These documents MUST be submitted in order to constitute a complete application for submission to the DLP:

Transcription

1 BASIC REEMPTION REQUIREMENTS All refund applications take approximately 3 months to process from the date all original documents are received by our office. Incomplete applications will be cancelled after 3 months. The Chamber Pension Plan reserves the right to request additional documentation to support all applications. EATH BENEFIT 1. Completed Refund Request application form 2. Notarized copy of your passport pages (photo, expiration, signature) 3. Notarized copy of identification for the deceased 4. eath Certificate 5. Birth Certificate (application made by children of the deceased) 6. Marriage Certificate (application made by spouses of the deceased) 7. epartment of Labour and Pension Office RSA Form (if OVER Cl$ ) 8. Completed ue iligence letter ISABILITY BENEFIT ISABILITY - This request is subject to the approval by the irector of Pension therefore the Chamber Pension Plan Office has NO control over the processing time of this application. As defined in the National Pension Law {2012 Revision) "disabled", in relation to a member, means unable because of a physical or mental condition to perform most or all of the tasks related to that member's employment; These documents MUST be submitted in order to constitute a complete application for submission to the LP: 1. Completed Refunds Request application 2. Notarized copy of your valid passport (photo, expiration, signature) 3. Current Medical Report- Report MUST be on the company letterhead with legible contact information and signed accordingly. The report must also include details of the medical condition and how it impacts the applicants life expectancy 4. Proof of medical insurance coverage or lack thereof must be provided 5. Additional information may be requested The above documentation may initially be faxed or ed to our office; however a payment date cannot be assigned until ALL requirements are met and the original copies of the documents are received by our office.

2 <! w r-, "' ;:, in ; ;}: "' ;:, in w ::; I vi w <ft:j:/;; CHAMBER PENSIONi Company Name Foroff1c10I use only Member II Name Lost Name First Nome Name of Member's Spouse Last Name First Nome My last period of employment ended on --ƒ-- -- Please indicate the address where all future correspondence is to be directed: Address Local Telephone a Overseas Telephone (if becoming non-resident) RETIRING I understand that I am entitled to benefits under the Cayman Island Chamber of Commerce Pension Plan in relation to my employment with the company listed above. I also understand that I can leave my pension benefits in the Cayman Islands Chamber of Commerce Pension Plan where it may grow/decline based on market values and when I reach retirement or early retirement age may apply for the commuted value of the accumulated contributions to become on approved retirement savings arrangement. Middle Name Middle Name I am of early retirement age (55-64) and I have ceased employment effective the date listed above. I would like to apply for an approved retirement savings arrangement. Should I return to work prior to the age of 60 I will immediately inform the Cayman Islands Chamber of Commerce Pension Plan. I am of retirement age (65+) and would like to apply for an approved retirement savings arrangement. In consideration of this payment I hereby discharge the Administrator of the Cayman Islands Chamber of Commerce Pension Pion from all further liability whatsoever in respect of my membership of that Pension Plan. Member Signature (as appears on passport) I ceased to reside in the Islands on (proof of non-residency may be required) MM I understand that I om entitled to pension benefits under the Cayman Islands Chamber of Commerce Pension Plan in relation to my employment with the company listed above. understand that I con leave my pension benefits in the Cayman Islands Chamber of Commerce Pension Pion where it may grow/decline based on market conditions until I retire or apply for o refund if certain criteria ore met. ate Please note. refunds ore only allowed in the following circumstances: 1) The commuted value of the pension is over Cl$5,000 AN a) the member's employment is terminated: AN b) that member ceases to reside in the Islands: AN c) no contributions have been made to a pension plan by. or on behalf of the member for a period of two years or more. I wish to apply for o refund of the commuted value of my pension benefit. In consideration of this payment I hereby discharge the Administrator of the Cayman Islands Chamber of Commerce Pension Pion from on further liability whatsoever in respect of my membership of that Pension Pion. Member Signature (as appears on passport) 2) The commuted value of the pension is under C1$5.000AN a) the member's employment is terminated; AN b) that member ceases to reside in the Islands. ate FOR INTERNAL USE ONLY HOUSING EATH BENEFIT ISABILITY REFUN

3 z"d Floor Mid Town Plaza 273 Elgin Avenue P.O. Box 2182 Grand Cayman KYl-1105 INIVIUAL TRANSFER REQUEST TO RETIREMENT SAVINGS ARRANGEMENT-EFINE CONTRIBUTION PLAN Name of Member Name of Member's Spouse I understand that I am entitled to benefits under the CHAMBER PENSION PLAN (Name of pension plan} ate of Birth Pension Plan ("the Transferring Plan") in relation to my employment with (Name of Employer) My last period of employment ended on (ate) declare retiring from all (elete if Inapplicable). r wish to transfer the current value of the accumulated contributions plus interest made by me and by my previous employer for me to an approved Retirement Savings Arrangement ("RSA"), The RSA is with MUFG FUN SERVICES (Name of company, institution or organization operating RSA) This institution is willing to accept this transfer and operate the RSA in accordance with the law. In consideration of this transfer, I hereby discharge the Admfnistrator of the Transferring Pension Plan from all further liabillty whatsoever in respect of my membership of that Pension Plan. I have read and understood the terms of the RSA and acknowledge that pension payments from the RSA in accordance with the terms of the RSA will be sate benefit arising in respect of my membership of the Transferring Plan. CHAMBER PENSION PLAN Administrator of RSA(Block letters) Signature:. ate: Name of Member (Block letters) Signature:. The irector of Labour & Pensions hereby confirms that the RSA embodies written terms and conditions that meet the requirements of the Law (ii) has been approved by the irector of Labour & Pensions and (Iii) is operated by an Institution approved by the Superintendent of Pensions. irector of Labour & Pensions

4 Individual Transfer Request to Retirement Savings Arrangement! STATEMENT OF TERMS & CONITIONS FOR RETIREMENT SAVINGS ARRANGEMENTS The Retirement Savings Arrangement for (ate of Birth) Full Name of Transferring Member ("the RSA") Is an arrangement set up for the transferring member in accordance with the section 34 of the National Pensions Law. "The National Pensions is the National Pensions Law (2012 Revision) as amended and regulations issued thereunder CHAMBERPENSIONPLAN Name of the Transferring Pension Plan Pension Plan!"# $%&'( )*"+, - " *./ BC BEFGHIJKLMNO pension plan for the transferring member to a retirement savings arrangement being an account/contract/policy issued and administered and managed by MUFG FUN SERVICES Name of Administrator of the RSA The administrator of the RSA shall administer the RSA in accordance with the National Pensions law and shall be deemed to hold the money in trust for the transferring employee. The arrangement is for the benefit of the transferring member and is in lieu of all rights to benefit and contingent rights to benefit for that transferring member and In respect of that transferring member under the Transferring Pension Plan. The Transferring Pension Plan is a defined contribution pension plan under which the pension is entitlement at retirement is what can be bought by accumulated contributions. The Retirement Savings Arrangement is set up in accordance with a written request from the member dated a copy of which is appended hereto. The Retirement Savings Arrangement is subject to approval by the irector of labour & Pensions in accordance with section of the National Pensions Law. The Retirement Savings Arrangement includes and shall apply the following conditions:- (a) that no money transferred, including all investment earnings, shall be withdrawn except- (i) to transfer the money to the pension fund of a registered pension plan; (ii) (iii} (iv) to transfer the money to another individual retirement account that meets the requirements of this regulation; to purchase an immediate or deferred life annuity provided by a person authorized under the Pensions Laws of the Islands to sell annuities under an insurance contract that meets the requirements of regulation of the National (General) Pensions Regulations Revision), provided that the annuity does not commence on a date earlier than years prior to the normal retirement date specified in section of the Pensions Law; or subject to maximum to be prescribed from time to time by the irector of Labour & Pensions; (b) that no money transferred, including interest, may be assigned, charged, anticipated or given as security except as permitted by sections and of the Pensions Law; Page 2 of 3

5 Individual Transfer Request to Retirement Savings Arrangement (c) that any transaction purporting to assign, charge, anticipate or give as security money transferred except as permitted undersections 55(2) and 56(4) of the Pensions Law, is void; (d) that except as permitted in sections 40 and 53 of the Pensions law, no money transferred including interest, may be commuted or surrendered during the lifetime of the former member;!" #$%& (f) ' ( ) *+,*-. / 0123 )4" :;< =>'? >? ( E F G H= 7 7IJK;%LM"N OPQ {ii) ' RSTR'USV RW?' X) *- A Y*E () Z K [7M"%$M $\ Q]^]`]Q abcdefg hi accordance with the Pensions Law and the Regulations; (g) that the transferee will advise in writing any subsequent transferee that the amount transferred must be administered as a pension or deferred pension under the Pension Law and this regulation; (h) that on the death of the holder of the registered retirement savings arrangement, the transferee will administer the money in accordance with section 39 of the Pensions Law, which shall be applied to mean the balance of the money in the individual retirement account at the time of death; (i) {j) that larger periodic amounts will be paid to a member whose life expectancy is likely to be reduced because of a mental physical disability; and the name of the beneficiary or beneficiaries. Under this RSA payments shall be made monthly/quarterly/yearly in accordance with the attached schedule. Payments will cease when all monies in the arrangement are expended. When all monies are expended, no further liabilities will arise in respect of the arrangement. The transferring member has read and understood the terms of the RSA. Signed and dated For Administrator of the RSA CHAMBER PENSION PLAN Name in Blocked Capitals Transferring Member Name in Blocked Capitals ate Page 3 of 3

6 CHAMBER PENSION[ Refund Method of Payment INTERNATIONAL WIRE will!"#$%&' () *+, (-./ This is the quickest way to receive your funds as they will be deposited directly to your bank account CURRENCY OF CHOICE: USO CON GBP EUR PERSONAL INFORMATION - NAME OF THE ACCOUNT HOLER PLEASE PRINT CLEARY NAME(S) OF BANK ACCOUNT HOLER: YOUR BANK ACCOUNT NUMBER: YOUR ARESS AN PHONE NUMBER: YOUR BANK INFORMATION PLEASE PRINT CLEARY BANK NAME AN ARESS: ABANUMBER: I SWIFT COE: I OTHER: US CORRESPONENT BANK INFORMATION PLEASE PRINT CLEARY USA CORRESPONENT REQUIRE BANK NAME AN FOR ARESS: NON-USA USA CORRESPONENT USA CORRESPONENT ACCOUNTS ABA NUMBER: SWIFT COE: OTHER: This wire transfer request should be stamped, signed, and dated by a representative of the banking mstitutlon m which you are requesting funds to be sent. This is to ensure that all information required to the send wire transfer is correct. If this information is in any way incomplete, a draft drawn on a USA bank will be sent to you. Name and signature of bank representative or Bank Stamp: Member signature:.

7 CHAMBER PENSION Refund Method of Payment Member#: CURRENCY OF CHOICE: LOCAL: KV US OVERSEAS: us CON GBP EUR SELECT ONE OPTION ONLY PLEASE REA CAREFULLY!! SENT BY FEERAL EXPRESS - FOREIGN CURRENCY BANK RAFT PLEASE PRINT CLEARY Bank drafts must be deposited-th EV CANNOT BE PAI IN CASH AN MAY BE HEL FOR CLEARANCE The draft will be sent to the address provided on your refund application form ALL applicable processing fee will be deducted from your total redemptron COMPLETE MAILING ARESS AN PHONE NUMBER: IMPORTANT NOTE: FEERAL EXPRESS CANNOT ELIVER TO PO BOXES CAYMAN ISLAN ACCOUNT - PLEASE PRINT CLEARY A local bank draft fee and or a local courier fee wlll be deducted from your total redemption NAME OF LOCAL BANK: LOCAL BANK ACCOUNT NUMBER: NAME(S) OF BANK ACCOUNT HOLER: SELF/ AUTHORIZATION FOR PICK UP OF BANK RAFT-PLEASE PRINT CLEARY VALI GOVERN EM ENT ISSUE IENTIFCIATION IS REQUIRE TO COLLECT This option allows authorization for the person named below to collect a bank draft on your behalf Bank drafts must be deposited - the authorized person CANNOT CASH THE RAFT as 1t will be payable to you, the account holder A draft fee be deducted from your total refund NAME OF SELF/AUTHORIZE PERSON: PHONE NUMBER OF SELF/AUTHORIZE PERSON Member signature: ate: