SURRENDER AND REGULAR WITHDRAWAL REQUEST FORM

Transcription

1 INTERNATIONAL PORTFOLIO BON SURRENER AN REGULAR WITHRAWAL REQUEST FOR When fully completed, please return this form to Canada Life International Assurance (Ireland) AC, Canada Life House, Isle of an Business Park, ouglas, Isle of an I2 2QJ Bondholder name(s) Bond number Contact telephone number Please note that we cannot process a surrender request if a death claim, cancellation or previously requested surrender is pending. A full or partial surrender is permitted at any time after the cancellation period has expired. The remaining surrender value of your bond should be at least 15,000 ( 22,500 or $30,000) if you want it to remain in force. Please read the notes on page 4 and complete the appropriate selection below: A. Full Surrender I wish to fully surrender my bond Please tell us how you wish to take the surrender value, by selecting the appropriate option from this section. We cannot comply with your request unless you tell us how you want us to take the surrender value from your bond. Where you wish to surrender whole policies, and the result does not match the requested amount exactly, we will surrender enough policies to achieve the nearest value in excess of the amount you require. Exit penalties may be applied by certain external assets including funds, fixed term deposits and structured products. We recommend that you check with your adviser in each case to understand the implications. B. Partial Surrender I wish to partially surrender across all in force policies Amount required C. Full surrender of individual policies Please surrender the following number of whole policies Amount required Preferred assets from which surrender value should be taken In the absence of any new instructions, we will refer to the order you stated at outset in the Application Form. If no order was confirmed when the bond started and you have not supplied an order in the table below, we will apply our liquidity policy, which is available upon request. If we need to sell several assets to satisfy our liquidity policy, we will apply dealing charges to each asset. ASSET NAE ASSET I (ISIN/SEOL/EXI) % $ $. Reason for the surrender Please let us know the reason for the surrender

2 Only one type of regular withdrawal can apply at any time. inimum payments 200 ( 300 or $400) per month. Other frequency periods are the relevant multiple of these amounts for example 1,200 ( 1,800 or $2,400) for six-monthly frequency and 2,400 ( 3,600 or $4,800) for yearly frequency. E. Regular WIthdrawal I would like to withdraw: * Please ensure the amount is divisible by the chosen frequency to a complete British Pound/US ollar/euro / / $ % % each year of the amount invested each year of the bond value total each year* Regular Withdrawal can only be paid in the bond currency. I would like payments to be made: (Please refer to the notes on page 4). Once a month Once every three months Once every six months Once a year Starting on (date): Ending on (date): PAENT INSTRUCTIONS Final payment will not be processed until all the necessary documentation has been returned. Payment must be by direct transfer, in the bond currency. Payment cannot be made by cheque. Payment can only be made to the legal owner of the bond. Please provide full details of the bank or building society to which the surrender value is to be paid. For standard payments (in British Pounds) to a UK bank account please complete Section A only. For payments which are not in British Pounds or for payments which are made to a non-uk account, please complete Sections A and B. SECTION A Standard payment details Name of bank/building society/other for payment Full postal address Postcode Name(s) of account holder(s) Bank/building society account number Branch sort code Bank identifier code International Bank Account Number (IBAN) SECTION B Intermediary bank payment details Name of intermediary bank for payment Full postal address Postcode Intermediary bank account number Intermediary bank branch sort code Intermediary bank identifier code Intermediary bank International Bank Account Number (IBAN) Surrender and Regular Withdrawal Request Form for the International Portfolio Bond page 2/5

3 TAX RESIENC Tax regulations require us to collect information about the tax residency of each individual who has an account with us. If you are resident in a reportable jurisdiction then we will share certain information with the Irish Revenue Commissioners. This information may also be exchanged by the Irish Revenue Commissioners with other tax authorities. our tax residency is generally the country in which you live for more than half a year. Special circumstances (such as studying abroad, working overseas, or extended travel) may cause you to be resident elsewhere or resident in more than one country at the same time (dual residency). The country(ies) in which you pay income tax are likely to be your country(ies) of tax residence. If you are a US citizen or hold a US passport or green card, you will also be considered tax resident in the US even if you live outside the US. Please complete this section in case you have never provided us with your Tax residency details or these have changed since you last communicated them to us. Please list the country(ies)/jurisdiction(s) in which you are resident for tax purposes, together with the corresponding reference number(s). our full name(s) our full name(s) ate of Birth ate of Birth our full name(s) our full name(s) ate of Birth ate of Birth our full name(s) our full name(s) ate of Birth ate of Birth IPORTANT INFORATION * our national insurance and tax reference numbers are the personal references which are assigned to you by the relevant authority. These can be found in a number of ways the most common of which are listed below: By contacting the relevant authority On your tax return or notification of coding On your payslip or through your employer From your accountant or tax adviser Should your tax residency change at any time in the future, you must notify the Company immediately. Any personal information that you may provide to the Company as data controller will be treated in accordance with the applicable ata Protection regulation. A National Insurance number is acceptable for UK residents. ou should be aware that the signatories to this form will be making any declaration on behalf of the Controlling Persons. Surrender and Regular Withdrawal Request Form for the International Portfolio Bond page 3/5

4 NOTES 1. If all sections of this form are not fully completed this may delay the processing of your instruction and we reserve the right to default report any persons associated with this bond to the relevant authority under the applicable Automatic Exchange of Information (AEOI) legislation. 2. Surrender instructions cannot be accepted by or telephone. 3. Surrender instructions cannot be accepted from your professional adviser. 4. If you have questions about the completion of this form, you can reach us at +44 (0) or However, you should note we cannot give tax, legal or financial advice regarding your policy. ou are strongly recommended to seek financial advice. 5. Once the bond has been fully surrendered, Canada Life International Assurance (Ireland) AC s liability under the above numbered bond(s) will be completely discharged. 6. Payment of surrender proceeds: a. We will pay the surrender value to the specified account as soon as all trades have been settled. b. Any transfer charges incurred will be deducted from the surrender proceeds prior to payment. c. In order that payment can be paid to a single policyholder in joint policyholder cases, we need all the signatures to be witnessed by a person of professional standing; for instance, a solicitor or bank. 7. We will deduct regular withdrawals from the main Transaction Account. We recommend that you hold sufficient cash in the main Transaction Account to cover any imminent regular withdrawals and periodic product charges. Regular withdrawals can only be paid in the Bond Currency. In the event that some assets in the bond have to be sold to maintain liquidity, for example, if the Transaction Account balance goes into arrears, we will ask you to nominate the order in which assets should be sold. Where you do not nominate an order, we will sell assets in accordance with our own liquidity policy. This is described in detail in the Investor s Guide to the Transaction Account. 8. If you would like to start regular withdrawals on a policy anniversary, we would like to remind you that we have to take the payment from your Transaction Account three days before we pay this to you. This could mean that we take more than the tax efficient withdrawals rate in any one policy year and this may result in a chargeable event occurring. Where this occurs, and you are a UK resident, we will issue you with a chargeable event certificate which you will need to include in your tax return to H Revenue and Customs. If you set up regular withdrawals so that we make the first payment to you three days after the policy anniversary, you are less likely to incur an immediate liability to income tax. 9. This form must be signed and dated by the policyholders. The form must not be altered, crossed out or amended in any way as this will invalidate it and we will ask for a new form to be completed. If this bond has been assigned, the assignee must countersign the authority to give consent to the transaction. If an assignment is being discharged as part of the surrender a Notice of Re-assignment must be provided. If a Power of Attorney exists for any policyholder, the person granted Power of Attorney should sign, and a copy of the Power of Attorney should be submitted with this form. 10. For UK residents a partial surrender across all policies that exceeds 5% of the original or subsequent investments, or the total of all partial surrenders and regular withdrawals that exceed 5% of the original or subsequent investments, may result in a chargeable event occurring. The cancellation of whole policies within the bond will always result in a chargeable event occurring. We recommend that you seek financial advice to understand the tax implications of surrendering any part of or the whole of your bond. 11. Facilitated adviser charges deducted from your bond are treated in the same way for tax purposes as any other withdrawals. Where you have asked us to facilitate the payment of adviser charges to your adviser s firm, you must add the adviser charges to all other withdrawals to work out if you have a liability to tax. Please see your Key Features and the Facilitated Adviser Charges Guide for more details. 12. If you have asked us to pay your adviser s firm an ongoing adviser charge as a fixed cash amount and you cash in some of your policies, we will not automatically reduce what we pay to your adviser s firm to take account of the policies you cash in. If required, you can ask us to reduce the amount of the payment. 13. The Company reserves the right to withhold payment of the surrender proceeds if additional information is needed to satisfy its obligations under international tax compliance regulations. Where additional information is required, we will require completion of the appropriate ata Capture or Self-Certification Form. Surrender and Regular Withdrawal Request Form for the International Portfolio Bond page 4/5

5 ECLARATIONS FOR THE APPLICANT(S) 1. I have read the notes on page 4 of this document and accept this payment in full discharge of Canada Life International Assurance (Ireland) AC s liability under the bond recorded on page 1 of this document. 2. I acknowledge that Canada Life International Assurance (Ireland) AC will not take into account the price or performance of an asset when selling assets according to the instructions I have given or when selling assets according to their liquidity policy. 3. I acknowledge that any surrender, exit penalties or dealing charges incurred during the surrender process may be deducted from the bond or proceeds prior to payment. 4. I declare that the information provided on this form is, to the best of my knowledge and belief, accurate and complete. 5. If submitting personal information about another person, by signing this form I confirm that I have their consent to provide such information to the Company and for their information to be used as set out in this notice. 6. By signing this form I consent to the Company using and sharing this information in accordance with the applicable Tax Regulations. Where any information is being released to any relevant authority, the Company may use electronic communications. First or sole policyholder/ authorised Second policyholder/ authorised ate ate Third policyholder/authorised Fourth policyholder/authorised ate ate Fifth policyholder/authorised Sixth policyholder/authorised ate ate This form is not valid without all signature(s) and date(s). For further information about Canada Life International Assurance (Ireland) AC, please visit or call us on +44 (0) Canada Life International Assurance (Ireland) AC, registered in Ireland no Registered office: Irish Life Centre, Lower Abbey Street, ublin 1, Ireland Telephone: +44 (0) Fax: +44 (0) ember of the Association of International Life Offices. Canada Life International Assurance (Ireland) AC is authorised and regulated by the Central Bank of Ireland. This paper is made from recycled materials I R