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Click ‘Get Form’ to open it in the editor.
Begin with Option 1 or Option 2. If you choose Option 1, indicate whether you wish to conduct a market review without transferring your policy by ticking the appropriate box.
Fill in the effective date and provide your signature along with your job title if applicable.
If opting for Option 2, confirm the transfer of your policy by ticking the relevant box and entering the effective date. Sign and include your job title if necessary.
In Section 3, complete your customer details including insurance company, policy number, full name, group name, postcode, and date.
Finally, Section 4 requires intermediary details. Ensure that both you and the intermediary sign this section after discussing the options.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (45 Votes)
2016	4.2 Satisfied (50 Votes)

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