Inflation Indexation and Freezing Premiums Annual Option Form

This form is to instruct the insurance company to turn off inflation indexing on your existing life, trauma, TPD and Disability covers.

You have a choice of turning it off 'permanently' or until such time as you choose to turn the increases 'on' again - which means you only need to give this instruction once - in this case tick the second choice - 'Turning OFF the inflation indexing until I instruct it to be turned back ON'.

OR

on an annual basis - which means you need to complete and send this letter in each year upon receipt of your Anniversary - ticking the 'Turning OFF the inflation indexing for this year ONLY'

Otherwise you can, of course, choose to leave the Inflation Indexing turned 'ON' as it is pre-set

plus to stop your stepped premium covers increasing with your age by choosing to FREEZE your premiums (no.4 option below), you need to be aware that this means the benefit you are covered for will reduce each year as you get older. eg. $100k of life cover costing $20 pm this year, if you FREEZE the premium might become $95k of life cover costing $20 pm and this reduction in benefit continues each year until you turn off the premium FREEZE which you can do each year.

Instructions - please fill in this form and sign on the screen using a touch screen device such as a smartphone or tablet. If you do not have access to one then please scroll to the bottom, download, fill in and scan the pdf back to george@tgn.co.nz

Please alter our policies numbered :

If you don't know these we can fill them in for you

Please choose how you wish to treat Inflation Indexing:

1. Turning OFF the inflation indexing for this year ONLY2. Turning OFF the inflation indexing until I/we instruct it to be turned back ON3. Please leave inflation indexing turned ON4. Please turn indexing back ON for the cover detailed below

Cover to have indexing turned back ON

ALSO, please tick how you wish to treat your stepped premiums and their associated benefits going forward –

I/We wish to keep the Benefit of our cover at it’s current amount unchanged, if we have previously FROZEN our cover we wish to UNFREEZE it going forward, I/we understand the premium will increaseI/We wish to FREEZE the premiums on our stepped premium policies – we understand that by choosing this option that the insured benefit amount (the amount I/we are insured for) will decrease each year I/ we maintain the FREEZE on our premium.

I/We wish to make this premium FREEZE -

Freeze permanentlyFreeze for ONE year ONLY (and review again next year)

This should be effected immediately and it is not necessary to contact me/us in regards to this. Please treat a copy as an original.

Signature Person 1

Name Person 1*

First NameLast Name

Date of Birth Person 1*

DayMonthYear

Signature Person 2

Name Person 2

First NameLast Name

Date of Birth Person 2

DayMonthYear

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Todays date*

DayMonthYear

If you would like to talk through your options please call George Bayley on 029 436 7432 or to book in a call or Zoom to suit you https://calendly.com/insurances/phone

TGN Advisers is a wholly owned subsidiary of TGN Investments Limited Co. Reg. 1139932

If you would prefer to print off a paper copy to fill in, sign and scan / photograph / post back to us please use this form -

Policy Alteration - Inflation Indexing