Application for Change of Agency

Investment company's address:

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Date........................

Dear Sirs,

Policy/plan number :..............................................................................

Policy/plan Type :..............................................................................

Policyholder :...................................................................Date of Birth...............

Please transfer the agency of the above numbered plan to:

Cavendish Online Ltd,
8 Bay Chambers
West Bute Street
Cardiff
CF10 5BB

Please forward all future renewal commission to Cavendish Online.

If you have any queries please contact either myself or Cavendish Online.

Yours faithfully

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Policyholder's signature