Change Of Details Form
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4Change of Details Form
1 September 2016
OnePath Life Limited
ABN 33 009 657 176 AFSL 238341
OnePath MasterFund
ABN 53 789 980 697 RSE R1001525
Customer Services
OnePath Custodian Pty Limited (OnePath Custodians)
Phone
133 667
Fax
02 9262 5319
ABN 12 008 508 496 AFSL 238346 RSE L0000673
Email
.au
242 Pitt Street, Sydney NSW 2000
Website .au
This form is to be used to change certain details for the following products:
• OneCare
• OneCare Super
• OneCare External Master Trust
• OneCare held in an SMSF
• WOP (World of Protection)
Instructions
• Complete this form with signatures from all relevant parties e.g. all policy owners and lives insured.
• Section A and Section C are mandatory. Please only complete Section B if you would like to change:
New contact details (e.g address, phone number etc)
Complete section B1
Change of name
Complete section B2
Change of nominated financial institution account
Complete section B3
Decline indexation increase
Complete section B4
• Please complete all relevant sections and send it to:
OnePath Life, GPO Box 4148, Sydney NSW 2001;
Fax: 02 9262 5319; or
Email: .au
Section A – Policy Owner details
Policy number(s)
Title
Mr
Mrs
Ms
Miss
Dr
Other
Surname
Given name(s)
or
Company/SMSF name
Section B – Change of details
1. New contact details (these cannot be the adviser’s address)
Residential address
(this cannot be a PO Box number)
Suburb/Town
State
Postcode
Country
Postal address
(if different from above)
Suburb/Town
State
Postcode
Country
Phone
Home
Business
Mobile
Fax
Email
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Parent category: Legal