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Get Instructions For Form 1128 (rev. April 1996). Application To Adopt, Change, Or Retain A Tax Year

1 Fax: (65) 6221 2188 Mailing address: Robinson Road Post Office P.O. BOX 1538 Singapore 903038 Foreigner Questionnaire WARNING: STATEMENT PURSUANT TO SECTION 25(5) OF THE INSURANCE ACT, YOU ARE TO DISCLOSE IN THIS FORM, FULLY AND FAITHFULLY, ALL THE FACTS WHICH YOU KNOW OR OUGHT TO KNOW, OTHERWISE, THE REQUEST EFFECTED HEREUNDER MAYBE VOID. Policy no Name of Life insured Name of Policyowner (if other than Life insured) 1. : :.

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