Dependant form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=110 BGCOLOR="#666699" TEXT="#080000" bgproperties="fixed" background="04a00840erlcjm.png"> <div> <B>Dragonair Pilot's Association</B><FONT SIZE="1" COLOR="#FFFFCC" FACE="Arial" ><B>     |    </B></FONT><FONT SIZE="2" COLOR="#FFFFCC" FACE="Arial" ><A HREF="index.htm" TARGET="_top" TITLE="Dragonair Pilots Association"><U><B>HOME</B></U></A></FONT></div> <bR> <div> </div> </td> </tr><tr> <td valign="top" width=190 BGCOLOR="#CCCCFF" TEXT="#080000" background="04411c00egdysm.png"> <div> <B>Form for updating of personal information.</B></div> </td> <td valign="top" height=370 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>Please cut/paste and print this form for any updates.  Place in DPA Mailbox at KA House.</B></div> <bR> <div> <B>DPA</B></div> <div> <B><U>Nomination of Beneficiaries Form.</U></B></div> <bR> <div> Dragonair Pilots Association (DPA) holds the master (primary) Group policy on behalf of ALL Members. All claims must be made in the first instance via the DPA. It is therefore mandatory that you complete the following form and return it to the DPA. It is strongly suggested that you keep a copy of your nominations. You may change your nominations at any time by completing a new form.</div> <bR> <div> <B><U>Members Details:</U></B></div> <bR> <div> Full name                                 <B>………………………………………………………………</B></div> <bR> <div> Rank                                         <B>………………………………………………………………</B></div> <bR> <div> Phone Number/e-mail            <B>………………………………………………………………</B></div> <bR> <bR> <div> <B><U>Beneficiary Nominations.</U></B></div> <bR> <div> <B><U>Member</U></B></div> <bR> <div> In the event of <B>my</B> death or total incapacity my nominated beneficiary is </div> <div> <U>Full Name</U>                         <U>Relationship</U></div> <bR> <bR> <div> <B>……………………………………………………………………………………………</B></div> <bR> <div> <B><U>Spouse</U></B></div> <bR> <div> In the event of the death or total incapacity of my <B>spouse</B>, the nominated beneficiary is </div> <div> <U>Full Name</U>                         <U>Relationship</U></div> <bR> <bR> <div> <B>……………………………………………………………………………………………</B></div> <bR> <div> <B><U>Child/Children</U></B></div> <bR> <div> In the event of the death of my <B>child / children</B>, the nominated beneficiary is</div> <div> <U>Full Name</U>                         <U>Relationship</U></div> <bR> <bR> <div> <B>……………………………………………………………………………………………</B></div> <bR> <div> In the event that the nominated beneficiary is not alive at the time that any benefit is payable, then I wish the benefit to paid to the Executors of my estate.</div> <bR> <bR> <bR> <div> ……………………………..               ………………..…..</div> <div> Members Signature                    Dated</div> <bR> <bR> <bR> <div> ……………..……………….               …………….…………………..</div> <div> Witness Signature                    (Please print Witnesses name)</div> <bR> </td> </tr></table></body>