death benefit revocation form

DEATH BENEFIT REVOCATION FORM Please complete this form in BLOCK CAPITALS if you wish to revoke any individual(s) nominated to receive your 6 month death benefit. If you have previously nominated multiple individuals you will also need to include their names in Section B below. If you would like any individual(s) to remain nominated or if you wish to add any new recipient(s) you will need to complete a new nomination form and return it to us. Please ensure that you have signed and dated this form before returning it to: British Friendly Society Ltd 1 Trevor Street, Bedford MK40 2AB

Section A - Your details Address:

Full name: Membership/policy number:

Section B - Revoke recipient(s) Use the below form to remove any recipient(s) of the 6 month death benefit payable in the event of your death.

Name:

Section C - Signatures Member’s name:

Signature:

Date:

Witness’s name:

Signature:

Date:

British Friendly Society Limited Registered Office: 45 Bromham Road, Bedford MK40 2AA Telephone: 01234 358344 Web: britishfriendly.com Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Reg no 110013. Incorporated under the Friendly Societies Act 1992. Registered no 392F. Member of the Association of Financial Mutuals. v_8.3.16.