1. Your personal details Personal identification number: Mr. Santos Send us a copy of your valid identification document

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1 Postbus 9159, NL-1006 AD Amsterdam Telephone: Telefax: Request form for a lifelong occupational retirement pension Why are receiving this form? What must you do? Do you have any questions? You have built up pension at Bpf Koopvaardij. You can request your pension using this form. Complete this request form. Correct any inaccuracies. Return the completed and signed form together with all enclosures. Go to for detailed information about the Bpf Koopvaardij pension scheme. Use the pension planner in My Koopvaardij via You can see what your choices will mean for the amount of your pension. Send your question to servicedesk@koopvaardij.nl. Call our Service Desk. The telephone number is The Service Desk is open from Monday to Thursday, inclusive, from 8 a.m. to 5.30 p.m. and on Friday from 8 a.m. to 5 p.m. 1. Your personal details Personal identification number: Name Date of birth Citizen service number (CSN) Address Pensionstreet 10 Post code, town/city Country Is this address also your correspondence address? Telephone number Mr. Santos Send us a copy of your valid identification document 3020 AB Pension City Spain Send us the completed life certificate Yes No, my correspondence address is: Address Post code.. Town/city. Country Personal identification number: Page 1 of 7 Continue on the next page

2 2. Your marital status Your marital status Were you previously married or did you have a registered partnership or did you cohabit on the basis of a cohabitation contract? I am married or I have a registered partnership. Send us a copy of your marriage certificate/registered partnership deed. I cohabit and I have a notarial cohabitation contract. Send us a copy of your cohabitation contract Details of partner: Partner s name... Partner s date of birth:. Partner s citizen service number (CSN): I cohabit but I do not have a notarial cohabitation contract. I am not married (single). No Yes, I am divorced / my partnership or cohabitation contract has been terminated: Ex-partner s name:... Ex-partner s date of birth: Ex-partner s citizen service number (CSN): Date of divorce/termination of partnership or cohabitation contract: Send us a copy of your marriage certificate and your divorce document, registered partnership deed and deed terminating the registered partnership. Have you been married or had partnerships several times? If you had a cohabitation contract, send us a copy of your cohabitation contract and the documents that demonstrate that this contract has been terminated. If your cohabitation agreement has been or is being terminated, you must notify us of that fact within two years of the termination. In that case, your former partner may qualify for a special partner s pension after your death. No Yes, the details of my ex-partner are: Ex-partner s name:... Ex-partner s date of birth: Ex-partner s citizen service number (CSN): Date of divorce/termination of partnership or cohabitation contract: Send us a copy of your marriage certificate and your divorce document, registered partnership deed and deed terminating the registered partnership. If you had a cohabitation contract, send us a copy of your cohabitation contract and the documents that demonstrate that this contract has been terminated. If your cohabitation agreement has been or is being terminated, you must notify us of that fact within two years of the termination. In that case, your former partner may qualify for a special partner s pension after your death. If you have several ex-partners, you can enclose the details on a separate sheet. Personal identification number: Page 2 of 7 Continue on the next page

3 3. Your pension Your pension amounts are listed below. The pension you receive may possibly be higher or lower than the following amounts. You will receive your pension in monthly instalments. We withhold wage tax on your gross pension. The amounts below are based on the data currently known to us. Any changes to the data may influence these amounts. Standard pension at state pension age Commencement date of your occupational retirement pension: Lifelong occupational retirement pension gross per year Partner s pension gross per year* *If you are divorced, all or part of your partner s pension may go to your expartner. If that is the case, your partner's pension will be reduced by the partner's pension for your ex-partner on the basis of the divorce or divorces known to us. 3a. Postponement Your pension normally commences at the age of 67. At present, the state pension age is not yet 67, but it is being increased more rapidly. You can have your occupational retirement pension commence at the same time as your state pension. In that case you are bringing forward your Bpf Koopvaardij pension. By doing so, your pension will be lower. You may also opt to have your pension commence at a later date. You can postpone your pension until the age of 70 at the latest. You must, however, still be working at the time. Do you wish to have your pension commence? Yes, I wish to have my pension commence on the above starting date. Proceed to question 3b No, I do not yet wish to have my pension commence. I will contact you. The contact details are stated at the top of this form. Proceed to question 7: signing. You do not need to complete anything else. Return this request form to us. We will no longer send you any reminders. 3b. Exchanging the partner s pension for a higher occupational retirement pension At Bpf Koopvaardij, you also build up a partner's pension. That means that when you pass away, any partner you may have will receive a partner s pension. In what cases should you exchange? If your partner has been properly taken care of financially in the event of your death, you can exchange part of your partner s pension for a higher occupational retirement pension. When you pass away, your partner will receive less or no partner s pension from Bpf Koopvaardij. If you do not have a partner, you can exchange all of your partner s pension for a higher occupational retirement pension. You will therefore have a higher pension each month. Remember: If you are divorced, your ex-partner may be entitled to part of the partner s pension. This is referred to as a special partner's pension. You cannot exchange this special partner s pension for a higher occupational retirement pension. Do you wish to exchange your partner s pension for a higher occupational retirement pension? I do not wish to exchange my partner s pension for a higher occupational retirement pension. I do have a partner and I wish to exchange part of my partner s pension for a higher occupational retirement pension. Send us a partner s pension waiver, which is enclosed with this form. I do not have a partner and I wish to exchange all of my partner s pension for a higher occupational retirement pension. You do not need to complete the partner s pension waiver. Remember: your choices cannot be reversed. *You can calculate the results using the pension planner via Personal identification number: Page 3 of 7 Continue on the next page

4 3c. Exchanging your occupational retirement pension for a higher partner s pension. Your partner s pension may be lower than 70% of your occupational retirement pension. This may be the case, for instance, after a divorce with your ex-partner being entitled to part of the partner s pension. You may opt to exchange part of your occupational retirement pension for a higher partner s pension. Your monthly occupational retirement pension will be lower as a result. Do you wish to exchange your occupational retirement pension for a higher partner s pension? I do not wish to exchange my occupational retirement pension for a higher partner s pension. I wish to exchange part of my occupational retirement pension for a higher partner s pension. The amount of my partner s pension must be:.% of my occupational retirement pension. The amount of the partner s pension may not be more than 100% of your occupational retirement pension. Remember: your choices cannot be reversed. *You can calculate the results using the pension planner via 3d. First a higher pension and subsequently a lower pension Normally, the amount of your lifelong occupational retirement pension remains unchanged from your state pension age. However, as a result of a personal situation or personal wishes, you may wish to have a higher occupational retirement pension at first. As a result, this will be followed by a lower occupational retirement pension. This is called a high-low occupational retirement pension. You can opt to receive a higher occupational retirement pension for up to ten years. The benefit after this period is then lower. The lower pension will be 75% of the higher occupational retirement pension. Do you wish to receive a higher occupational retirement pension temporarily?* No, I do not wish to change anything Yes, I wish to receive a higher pension at first and subsequently a lower pension. Expiry age of the higher occupational retirement pension. years and. month(s) Remember: your choices cannot be reversed. *You can calculate the results using the pension planner via If you do not opt to change your pension above, we will assume that you are choosing the standard pension. We can understand that choosing may be difficult. If you would like more information, you can contact our service desk. The contact details are stated at the top of this form. 4. Wage tax exemption Wage tax is withheld from your pension. You may also have to pay tax on your pension in the country where you live. In that case, you can request an exemption from the Tax and Customs Administration. The address is: Belastingdienst Particulieren/Ondernemingen Buitenland. Postbus DJ Heerlen, The Netherlands. I would like a wage tax exemption to be applied to my Bpf Koopvaardij pension Yes Send us the exemption decision of the Tax and Customs Administration No Personal identification number: Page 4 of 7 Continue on the next page

5 5. Account number IBAN BIC You will find your IBAN and BIC on your bank statement. Is this an account number of a foreign bank? Is the account number in your name? Send us a copy of a bank statement, bank agreement or Internet banking screen print containing your IBAN and BIC. No Yes, the details of the foreign bank are: Name:. Address:. Country:... Yes No, the name of the account holder is:.. Ask the account holder to sign below. The account holder hereby grants permission for us to transfer your pension to this account number. Account holder s signature :.. Personal identification number: Page 5 of 7 Continue on the next page

6 6. Enclosures Send your copy in A4 format Tick the enclosures that you have included. Have you enclosed the copy? Copy of a valid identification document Yes, obligatory, see question 1 Life certificate Because you live abroad, we do not automatically receive your data from the Persons Database (BRP), which is why we require a life certificate. This enables us to check whether you are still entitled to a pension. The life certificate is enclosed with this form. Copy of the marriage certificate and/or divorce document/registered partnership deed At Bpf Koopvaardij, you also build up a partner's pension automatically. That means that when you pass away, your partner or ex-partner may be entitled to a partner s pension. We check the details using this copy. Copy of the cohabitation contract At Bpf Koopvaardij, you also build up a partner's pension automatically. That means that when you die, your partner or expartner may be entitled to a partner s pension. We check the details using this copy. If you had a cohabitation contract, send us the documents that demonstrate that this contract has been terminated. Partner s pension waiver If you exchange the partner s pension, you must complete a partner s pension waiver. If you have a partner, your partner s signature must be authenticated by a civil-law notary. The waiver is enclosed with this form. Wage tax exemption decision If you wish to have a wage tax exemption applied to your pension, you must enclose a copy of the exemption decision from the Tax and Customs Administration. You can request this exemption from the Tax and Customs Administration. The address is: Belastingdienst Particulieren/Ondernemingen Buitenland. Postbus 2865 NL-6401 DJ Heerlen. Copy of your bank statement, bank agreement or Internet banking screen print In order pay out your pension, we require a copy of a recent bank statement on which the account number and the account holder are clearly stated. You may block out the other details. If you do not have a bank statement, you can send us a screen print from your internet banking programme. Yes, obligatory, see question 1 Yes, obligatory, see question 2 No, not necessary, see question 2 Yes, obligatory, see question 2 No, not necessary, see question 2 Yes, obligatory, see question 3 No, not necessary, see question 3 Yes, obligatory, see question 4 No, not necessary, see question 4 Yes, obligatory, see question 5 Personal identification number: Page 6 of 7 Continue on the next page

7 7. Signing Have you checked all the details? If information is missing or inaccurate, please let us know in writing. We have taken the information currently available to us and the applicable pension scheme rules as a basis. The pension scheme rules prevail over all other sources. This means that you cannot derive any rights from inaccurate information and amounts. You can request the pension scheme rules from us or download them at Your name. Date.. Place.. Your signature. Check whether you have completed all questions. If your request is not complete, we cannot process it and your request will be delayed. What must you do? Return this request form and all enclosures, completed and signed, within one month. Use the reply envelope. Bedrijfspensioenfonds voor de Koopvaardij Antwoordnummer: NL-1060 VB Amsterdam Personal identification number: Page 7 of 7 Continue on the next page