C S l S Sovernment Service Insurance System Financial Center, Pasay City, Metro Manila 1308 DESIGNATION/CHANGE OF BENEFICIARYIIES FOR LIFE ENDOWMENT POLICY (LEP) AND ENHANCED LIFE POLICY (ELP) Please check the reason for designation or change of beneficiary Without a legitimate spouse and legitimate, legiimated, adopted and declared legitimate chilcren. 7 Death of the designated beneficiary. Revocation ofthe legitimate spouse as beneficiary and the policy holder is childless , with Business Partner Number and insured under Policy No. hereby request that the Beneficlaryies named hereunder be acknowledged as my Benefcaryies: DESIGNATION OF BENEFICIARYIIES: PRINTED NAME OF RELATIONSHIP DATE OF BIRTH BENEFICIARYIES GenoeR COMPLETE ADDRESS (Cue AERARIES | totheinaured (rmsaiyyy) (CHANGE OF BENEFICIARYIIES: FORNER New are oF severcunes. | _sencrcwevnes | SEATENEH? | cevper | RECT | coupuereaooRESS (serane Ger ane) | Gurans Gs Hane i) (amis) Executed at. on day ot ‘Signature of insured Right Thurber (tunable to af irature)