Whole of Life Application Form (W10243) - Legal & General

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PART 7 – POLICY OWNER QUESTIONNAIREThis questionnaire only applies if you have answered ‘Yes’ to the third question in Part 3 on page 12.• The Policy Owner is the person who will be the owner of any benefits paid out on the policy.• Please note, if the Policy Owner is not the Client(s) they must be over 18 and have an insurable interestin the Client(s).• Please consult your Financial Adviser if you wish to assign your policy to someone else once the policyhas been accepted and issued.• Your Financial Adviser can help you to complete this section.Policy OwnerSecond Policy Owner (if applicable)1. Is the Policy Owner anindividual or a business?For Joint cover, use the ‘Policy Owner’ column foranswers in this Part.An individualA businessAn individualA business2. What is the name of thePolicy Owner?Give the full name or businessname as applicable.Mr/Mrs/Miss/Ms/Dr/Rev/OtherForename(s) and middle name(s) in fullMr/Mrs/Miss/Ms/Dr/Rev/OtherForename(s) and middle name(s) in fullorSurnameBusinessnameorSurnameBusinessname3. Contact name within theorganisation?4. What is the Policy Owner’srelationship to the Client(s)?SpouseBusiness PartnerEmployerEx-spouseSpouseBusiness PartnerEmployerEx-spouseCohabiting PartnerEx-partnerCohabiting PartnerEx-partnerRegisteredCivil PartnerTrusteeRegisteredCivil PartnerTrusteeCreditorOtherCreditorOtherCo-shareholderCo-shareholder5. What is the Policy Owner’scurrent address?Please give the full address(including postcode) of theperson or business who is toown the policy(ies).PostcodePostcode6. What are the Policy Owner’scontact details?If the policy is to be owned bya business, please give thecontact details of the business’srepresentative.Work phoneHome phoneMobile phoneWork phoneHome phoneMobile phone7. Declaration of the Policy Owner(s)(who is not the Client(s))This Declaration should beread, confirmed, signed anddated by the Policy Owner,not by the Client(s).Page 18I declare that the answers given are, to the best of my knowledge and belief, true and complete.Use of personal information: Legal & General takes client privacy very seriously. I understand thatLegal & General will use the personal information collected via this application and any other informationthat I provide to Legal & General (“my information”) for the purposes of:1. Providing me with Legal & General products and services and dealing with my enquiries and requests;2. Underwriting and administering my policy including processing claims; and3. Carrying out market research, statistical analysis and client profiling.I understand that given the global nature of Legal & General’s business, it may be necessary to transfermy information to countries outside the European Economic Area in order to provide Legal & General’sservices to me.Whole of Life Protection Plan – Application Form and Additional Questionnaires
PART 7 – POLICY OWNER QUESTIONNAIRE continuedDisclosures: I understand that Legal & General will disclose my information to other companies withinthe Legal & General group of companies, regulatory bodies, law enforcement agencies, future owners ofLegal & General’s business, suppliers engaged by Legal & General to process data on its behalf and whennecessary, to a reinsurer.If I have been dealing with a financial adviser, Legal & General will give them information about theproduct and, where appropriate, provide them with other information about my dealings withLegal & General to enable them to give me informed advice.Where I have been introduced to Legal & General by another company (e.g. a bank, insurer or buildingsociety), Legal & General may share my information with them to enable them to:(a) carry out market research, statistical analysis and client profiling; and(b) send me marketing information about their products and services and products and servicesof companies in the Legal & General group and of third parties whose products and servicesLegal & General offers to its clients.By signing this Declaration I agree to receive the information as described in (b) above by post ortelephone, unless I indicate otherwise by writing with my full contact details to Legal & GeneralP10290, 5 Gemini Business Park, Europa Boulevard, Warrington, Cheshire WA5 7YF.Access: I understand that I have the right to ask for a copy of my information in return for paymentof a small fee. To obtain a copy of your information please write to Legal & General at UKSO BusinessStandards, Legal & General Assurance Society, Legal & General House, St Monica’s Road, Kingswood,Surrey, KT20 6EU.Approaching fraud prevention agencies: Legal & General will check my details with fraud preventionagencies. If false or inaccurate information is provided and fraud is identified details will be passed tofraud prevention agencies. Law enforcement agencies may access and use this information.Legal & General and other organisations may also access and use this information to prevent fraud andmoney laundering, for example, when:• checking details on applications for credit and credit related or other facilities;• managing credit and credit related accounts or facilities;• recovering debt;• checking details on proposals and claims for all types of insurance;• checking details of job applicants and employees.Legal & General and other organisations may access and use from other countries the informationrecorded by fraud prevention agencies.7. Declaration of the PolicyOwner(s) (who is not theClient(s))This Declaration shouldbe read, confirmed,signed and dated by thePolicy Owner, not bythe Client(s).I understand that I can contact Legal & General at Group Financial Crime, Legal & General House, Kingswood,Tadworth, Surrey KT20 6EU if I want to receive details of the relevant fraud prevention agencies.I request that Legal & General Assurance Society Limited issue the proposed policy in my name or thebusiness’s name and I understand that this request and Declaration, and any other statement signedby the Client(s) in connection with this application, will be used to determine whether to offer a policyand to assess how much premium should be paid. Alongside the Policy Schedule and Policy Terms andConditions this information will form part of the legal relationship between us and if any of it is incorrectit may mean that a claim will be declined and the policy cancelled.Policy OwnerPolicy Owner signatureSecond Policy Owner (if applicable)Policy Owner signatureDateD D M M Y Y Y YDateD D M M Y Y Y YDateof birthD D M M Y Y Y YDateof birthD D M M Y Y Y YPlease now go straight to Part 9 (Client Declaration and Consent).PART 8 – ADDITIONAL INFORMATIONThis section only applies if you need more space to answer any questions. If you don’t need more space, please now go straight to Part 9.Client oneClient twoPart No. andQuestion No.Additional InformationPart No. andQuestion No.Additional InformationWhole of Life Protection Plan – Application Form and Additional Questionnaires Page 19
Page 1 and 2: WHOLE OF LIFE PROTECTION PLANCONFID
Page 3 and 4: Your personal and medical informati
Page 5 and 6: About your plan continuedClient one
Page 7 and 8: SECTION B Full application details
Page 9 and 10: PART 2 - GENERAL HEALTH AND LIFESTY
Page 11 and 12: FAMILY HISTORYClient one3No. ofrela
Page 13 and 14: PART 4 - PERSONAL ASSURANCE QUESTIO
Page 15 and 16: PART 5 - HAZARDOUS PURSUITS QUESTIO
Page 17: MEDICAL QUESTIONNAIRE 2Use this pag
Page 21 and 22: PART 9 - CLIENT DECLARATION AND CON
Page 23 and 24: PART 10A - SAR MEDICAL CONSENT FORM
Page 25 and 26: PART 10B - SAR MEDICAL CONSENT FORM
Page 27 and 28: ✁PART 11 - DIRECT DEBIT INSTRUCTI

Whole of Life Application Form (W10243) - Legal & General

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