*
Prefix First Middle Last
Applicant 1: D.O.B*

dd/mm/yyyy
Applicant 2: D.O.B*

dd/mm/yyyy
Applicant 1: Email
Applicant 2: Email
Applicant 1: Phone
Applicant 2: Phone
Applicant 1: Address*
Street Address Address Line 2 City ZIP / Postal Code
Do both applicants reside at the same address?*
- Yes
- No
Applicant 2: Address*
Street Address Address Line 2 City ZIP / Postal Code

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Your Trustee(s) Details
How many Trustees would you like to Nominate?*
- 1
- 2
- 3
It's recommended that you nominate 3 Trustees.
Trustee 1: Name*
Prefix First Middle Last
Trustee 1: D.O.B*

dd/mm/yyyy
Trustee 1: Phone
Trustee 1: Email
Trustee 1: Relationship to you
i.e. Brother, Sister, Friend etc.
Trustee 1: Address*
Street Address Address Line 2 City ZIP / Postal Code
Trustee 2: Name*
Prefix First Middle Last
Trustee 2: D.O.B*

dd/mm/yyyy
Trustee 2: Phone
Trustee 2: Email
Trustee 2: Relationship to you
i.e. Brother, Sister, Friend etc.
Trustee 2: Address*
Street Address Address Line 2 City ZIP / Postal Code
Trustee 3: Name*
Prefix First Middle Last
Trustee 3: D.O.B*

dd/mm/yyyy
Trustee 3: Phone
Trustee 3: Email
Trustee 3: Relationship to you
i.e. Brother, Sister, Friend etc.
Trustee 3: Address*
Street Address Address Line 2 City ZIP / Postal Code

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Important points to consider when choosing a trustee