Zurich Global Choice Claim Form

3UAE plans onlyIf you have fully encashed any other insurance plans within the last 12 months, either with Zurich or otherinsurers, please provide details in the space below.4 Options – please tick one onlyReason for cashing inAll encashment amounts are deducted in the plan currency.You can arrange for the encashment amount to be paid to you in the currency of your choice by completing theappropriate part of section 5 – Method of payment – on page 3.Option A Full encashment – this will terminate your entire planPlease note that a cash-in charge may apply.If you are making a full encashment, please return your plan schedule(s).If you have lost or misplaced your plan schedule(s), please complete the lost plan indemnity sectionon page 7.I have enclosed my original documentsI have completed the lost plan indemnity sectionOR, Option B Partial encashment across all fundsAmount (in plan currency)OR, Option C Partial encashment across specific fundsAmount (in plan currency)If you would like to sell from particular funds, please enter the full name of the funds, fund codes and whereapplicable the funds currency. To avoid any delays, please make sure that you write fund codes and fund names in fulland in CAPITAL letters.If you do not specify a percentage allocation we will make up the amount by cashing in the samepercentage value from each of the daily-priced funds in your plan.Fund code/currency Fund name (including name of fund management company) % of withdrawal amount(NOT % of fund value)’100%2