CI Pro Universe | Magic Filler

Nomination Form

1Policy

2Person

3Nominee

4Sign

5Generate

Policy Details

Policy No.

Insured Details

Insured Name

Marital Status

Single Married Widowed Divorced

Religion

Muslim Non-Muslim

Policy Owner Details

(Tick if) Policyowner is same as Insured

Policy Owner Name

NRIC/Passport No.

Witness Details

Witness Name

NRIC/Passport No. Mobile No.

Trustee Details

Trustee Name

NRIC/Passport No.

Up to 5 Nominees

Signature Details

Signed at (State)

Day Month Year

Policy Owner Signature

Name: -

Tap to Sign (Policy Owner)

Witness Signature

Name: -

Tap to Sign (Witness)

Trustee Signature

Name: -

Tap to Sign (Trustee)

Generate PDF / Reset Form

Noimnation Form LF4054 (email to POS : mypos@manulife.my )

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