Sussex Group Life Assurance Scheme – Expression of Wish Form
Lump sum benefits from the Sussex Group Life Assurance Scheme (the “Life Assurance
Scheme”) are paid to your beneficiaries as decided by the Trustees, using their powers set out in
the Rules. However, you can use this form to nominate your preferred beneficiaries. Please
return the form to Human Resources at Sussex House, where it will be held for safekeeping on
behalf of the Trustees.
Your wishes will be treated as confidential, but you may prefer to place your completed form in a
sealed envelope, which will only be opened if you die. If you wish to place it in an envelope,
please ensure you mark the outside clearly "Expression of Wish Form" with your full name and
National Insurance number, the Scheme name and the date.
You can complete a fresh form at any time, if your circumstances change.
______________________________________________________________________
To: The Trustees of the Sussex Group Life Assurance Scheme
I would like any lump sum benefits from the Life Assurance Scheme to be paid as follows:
Full Name and Address
Relationship(if
any) to me
Percentage
share of benefit
I understand that when disposing of the benefits the Trustees will not be bound by this
Expression of Wish Form, but I ask that they consider it. This nomination replaces any others I
have made.
Signature: ...........................................................
Date: ..............................
Name of employee (please print): ...................................................................