E126 (Rev. 2020-03-02)
ARIZONA DEPARTMENT OF INSURANCE CASH RELEASE FORM
You must complete this form to withdraw cash from Union Bank. Select one Reason for Release Request at
the bottom of the form. For Excess/Partial or Substitution release transactions, requests are processed after
Account Value is confirmed. Please contact Union Bank if you have any questions.
MAIL
MUFG Union Bank, N.A.
350 California Street, 17th Floor
San Francisco, CA 94104
FAX
(877) 837-3292
PHONE
(800) 962-1784
Union Bank
Account Name:
Union Bank Account Number:
Company Contact: Company Contact Telephone:
Type of Release Requested (check method of delivery and complete detail on security)
Cash via Check Cash via Wire
For Federal Reserve securities or DTCC Eligible
securities, provide asset detail information
below:
Amount To be Released:
:
Cash Delivery Instructions:
Bank Name
ABA
For Credit to
For Further Credit to
REASON FOR RELEASE REQUEST- check one
Total Release – Request to withdraw all securities in the account (See Note below)
Excess/Partial Release – Request to withdraw funds in excess of required Minimum Account Balance
Substitution Release – Request to replace an existing security with another security.
Note: A Total Release requires prior approval from the Arizona Department of Insurance.
If we have not received their prior approval, your request will be forwarded to them.
Authorized Signature on File with Union Bank Printed Name & Title Date
ACH
Check Delivery Instructions (Address):
