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Nomination of Beneficiary Form For MPF Scheme Members

The document is a nomination of beneficiary form for an airport authority's group life insurance plan for MPF scheme members. It allows the member to nominate beneficiaries to receive life insurance payouts upon their death. Key details include requiring beneficiaries to be at least 18 years old and a family member of the insured. If multiple beneficiaries are listed, the percentage of payout for each must be stated. The form also includes declarations for the insured to sign agreeing to the insurer's use of their personal information.

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Thamizh Anban
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92 views

Nomination of Beneficiary Form For MPF Scheme Members

The document is a nomination of beneficiary form for an airport authority's group life insurance plan for MPF scheme members. It allows the member to nominate beneficiaries to receive life insurance payouts upon their death. Key details include requiring beneficiaries to be at least 18 years old and a family member of the insured. If multiple beneficiaries are listed, the percentage of payout for each must be stated. The form also includes declarations for the insured to sign agreeing to the insurer's use of their personal information.

Uploaded by

Thamizh Anban
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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AIRPORT AUTHORITY

GROUP LIFE INSURANCE (FOR MPF SCHEME MEMBERS)


NOMINATION OF BENEFICIARY FORM

Staff Name : / /
Surname Other Name Chinese (if applicable)

Staff Number : Sex:


Male

Date of Birth :

H.K.I.D./Passport Number :

I nominate the following person(s) as beneficiary(ies) for my Group Life Insurance and revoke all my previous
beneficiary nomination in respect of my death benefit under this plan:-

Full Name in English Full Name in Chinese H.K.I.D./ Relationship Percentage


(Surname First) Passport No. (%)

Condition
 Designated beneficiary MUST be the Insured Member’s next of kin and attained age 18.
 If more than one beneficiary is nominated, the percentages allocated to each beneficiary MUST be
stated. If NO percentage of Benefit split has been stated, the claim payment will be paid in equal
proportions by the numbers of beneficiaries.
 Should any beneficiary pre-deceased the Insured Member, the relevant percentage of Benefit or equal
proportion if not stated, the insurer may pay the benefits to the Estate of the Insured Member and or
reserve the right to pay to the Policyholder.

Declaration
I hereby declare that this form constitutes part of the Group Life Policy and agree that any personal information
collected or held by The Insurer, whether contained in this form or otherwise obtained, is provided and may be
held, used, and disclosed by The Insurer to individuals / organizations associated with The Insurer or any
selected third party (within or outside of Hong Kong, including reinsurance and claims investigation companies
and industry associations / federations) for the purposes of processing this application and providing
subsequent services, and data matching, and to communicate with me for such purposes. I understand that I
have the right to obtain access to and to request correction of any personal information held by The Insurer
concerning me (and my dependants, if any). Such requests will be made in writing to The Insurer.

Signature of the Insured Member Date

Authorized Signature of Policyholder & Company Chop Date

Note : The above data are required by the Authority and The Insurer for record keeping of your nominated
beneficiary(ies) for the Group Life Policy. Please send the completed form to Human Resources for
processing.

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