Fillable SURRENDER REQUEST SERVICING Please note, we will not (RL360)

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SURRENDER REQUEST SERVICING Please note, we will not (RL360)

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1
WHO IS THIS FORM FOR?
This form is for policyholders who
wish to surrender their policy in full
or surrender a policy segment(s).
If you wish to take a withdrawal
from your policy, please use our
Withdrawal Request form which
is available to download from our
website or by contacting us.
Depending on how long you have
held your policy and the terms
on which it was set up, there may
be a surrender penalty where
one or more policy segments are
cashed in. This information can be
provided upon request.
COMPLETING THIS FORM
By completing this form you will
be surrendering all or a number
of segments from your policy. We
recommend that you speak to your
financial adviser before doing this
so that they can make you aware
of any tax charges that may apply.
If you need help completing this
form please contact our Customer
Services Team on +44 (0)1624
681682 or alternatively you can
email csc@rl360.com.
We will accept emailed or faxed
scans of instructions. However,
we reserve the right to request
original documents in some
circumstances, so these must be
retained in your records. Where
the policyholder is resident in
Africa, we will still require original
signed instructions.
Please note, we will not pay out
any surrender proceeds until we
have received:
• this Surrender Form fully
completed and signed by all
policyholders, trustees or
authorised signatories.
•
a certified copy of current
passports and proof of
address for:
• all policyholders and each
individual trustee; or
• 2 directors, one of which must
be an executive director, for
company policies or corporate
trustee policies.
•
documents to evidence your
current residential address
must be the most recently
issued and ideally not more
than 3 months old.
•
the Policy Schedule and any
Policy Endorsements (applicable
for both full and segmen
t
surrenders). I
f you cannot find
your Policy Schedule, you will
need to complete a Lost Policy
Questionnaire After completing
the Lost Policy Questionnaire
,
you may be required to complete
a Form of Indemnity which will
be provided to you by RL360.
•
your latest bank statement.
This will be required where
we have not made payments
before to the bank details
you provide under Payment
Instructions on Page 3 or if
premiums have not been paid
to us from these bank details.
•
you may also need to send us any
applicable Trust Deed, Deed(s) of
Assignment or Transfer, and/or
any other documents relevant to
claiming the surrender proceeds
from the policy
Please make sure you read the
important notes section of this form.
WHEN YOU HAVE COMPLETED
THIS FORM
For all policies (except Hong Kong)
Please send this form to
servicing@rl360.com
or fax it to: +44 (0)1624 677336
Alternatively you can post it to:
Policy Servicing, RL360,
International House, Cooil Road,
Douglas, Isle of Man, IM2 2SP.
For Hong Kong policies
If you hold a Hong Kong policy (a
policy taken out whilst resident
in Hong Kong) please send it to
servicing@rl360.com or fax it to
+852 2169 0181
Alternatively you can post it to:
RL360, Room 1403, Sun House,
181 Des Voeux Road Central,
Sheung Wan, Hong Kong.
Please note that we cannot be
held responsible for requests that
are delayed or missed because
they have been sent to a fax
number other than the applicable
number specified above.
A confirmation letter will be sent
to you once we have released
your payment.
SURRENDER
REQUEST
SERVICING
2
SURRENDER REQUEST FORM
Your details
RL360 policy number
Policyholder 1 Policyholder 2 (if applicable)
First name(s)
Last name(s)
Current residential
address and
postcode (in full)
Daytime telephone
Email address
Trust details (if applicable)
Trust name
Correspondence
address and
postcode
Daytime telephone
Email address
Company details (if applicable)
Company name
Correspondence
address and
postcode
Country or countries
of tax residence
Company tax
reference number(s)
FATCA GIIN
(if applicable)
Daytime telephone
Email address
TYPE OF SURRENDER REQUIRED
Please tick only one option.
Surrender policy in full OR
Surrender individual policy segments
If you are surrendering policy segments,
please tell us how many to surrender.
I request that the above numbered policy be surrendered in accordance with the Terms and Conditions of the policy and that
RL360 Insurance Company Limited (RL360) pay the surrender value in-line with the instructions provided on this form. I confirm
that this payment will discharge RL360 from all liabilities and claims arising out of the policy or surrendered policy segments.
I confirm that I am entitled to the proceeds of the above numbered policy and that no receiving order has been made against
me. I am not bankrupt and the policy has not been assigned or transferred, nor does any other person have legal rights to the
surrender proceeds under the policy (other than the details provided in any supporting documentation).
3
PAYMENT INSTRUCTIONS
Payment method
TT (£20 charge) OR
BACS (no charge) OR
Cheque
(tick only one)
TT can be used for payments of any currency to UK or international bank account. BACS
payments require up to 3 days to clear and can only be used for GBP payments to a UK bank
account. Some banks may require cheques to be signed on the reverse by the payee before
they will be accepted. Cheques can also take several weeks to clear with banks outside the UK.
For payments by TT or BACS
Bank name
Bank address and postcode
Account holder’s name
Bank Swift Code OR Bank Sort Code (UK only)
- -
(International)
Swift Code must be either 8 or 11 digits
Account number or IBAN
for banks within Europe
Reference (optional)
For payments by cheque
Cheque payee name
Please send cheque to Residential address
Trust correspondence
Company correspondence
(tick as appropriate) shown on page 2 address shown on page 2 address shown on page 2
OR
Please send cheque to
(insert address)
4
SIGNATURES
Before signing this form, it is very important that you read and understand the important notes on page 5.
Also, depending on how long you have held your policy and the terms on which it was set up, there may be a surrender penalty
where one or more policy segments are cashed in. This information can be provided upon request.
Policyholder/Trustee/Authorised Signatory 1 Policyholder/Trustee/Authorised Signatory 2
Signature
Date (dd/mm/yyyy)
Full name
Country of birth
Country or countries
of tax residence
Tax Identification Number (TIN)
If unavailable, provide a functional equivalent (eg National Insurance Number, Social Security Number, resident registration number)
Are you a Specified US Person?
Yes
No
Yes
No
Trustee/Authorised Signatory 3 Trustee/Authorised Signatory 4
Signature
Date (dd/mm/yyyy)
Full name
Country of birth
Country or countries
of tax residence
Tax Identification Number (TIN)
If unavailable, provide a functional equivalent (eg National Insurance Number, Social Security Number, resident registration number)
Are you a Specified US Person?
Yes
No
Yes
No
YOUR REASON(S) FOR SURRENDERING
We are dedicated to improving our customer experience and as such if you are surrendering your policy in full, please tell us
your reason(s) for doing so.
House purchase
School fees
Medical emergency
End of charging period
Mis-sold product
Poor financial advice
Poor investment return
High product charges
Poor customer service
Complaint against RL360
Complaint against adviser
Financial concerns
Unable to pay further premiums
Moving to another provider
Payment terms completed (Matured)
Urgent money requirements
Change of investment strategy
Tax reasons
Other (please specify)
5
IMPORTANT NOTES
Withdrawals
Any payment taken from your policy will be subject to the minimum payment amounts as detailed in your policy literature. The
payment amount may need to be reduced if it will take your policy below the minimum allowable policy value.
Tax
We recommend that you speak to your financial adviser or tax professional about your tax situation before taking action on
your policy.
General
Depending on the investment(s) to which the value of your policy is linked, some investment managers may have terms and
conditions that prevent us from realising a cash value in a timely fashion, and this could delay your withdrawal payment.
Where applicable, please ensure that the authorised signatory list(s) that we hold for this policy are up-to-date before submitting
withdrawal instructions. Where authorised signatories have changed and we are unable to match those on this form with our
records, this will delay the withdrawal. We may also require further information for the purposes of Anti-Money Laundering.
Specified US Person
Specified US Person means a US citizen or tax resident individual who has a US residential/correspondence address or who
either holds a US Passport, a US Green Card or who was born in the US and has not yet renounced their US citizenship. More
information on US FATCA can be found at: www.irs.gov/Businesses/Corporations/Foreign-Account-Tax-Compliance-Act-FATCA
If you choose Yes to being a Specified US Person, you will need to provide us with your US Taxpayer Identification Number (TIN)
or US Social Security Number (SSN).
If you choose No but you have a US residential/correspondence address, hold a US Passport, a US Green Card or you were born
in the US, you will need to provide us with documentary evidence that you are in the process of or have renounced your US
Citizenship. RL360 can accept a certified copy of your DS-4083 form (also known as CLN – Certificate of Loss of Nationality)
and/or a certified copy of your passport in which you are obtaining new citizenship.
Privacy policy
Our full privacy policy can be viewed at www.rl360.com/privacy or can be obtained by requesting a copy from our Data
Protection Ocer.
RL029o 02/20
RL360 Insurance Company Limited. Registered Oce: International House, Cooil Road, Douglas,
Isle of Man, IM2 2SP, British Isles. Registered in the Isle of Man number 053002C. RL360
Insurance Company Limited is authorised by the Isle of Man Financial Services Authority.
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