Zurich Global Choice Claim Form

10Claim form – guidance notes1 Returning your formPlease complete this form in CAPITAL letters andsend it to your relevant financial professional or toZurich International Life Limited, 43-51 Athol Street,Douglas, Isle of Man, IM99 1EF, British Isles.Telephone +44 1624 691111. Telefax +44 1624662038. If in Asia, our Hong Kong office at24/F One Island East, 18 Westlands Road, Island East,Hong Kong. Telephone +852 3405 7150.Telefax +852 3405 7268. Our Singapore office atSingapore Land Tower #29-05, 50 Raffles Place,Singapore, 048623. Telephone +65 6876 6750.Telefax +65 6876 6751. Or if in the Middle East,our Bahrain office at P.O. Box 10032, 19th Floor,Almoayyed Tower, Seef District, Kingdom of Bahrain.Telephone +973 175 63322. Telefax +973 175 64291.Our Dubai office at P.O. Box 50389, Al Mussalla Towers,Khaled Bin Al Walid Street, Dubai, United Arab Emirates.Telephone +971 4 397 4444 Telefax +971 4 397 4443.Our Qatar office at P.O. Box 26777, 404 Fourth Floor,Qatar Financial Centre Tower, West Bay, Doha, Qatar.Telephone +974 4496 7555. Telefax +974 4496 7556.2 Plans written in trustWe will make any cheque or transfer payable to all thetrustees. In some cases trustees may also authorisepayment jointly to themselves or to their professionalagent (e.g. a bank or solicitor).It is the trustees’ responsibility to ensure that theproceeds of the plan are used in accordance with theterms of the trust. Some trusts specifically exclude thesettlor (the person(s) who declared the trust) frombenefiting from the proceeds of the plan.3 Non-admittance of liabilityThe issue of this form does not imply admittance ofany liability to pay the claim by Zurich International Life.4 Cash-in optionsThere are three ways that you can take a single amountfrom your plan – please see below. The funds and theamount and currency required should be specified inthe options and payment method sections.Option A – full encashmentThere are alternatives to cashing in your plan andbefore deciding on the option you wish to take, werecommend that you take advice from your relevantfinancial professional. To close your plan we must sellall its fund holdings and deduct outstanding charges(as applicable) to obtain the final encashment value.Once we have received a full encashment instruction,you will not be able to reverse this decision, which willconstitute a full and final settlement of your plan withno further liability to Zurich International Life.Option B – cash-in across all fundsThis means that you take an equal amount across theplan to raise the amount required. The value of yourencashment will be deducted from all funds held.Option C – cash-in from specific fundsThis means you can specify which funds you would liketo deplete. If the value of the requested fund(s) isinsufficient to allow the withdrawal to take place, wewill need to obtain alternative instructions from you.This will lead to delays in providing you with theencashment amount.5 Cash-in chargeIf you make a partial encashment and the remainingplan value is less than USD15,000 or twice theoutstanding cash-in charge (whichever is the greater)then we will fully cash-in the plan, deduct anyoutstanding encashment charge or other charges andpay you the balance.If you fully cash-in during the first five years, or withinfive years of making an additional contribution, acash-in charge will apply which will be deducted fromthe value before payment is made to you. For additionalcontributions the cash-in charge will only apply tothose contributions made within the last five years.6 The effect of exchange rates and unit prices onclaim valueThe value of your claim will depend on the unit pricesapplicable on the date of payment. As exchange ratesand unit prices change daily, there may be a differencebetween your payment and any amount quoted atany earlier date.Zurich International Life Limited (Singapore branch) is authorised by the Monetary Authority of Singaporeto conduct life insurance business Singapore. Member of the Life Insurance Association of Singapore.Member of the Singapore Financial Dispute Resolution Scheme.Zurich International Life Limited is registered in Bahrain under Commercial Registration No. 17444.Zurich International Life Limited is authorised by the Qatar Financial Centre Regulatory Authority.Zurich International Life Limited is registered (Registration Number 63) under UAE Federal Law Number 6of 2007, and its activities in the UAE are governed by such law.MSP7039 (711039001) (08/10) RRDZurich International Life Limited provides life assurance, investment and protection products and isauthorised by the Isle of Man Government Insurance and Pensions Authority.Registered in the Isle of Man number 20126C. Registered office: 43-51 Athol Street, Douglas, Isle of Man,IM99 1EF, British Isles. Telephone +44 1624 662266. Telefax +44 1624 662038.Zurich International Life Limited is acting through its Singapore branch at Singapore Land Tower #29-05,50 Raffles Place Singapore 048623. Registered in Singapore No. F06754G.www.zurichinternational.comZurich International Life Limited is part of the Zurich Financial Services Group which has a representationin more than 50 countries.