Nomination Form

SECTION 1 - Personal Details

This information will help the Trustee in relation to payment of any death benefits from your pension scheme.

The Trustee will consider the wishes you express, but will not be bound by them and will exercise full discretion as to whom your benefits should be paid to.

SECTION 2 - Nomination Of Beneficiaries

If you are nominating an existing trust arrangement, please state 'TRUST' under the relationship.

You may amend your nomination at any time by completing a new Nomination of Beneficiaries Form. On your death the Trustee will refer to the latest nominations received.

In the event of my death I would like the Trustee to consider making payment of death benefits arising under the Plan to the following persons. I understand that this nomination will not be binding on the Trustee, although it may take this into account when distributing death benefits following my death: