Switch request and/or future fund variation form - Clerical Medical

Switch request and/or future fund variation form
Please read the notes below before completing this form
It’s not necessary to forward any policy documents.
The first twelve switches in any plan year commencing from the start date of the policy are free; thereafter a charge will be made as set out
in the Provisions. Please contact Clerical Medical if you require further details.
The bid price of units sold and bought will be those calculated at the valuation following acceptance of your request. For the avoidance of
doubt, where instructions are made by fax, the switch will only be processed using prices calculated at the valuation on the day of receipt if
those instructions are received before 11.00am (British time). If instructions are received after this time the switch will be processed using
prices calculated the following working day.
If this request is being made by the policyholder(s) or the financial adviser, the consent of any assignee(s) should accompany this request.
If this request is being made by the assignee(s), and Clerical Medical has not been previously notified of the assignment, Clerical Medical
requires sight of the original Deed of Assignment (which will be returned by recorded delivery).
Please complete this form in CAPITAL LETTERS.
I/We
Full name of policyholder(s)/appointed fund adviser/assignee(s)*
Request the following switch and/or future investment choice in respect of
Plan/contract number
Please carry out the instructions overleaf in respect of the investment.
Correspondence address
Postcode
Signature(s) of policyholder(s)/appointed fund adviser/assignee(s)* Date
/ / 2 0
Signature(s) of policyholder(s)/appointed fund adviser/assignee(s)* Date 2 0
/ /
* Please delete as appropriate.
CMI Insurance Company Limited
For existing clients’ information only

Switching existing investment funds
Please complete boxes A and B if you wish to switch units into different funds. Please quote the percentage of the existing fund you wish
to switch and ensure that the percentage of units you wish to switch into totals 100%.
A. Switch from
Percentage of existing fund(s) to be switched
(whole percentages only)
Fund number
(for Clerical Medical use)
Fund name
Percentage
amount %
A1. From: %
B. Switch to
Fund(s) into which units are to be switched (after deduction of any
charge) and percentage of proceeds to be applied to each fund
(whole percentages only)
Fund number
(for Clerical Medical use)
Fund name
Percentage
amount %
B1. To: %
Total 100%
A2. From: %
B2. To: %
Total 100%
A3. From: %
B3. To: %
If you wish to switch your total unit holding into different funds please state ‘Total holding’ in box A1 and the new allocation in box B1.
Total 100%
Directing future investments into different funds
Please complete box C below if you wish your regular premiums to be invested in different funds in future. Please specify the percentage of
the regular premium to be invested in each fund.
C. Future regular premium investment choice
Funds to which future premiums are to be allocated and percentage of regular premium to be allocated to each fund (whole percentages only).
Please ensure the total allocation equals 100%.
Fund number
(for Clerical Medical use) Fund name Percentage amount %
%
After completion please return this form to:
Clerical Medical Policy Servicing Department
Clerical Medical House
Victoria Road, Douglas
Isle of Man
British Isles IM99 1LT
Telephone +44 (0)1624 638888; Fax +44 (0)1624 638981
Note: This form is not intended for distribution in the UK and is not for UK investors
www.hke.clerical-medical.com
CMI Insurance Company Limited, Clerical Medical House, Victoria Road, Douglas, Isle of Man IM99 1LT, British Isles.
Registered no. 33520 Isle of Man. Telephone: +44 (0)1624 638888.
Hong Kong Representative: CMI Financial Management Services Limited, 26/F Oxford House, Quarry Bay, Hong Kong.
Telephone: +852 2956 1288. Fax: +852 2956 2302.
HE051/1113