absolute assignment form - fwd singapore · assignment is inclusive of the cash surrender and loan...

1. policy number

Name of insured

Name of Assignee

Name of Policyholder(also the Assignor)

NRIC/FIN

NRIC/FIN

Contact No.

Mailing Address

Relationship of Assigneeto Assignor

Reason for Assignment

NRIC/FIN

2. particulars of insured and policyholder/assignor

3. particulars of assignee

ABSOLUTE ASSIGNMENT FORM

Company Registration No. 200501737H | www.fwd.com.sgCopyright © 2018 FWD Singapore Pte. Ltd. All Rights Reserved.

FWD Singapore Pte. Ltd.6 Temasek Boulevard, # 18-01 Suntec Tower 4,Singapore 038986. T: (65) 6820 8888.

4. common reporting standard (crs) tax residency self-certi�cation (for assignee)

“5. your declarations”



5. your declarations

The Policyholder/Assignor hereby assign and transfer to the above named Assignee (which shall include his/their executors, administrators and assigns), the full bene�t of all moneys assured or to become payable by or under the aforesaid policy (the “Policy”) issued by FWD Singapore Private Limited (“FWD Singapore”) (“Assignment”). This Assignment is inclusive of the cash surrender and loan value of the Policy and any dividends that may be declared upon the Policy from time to time.

The Policyholder/Assignor and the Assignee hereby declare and agree that:

1) I/We have not and will not do or knowingly cause anything to be done which may render the Policy void or voidable or prevent the Assignee from receiving or be deprived of the right to receive the moneys assured or to become payable under the Policy;

2) With e�ect from the date of this Assignment, a receipt signed by the Assignee shall fully discharge FWD Singapore from its liabilities and obligations under the Policy in respect of which the receipt is given;

3) I/We understand that a revocable nomination made under Section 49M(7) of the Singapore Insurance Act (Chapter 142) is deemed revoked (applicable if a nomination pursuant to Section 49M(2) of the Insurance Act was made previously);

4) I/We are not undischarged bankrupt(s) and to my/our knowledge, there are no current, pending or threatened bankruptcy proceedings against me/us;

5) The date of the Assignment shall be the date as speci�ed next to the Policyholder/Assignor’s signature;

6) FWD Singapore is entitled not to accept or process this form should the Assignee be found to be a Prohibited Person, meaning a person subject to any laws, regulations and/or sanctions administered by any regulatory authorities in any country, which have the e�ect of prohibiting FWD Singapore from providing insurance coverage, transacting business with or otherwise o�ering any economic bene�ts to me/us or any other bene�ciary under the relevant Policy, and the decision of FWD Singapore shall be �nal. I/We further agree that in the event that FWD Singapore becomes aware subsequently that I/We have become a Prohibited Person, FWD Singapore may block and/or terminate the relevant Policy with immediate e�ect and shall not thereafter be required to transact any business with me/us in connection with the relevant Policy, including but not limited to, making or receiving any payments under the relevant Policy.;

7) I/We consent to furnish any information and/or document(s) requested for by FWD Singapore for the purpose of processing this form, including but not limited to information and/or document(s) in connection with the paragraph above on Prohibited



Persons, and further understand and agree that FWD Singapore is entitled not to accept or process this form should such requested information or document(s) be withheld or is not furnished; and

8) I/We consent to FWD Singapore, its associated persons/organisations, its and their third party service providers and its and their representatives, whether within or outside Singapore (collectively “FWD Persons”) to collect, use, disclose and/or transfer (individually and/or collectively, “Processing”) all personal data and information (“Personal Data”) that had/has been provided to FWD Persons and/or that FWD Persons possess about me/us (whether from me/us or a third party), in the manner and for the purposes described in the FWD Personal Data Protection Policy (“PD Policy”), which can be found at http:// www.fwd.com.sg/corporate/privacy-policy.html, including but not limited to, processing of this form and/or to provide subsequent advice or services to me/us in relation to this Policy/form and/or any other existing or future policy/policies that i/we may hold with FWD Singapore (“Purposes”).

Without prejudice to the foregoing, i/we agree to comply with the terms of the PD Policy, including where such PD Policy is amended from time to time by FWD Singapore in accordance with its terms.

Where Personal Data of a third party is disclosed by me/us, i/we represent and warrant that i/we have obtained the individual’s consent to the Processing of their Personal Data for the Purposes, except to the extent such consent is not required under relevant laws.

IN WITNESS WHEREOF, we, the Policyholder/Assignor and the Assignee have set our hands on the date stated below:

Signature of Policyholder/ Assignoror authorised signatory(ies)

Signature of Witness 1

Name & NRIC/FIN Name & NRIC/FIN

Signature of Witness 2

Signature of Assigneeor authorised signatory(ies)

Date Date

Date Date



NOTICE OF ABSOLUTE ASSIGNMENT

To: FWD Singapore Private Limited

Policy Services Department

I/We hereby give you notice of the absolute assignment of the above Policy issued by FWD Singapore Private Limited.

The date of the assignment shall be the date as speci�ed next to the Policyholder/Assignor’s signature.

I/We hereby hold FWD Singapore Private Limited free of any liability or responsibility for any payments made to the Policyholder/Assignor and for carrying out its other obligations to the Policyholder/Assignor prior to the receipt of this Notice of Absolute Assignment.

Yours sincerely,Signature of Assignee(or authorised signatory(ies)

Date



This form is provided by FWD Singapore Private Limited as a matter of courtesy, but FWD SingaporePrivate Limited assumes no responsibility or liability for the validity or legality of the Assignment.

absolute assignment form - fwd singapore · assignment is inclusive of the cash surrender and loan...

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