Document Library

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Market: United Kingdom (UK)

Language: English (EN)

Asset Type: Operational Forms

Process: Surrender or Claim

Documents

Title	Description	Insurer	Product	Regime	Excerpt
Portfolio Bond Withdrawal / Surrender Form	Surrender and Withdrawal Request Form for Portfolio Bond	Utmost Wealth Solutions	Non Product Specific	FOS	Surrender and Withdrawal Request Form for Portfolio Bond Operational Forms Portfolio Bond Withdrawal / Surrender Form UWSQ PR \| 13485
UWS Multi-Product Withdrawal and Surrender Form	This form should only be used for surrender or withdrawal requests from products designed forUtmost International Isle of Man Limited within the UK market or for any product where the policyholder is now UK resident.	Utmost Wealth Solutions	Non Product Specific	FOS	This form should only be used for surrender or withdrawal requests from products designed forUtmost International Isle of Man Limited within the UK market or for any product where the policyholder is now UK resident. Operational Forms UWS Multi-Product Withdrawal and Surrender Form IOM PR 0027
Bereavement Claim Form	Bereavement Claim Form for Life Assurance Bonds	Utmost Wealth Solutions	Evolution, Selection	FOS	Bereavement Claim Form for Life Assurance Bonds Operational Forms Bereavement Claim Form UWS PR 0182
Tax Declaration and Self Certification for Individual Investors	For Use with Utmost Worldwide, Utmost PanEurope and Utmost International Isle of Man products. You have been asked to complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders, persons authorised to sign on behalf of the policyholder, for example their Power of Attorney or court appointed Deputy, and individuals linked to the trust where Utmost International Trustee Solutions Limited are the appointed trustee.	Utmost Wealth Solutions	Non Product Specific	FOS	For Use with Utmost Worldwide, Utmost PanEurope and Utmost International Isle of Man products. You have been asked to complete this form in order that we can accurately report your policy under the relevant tax information exchange agreements, including Foreign Account Tax Compliance Act (FATCA) and the Common Reporting Standard (CRS) regulations. This form should be used for individual policyholders, persons authorised to sign on behalf of the policyholder, for example their Power of Attorney or court appointed Deputy, and individuals linked to the trust where Utmost International Trustee Solutions Limited are the appointed trustee. Operational Forms Tax Declaration and Self Certification for Individual Investors UWSQ PR \| 12373
UPE Declaration of Residence Outside of Ireland	Utmost PanEurope Policyholders resident outside of Ireland must make the declarations contained in this form in order to receive payments without the deduction of Irish tax if they hold a policy issued by an Irish insurer.	Utmost PanEurope	Non Product Specific	FOS	Utmost PanEurope Policyholders resident outside of Ireland must make the declarations contained in this form in order to receive payments without the deduction of Irish tax if they hold a policy issued by an Irish insurer. Operational Forms UPE Declaration of Residence Outside of Ireland UPEQ PR \| 20900
PWP UK – Death Benefit Claim Form	Private Wealth Portfolio UK – Death Benefit Claim Form	Utmost PanEurope	Private Wealth Portfolio - UK	FOS	Private Wealth Portfolio UK – Death Benefit Claim Form Operational Forms PWP UK – Death Benefit Claim Form UPE_WS \| 05213
Never Received or Lost Policy Schedule Declaration (EN)	Utmost Pan Europe dac Never Received or Lost Policy Schedule Declaration	Utmost PanEurope	Apex (France), Apex (Portugal), Non Product Specific, Private Wealth Portfolio - Italy, Private Wealth Portfolio - Portugal, Private Wealth Portfolio - Spain, Private Wealth Portfolio - UK, Private Wealth Portfolio (PWP) France, Selection, Target	FOS	Utmost Pan Europe dac Never Received or Lost Policy Schedule Declaration Operational Forms Never Received or Lost Policy Schedule Declaration (EN) UPE PR 12847
Unit Linked Accounts Withdrawal/Closure/Maturity Form (English)	This form should only be used to request a partial, full surrender or maturity from the following Utmost International unit-linked products Managed Capital Account, Managed Savings Account, Managed Pension Account, Executive Wealthbuilder Account and European Capital Account.	Utmost International - IoM	Managed Capital Account	FOS	This form should only be used to request a partial, full surrender or maturity from the following Utmost International unit-linked products Managed Capital Account, Managed Savings Account, Managed Pension Account, Executive Wealthbuilder Account and European Capital Account. Operational Forms Unit Linked Accounts Withdrawal/Closure/Maturity Form (English) ULQ PR \| 13694
Assignment of Policy Segments for Immediate Surrender (for use with Former Quilter Products)	This deed is to be used to assign Policy segments for an immediate surrender for use with Former Quilter products only.	Utmost International - IoM	Executive Investment Bond	FOS	This deed is to be used to assign Policy segments for an immediate surrender for use with Former Quilter products only. Operational Forms Assignment of Policy Segments for Immediate Surrender (for use with Former Quilter Products) UL PR 00432
Assignment of Policy for Surrender Form	This Assignment and Surrender Form can be used for assigning of policies for immediate surrender.	Utmost International - IoM	Non Product Specific	FOS	This Assignment and Surrender Form can be used for assigning of policies for immediate surrender. Operational Forms Assignment of Policy for Surrender Form UL PR 00334
Permanent Health Insurance Claim Form	Permanent health insurance claim form to request the health details of the life assured and consent to Utmost PanEurope dac seeking and processing information in order to be able to process this claim.	Utmost PanEurope	Non Product Specific	FOS	Permanent health insurance claim form to request the health details of the life assured and consent to Utmost PanEurope dac seeking and processing information in order to be able to process this claim. Operational Forms Permanent Health Insurance Claim Form UIC PR 00184
Full Encashment Request Form	This form is used to request full encashment. Please note the encashment value will be based on the date of receipt of all requirements and payable to the individual who according to Utmost PanEurope dac’s records is entitled to receive it.	Utmost PanEurope	Non Product Specific	FOS	This form is used to request full encashment. Please note the encashment value will be based on the date of receipt of all requirements and payable to the individual who according to Utmost PanEurope dac’s records is entitled to receive it. Operational Forms Full Encashment Request Form UIC PR 00179
Lapse Value Claim Form	Lapse Value Claim Form to claim the cash in value of the policy at the date of lapse together with late payment interest in full and final settlement of the policy.	Utmost PanEurope	Non Product Specific	FOS	Lapse Value Claim Form to claim the cash in value of the policy at the date of lapse together with late payment interest in full and final settlement of the policy. Operational Forms Lapse Value Claim Form UIC PR 00180

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