Endowment compensation or missold endowment claim form


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ENDOWMENT COMPENSATION FEEDBACK FORM

Endowment Compensation Enquiry Form
Title: Mr Mrs Ms Dr
First Name: * Surname: *
Address:
Town/City:
County:
Post Code:*    
Telephone Day: * Telephone Evening:
Email: * Fax:
Your Policy Details: ( * Obligatory to fill in)
Issuing Life Office: * (Please Select from Pull Down Menu)
   
Start Date of Policy: * must start pre 2004

 (dd/mm/yy - eg. 21/03/79) 		End Date of Policy: * dd/mm should be same as start date
(dd/mm/yy - eg. 21/03/06)
Premium: * £ eg 23.00 not 23-00 Frequency: *
Monthly
Annual
Quarterly
Semi-Annual:
Minimum Sum Assured: * £
NB:*not death benefit*
Bonuses: * £ eg 23.00 not 23-00 Bonus date: *
(dd/mm/yy - eg. 21/03/04)
Surrender Value: * £ eg 23.00 not 23-00 Surrender Value Date:*
 (dd/mm/yy - eg. 21/03/04)
Has the Policy been altered? *
 (Please Select from Pull Down Menu) 		Has the Policy been Assigned? *
Yes
No
Special bonus £ eg 23.00 not 23-00 Policy Number: *
Life Assured: * 2nd Life Assured
(if applicable)
Gender of 1st life assured * Gender of 2nd life assured
Do you have the policy documents: *
Yes
No
Comments:

   

 
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